Key Knowns - NES · to support decision makers in planning their workforce and securing high...

The Future of Postgraduate Medical Education

In the context of HEE/LETB

Second National Scottish Medical Education Conference

Prof D Sowden

DME (England)

Key Knowns • Arrangements for health services and pgme are increasingly

influenced by country specific factors (England and DAs) • Fiscal constraints will worsen not ease

(CSR 2013) • SHAs will remain until April 2013 but as 4 clusters

: London : South and South West : Midlands and the East : North

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Key Knowns

• HEE will begin work as a Special Health Authority from October 2012 • LETB’s should now be established as SHA Cluster Sub – committees

(April 2012). • HEE Senior appointment cascade commenced with Chair (April 23 rd ). • LETB authorisation process will begin in October 2012

Principles of reformed Workforce & Education System

• Securing an effective system for developing the whole workforce • Greater transparency, fairness and efficiency in investment – tariff/levy • Accounting for NHS Education resource investment and outcomes achieved • Build on the best of what we do already­ and reform those things that need

change. • Greater autonomy & accountability for NHS employers/providers in relation

to planning and developing their workforce (within an HEE national oversight)

• Supporting NHS values and behaviours­ person centre, safe, effective. • Supporting innovation, research and quality improvement. • Opportunity to involve and engage with a wide range of stakeholders. • Importance of recognising we are working within an environment of financial

constraint.

Health Education England (HEE) ­ an overview

• Role: The new organisation set up to support decision makers in planning their workforce and securing high quality education and training.

• Aim: To ensure that the right numbers of health professionals are trained ­ with the right skills– to deliver high quality care across England.

Health Education England

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Health Education England

The purpose of HEE is: “to ensure that the health workforce has the right skills, behaviours and training, and is available in the right numbers, to support the delivery of excellent healthcare and health improvement.”

1. Providing national leadership on planning and developing the healthcare and public health workforce

2. Authorising and supporting the development of

Local Education & Training Boards

3. Promoting high quality education and training,

responsive to the changing needs of patients and local communities.

4. Allocate and account for NHS education and

training resources and the outcomes

achieved

HEE has five key functions:

Health Education England (HEE) will, from October 2012, operate as a Special Health Authority (SpHA), accountable to the SofS.

Core responsibilities include: Ø Securing a national system for education and training Ø Delivery against national priorities and standards including the Education Outcomes Framework Ø Authorisation and oversight of Local Education & Training Boards Ø Management and allocation of the MPET budget to Local Education & Training Boards Ø Ensuring security of supply of health care professionals, with continuous quality improvement in education and training

5. Ensuring the security of

supply of the professionally qualified clinical

workforce

Health Education England’s role is framed by two key duties….. 1) HEE must exercise on behalf of SofS the duty under section 1F of the Health and Social Care Act 2012 (duty to secure an effective system for the planning and delivery of education and training for healthcare workers) (Clause 2)

2) HEE must exercise its functions with a view to ensuring that a sufficient number of persons with the skills and training to practise as health professionals is available to do so throughout England (Clause 3)

DUTIES • SofS must publish (and may revise) a document which specifies the priorities and outcomes that they have set in relation to E&T of care workers (to which HEE must have regard)

• HEE must publish a document annually that specifies priorities and outcomes for the planning and delivery of E&T across the system

• HEE must have to have regard to the likely future demand for NHS services, sustainability of supply, the priorities of NHS providers, the Mandate, SofS public health functions, SofS’s outcomes document, the NHS Constitution

• HEE must make arrangements for obtaining advice on the exercise of its functions (clause also lists from whom it should receive representation) and must advise SofS on such matters relating to its functions as SofS decides

• HEE must co‐operate with SofS in the exercise of public health functions (for the purposes of co‐operation HEE is classed as an NHS body)

• HEE must exercise its functions with a view to securing continuous quality improvement in the quality of education and training

•HEE must promote research

•HEE must obtain the approval of SofS before publishing ( and revising) the LETB authorisation criteria

REGULATION MAKING POWERS SofS may by regulations:

• Amend the persons (can include persons who are NOT providing functions under the 2006 Act) and functions (should be SofS’s existing functions) to whom his duty to secure an effective system for education and training applies

• Specify who HEE’s duty to secure sufficient numbers of healthcare workers should and shouldn’t apply

• Specify how HEE should decide the number of persons that is sufficient for specific categories of NHS services

• Specify other matters to which HEE must have regard

• Specify matters on which HEE must obtain advice, the way in which HEE should do this and from whom it should receive advice

• Specify persons with whom HEE must co‐operate

•Require HEE to exercise any of its functions as they specify

•Give HEE further functions and provide for HEE to exercise on behalf of others functions relating to education and training

• Specify circumstances in which HEE may impose conditions on or intervene in LETBs

Establishment provisions (*and DH / ALB Sponsorship Arrangements, not in

legislation) • SofS appoints the chair and non‐executive members , (approves CE appointment*).

• SofS may remove or suspend any non‐ executive members

• Payment, allowances, pensions etc of non‐ executive members is subject to SofS’s decision (employees pay and t&c for HEE to decide)

• HEE must exercise its functions effectively, efficiently and economically

• HEE must prepare annual accounts and SofS may direct HEE to prepare interim accounts

• HEE must prepare an annual report

• A framework agreement between HEE and DH setting out lines of accountability and financial regime – DH appoints CE as accounting officer*

• Annual business plans and performance reporting*

• A formal performance and capability review at least every three years*

HEE (and SofS) will be subject to a combination of duties and regulation making powers. The establishment provisions and DH / ALB sponsorship arrangements are also relevant here…

LETBs – an overview • Role: To provide local leadership and direction to shape the workforce and secure high quality education and training locally.

• Aim: To ensure that the right numbers of health professionals are trained locally ­ with the right skills and behaviours – to deliver high quality care.

Health Education England

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Local Education& Training Boards (LETBs)

Local Education & Training Boards are the vehicle for leading on planning and commissioning of education locally.

The purpose of the Local Education & Training Boards is: To lead workforce planning and education commissioning, on behalf of all providers of NHS funded care, within a local geographically defined area; ensuring security of supply of the local health and care workforce and supporting national workforce priorities set by HEE.

Local Education & Training Boards have five core functions: • Ensuring security of supply of the local health and care workforce providing NHS funded services and supporting national workforce priorities

• Workforce planning and identifying local priorities for education and training • Holding and allocating funding for the provision of education and training • Commissioning education and training on behalf of member organisations, securing quality and value from education and training providers in accordance with the requirements of professional regulators and the Education Outcomes Framework

• Securing effective partnerships with clinicians, local authorities, health and well­being boards, universities and other providers of education and research and providing a forum for developing the whole health and care workforce

Health Education England will be under a duty to establish “Local Education and Training Boards”…

LETBs will be established as committees of HEE. Their role will be to exercise HEE’s two key duties on its behalf, leading activity locally on the planning, commissioning and quality assurance of education and training. (Clauses 7, 8 and Schedule 2)

LETB MEMBERSHIP – All providers of NHS services in the LETB geographic area will be required to be members of the LETB. The NHS standard contract will be amended to require all providers of NHS services to co­operate with HEE in the discharge of the education and training duty by becoming members of the LETB. Providers must co­operate with the LETB to which they belong, and may be a member of more than one LETB if that is necessary.

LETB BOARD – Each LETB will have a Board drawn from representatives of NHS providers in the area. The Board may also include representation from other key stakeholders e.g. education providers. HEE will appoint the Chair who must be independent and and not from a provider of NHS services in the LETB area. The LETB will be supported by operational staff who are employees of HEE. The geographical area of a LETB will be self­determined but HEE will be under a duty to ensure that it doesn’t overlap with that of another LETB and LETBs together cover the whole of England.

Health Education England will be under a duty to establish “Local Education and Training Boards”…

LETB ESTABLISHMENT – HEE will conduct a rigorous authorisation process to establish LETBs. It will set minimum criteria that LETBs must meet to be established. LETBs that are established can then meet additional criteria to earn greater autonomy in how they operate. HEE must keep the criteria under review and seek the approval of SofS before publishing the criteria. HEE should have a duty to assess whenever it considers appropriate, whether a LETB is meeting both the minimum and additional criteria.

LETB EDUCATION AND TRAINING PLANS – Clause 9, each LETB must each financial year publish an education and training plan, specifying how it proposes to exercise HEE’s two key duties on its behalf. In preparing their plans, LETBs must have regard to national and local priorities and must involve organisations it / HEE considers appropriate. All plans will be submitted to HEE; HEE will scrutinise in detail and sign­off plans for those LETBs that meet the minimum criteria and provide a high level review (for assurance purposes) for those that meet the additional criteria (therefore more autonomous).

LETB COMMISSIONING EDUCATION AND TRAINING – Clause 10, each LETB must for each financial year arrange for the provision of education and training in accordance with its local plan and any priorities specified by HEE. A LETB will be permitted to arrange for another person to assist it in the discharge of its functions (it will not be able to delegate them). Where HEE considers it preferable to commission at a national level, HEE will have a power to commission education and training or direct a particular LETB to do so on its behalf.

HEE INTERVENTION – HEE will have various powers of intervention if it considers a LETB is not meeting its minimum criteria, or is failing to exercise a function (or there is a significant risk of such failure)

LETB authorisation and accountability framework

Health Education England

Accountability structure

Secretary of State / Department of Health

Health Education England

Local Education Training Boards

c£5bn MPET budget

Authorisation process/Commissioning

and Contracts

Providers of education and training

Through contracting

(ΞLDAs)

Accountability mechanisms

HEE will ensure greater accountability by: • Managing the authorisation process for LETBs • Scrutinising LETB work plans (to ensure local

and national alignment) • Holding LETBs to account through annual

contracts • Intervening in the business of LETBs where

there are concerns about core deliverables.

Health Education England

Funding • Hee and LETB will be

established within a specified running cost envelope.

• HEE will develop an allocation policy for distributing the MPET funding

• HEE will implement a tariff based system for education placements from April 2013

• MPET may, over time, be funded through a levy on all providers

• The size of the MPET budget from 2013/14 onwards will be determined.

Health Education England

Education Outcomes Framework

5. Widening participation

4. NHS values and behaviours

3. Adaptable and flexible workforce

2. Competent and capable staff

1. Excellent education

Ensure the health workforce has the right skills, behaviours and training, available in the right numbers, to support the delivery of excellent healthcare and health improvement

Ensure the health workforce has the right skills, behaviours and training, available in the right numbers, to support the delivery of excellent healthcare and health improvement

Safety

Excellent experience for staff (inc. students

/ trainees) and patients

Effectiveness

Aim Domains Quality

The vision

An education and training system which is…

• Led and driven by local ownership

• Responsive to the needs of the patients, service users and the workforce

• Professionally informed to address future challenges

• Accountable, transparent, efficient and evidence­based

Health Education England

What don’t we know (not a complete list)

• Find structure for HEE AND LETB’s • Impact of running cost envelope, continuing MPET review and CSR. • Full Impact of trainee revalidation. • GMC consultation on trainer recognition. • How the EOF will be researched/developed

What we Don’t know

• Result of Shape of Training review