1. Where are Deaneries going? D.Sowden COPMeD 10 th National Multi-specialty meeting. 25 th January 2012

2. Liberating the NHS: Developing the Healthcare Workforce From Design to Delivery Six key elements: The design and creation of an effective Health Education and Training System The design, development and establishment of Health Education England The development and establishment of Local Education and Training Boards (LETBs) The development of an effective Health Interface with the Education and Research sectors The development of mechanisms to manage the flow of funding for education and training The development of a Workforce Information Architecture, to support improved workforce education and training commissioning and planning Published: 10 January 2012 2

3. Key Knowns Arrangements for health services and pgme are increasingly influenced by country specific factors (England and DAs) Fiscal constraints will worsen not ease SHAs will remain until April 2013 but as 4 clusters : London : South and South West : Midlands and the East : North 1 3

4. Health and Social Care Bill now specifies (probably): “a [new] duty on the SoS to exercise his functions ….so as to secure….an effective education and training system” 4

5. Education and Training System Secretary of State Department of Health NHS Commissioning Board Public Health England Health Education England Local Education & Training Boards Education Health Service Providers Research 5

6. Principles of reformed Workforce & Education System Securing an effective system for developing the whole workforce Greater transparency, fairness and efficiency in investment – tariff/levy Build on the best of what we do already – and reform those things that need to change Greater autonomy & accountability for NHS employers in relation to planning and developing their workforce Supporting NHS values and behaviors – person centered, 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 6

7. What do we expect the roles of the new organisation to be? 7

8. Health Education England (HEE) HEE is intended to provide national oversight of effective workforce planning and the provision of high quality education and training to the health care workforce, and to support planned provider led local arrangements for the commissioning and planning of such education and training. (Ref Letter from Richard Douglas DoH, 31 st October 2011) 8

9. Functions of HEE Accountable to DH for effective allocation of resources and compliance with quality and performance assurance requirements National leadership of planning and development of the healthcare workforce - objective security of supply of professionally qualified clinical staff in the UK Promoting high quality education Relationship management with professional bodies, NHS Commissioning Board, Regulators, Public Health England, Centre for Workforce Intelligence etc Authorising and supporting development of LETBs to enable greater local responsibility for decision making Hosting employment of staff in LETBs 9

10. HEE Steering Group Membership NameJob TitleSteering Group Role Kate LampardChair, South East CoastChair Christine OutramManaging Director, Medical Education England HEE SRO/Workstream Lead Jan SobierajManaging Director NHS and Social Care Workforce Senior Responsible Owner Phil WadeTransition Director of Development and Communications, HEE HEE Representative Nicki LathamTransition Director of Operations and Partnerships, HEE HEE Representative Janice SigsworthDirector of Nursing, Imperial College Healthcare NHS Trust Nursing Profession Representative David NoyceAssociate Director, HEFCEHigher Education Representative Sir David MelvilleFormer Chief Executive, Further Education Funding Council Higher Education and Deanery Representative Malcolm WrightChief Executive, NHS Education ScotlandDevolved Administrations Representative Martin BarkleyChief Executive, Tees, Esk and Wear Valley NHS Foundation Trust Provider/Employment Representative Wendy SaviourDirector of Commissioning Development, NHS East Midlands NHS Commissioning Board Representative Richard StephensonDean of the Faculty of Health, Plymouth University Higher Education Representative Neil DouglasPresident, Academy of Medical Royal Colleges Academy Representative 10

11. NameJob TitleSteering Group Role Dean RoylesDirector, NHS EmployersProvider/Employment Representative Barry CockcroftChief Dental Officer, DHDental Profession Representative Tim GilpinDirector of Workforce and Education, NHS NE SHA Cluster SHA Representative Stephen WelfareDirector of Workforce and Leadership, NHS Midlands and East SHA Representative Elizabeth ManeroLay/Patient Representative Tony WeetmanChair, Medical Schools CouncilEducational Representative Paul JohnstoneDirector of Public Health, NHS Yorkshire and the Humber Public Health Representative Jane PoveyClinical Engagement Director, Commissioning Development Directorate, DH Primary Care Representative Chris FranklinPostgraduate Dean and Chair of the Committee of Postgraduate Deans and Directors (COPDEND) Professions Representative Miles ScottChief Executive, St Georges Healthcare NHS Trust Provider/Employment Representative, Foundation Trust Network Representative Sir Jonathan MichaelChief Executive, Oxford University Hospitals NHS Trust Provider/Employment Representative Tony HunterChief Executive, North East Lincolnshire Council Local Government Representative 11

12. Functions of LETBs Bringing together Health Providers, Education, Local Government and Research sectors to develop skills and development strategy for the local health workforce Consulting with patients, communities and staff to ensure strategy is responsive to views Aggregating workforce data and plans for local health communities Developing model for effective leadership by employers and clinicians Planning and commissioning education and training in the interests of sustainable, high quality provision Ensuring funding in the new system follows the student/trainee on the basis of quality education outcomes Accountable to HEE for delivery against funding, quality and performance assurance requirements 12

13. Establishment of LETBs In line with the direction set out in the publication, LETBs will need to be established in shadow form by April 2012 as SHA sub- committees and by April 2013 as provider-led Boards, accountable to HEE. This will enable the employment contracts of transferring SHA Education & Training staff to be transferred to HEE and the line of accountability for the LETB Boards to move seamlessly from SHAs to HEE. The level of delegation available to individual LETBs will be determined through an authorisation process, so it will be important for SHAs to ensure that LETB development is aligned to the emerging Education Outcomes Framework, the authorisation criteria and the HEE/LETB accountability framework. DH and HEE will seek SHA and Shadow LETB support in the development of the frameworks It is expected that the authorisation process will commence in October 2012 13

14. LETB Authorisation Criteria Collaborative leadership for education and training Proper constitutional and governance arrangements Financial control, capacity and capability Meaningful partnerships and engagement Education and training commissioning Workforce strategy and planning Clinical focus on safety and quality In order to be established, LETBs must provide evidence to demonstrate: 14

15. PG Deaneries (including PG Deans!) and their staff are to be secured; linked to LETBs As are SHA workforce and educational commissioning staff HEE will be established as an SpHA and will be fully operational when the SHAs close; it will eventually become a statutory non-departmental arms length body. 2 15

16. “The question of postgraduate deaneries was raised…..Securing continuity for the work of the deaneries will be a key part of a safe transition. It is expected that [pg]deans and many of their staff will continue to take forward the work of deaneries…..” Earl Howe Lord’s debate 14 th Nov 2011 16

17. The continuing success of the healthcare system is dependent on a strong relationship with higher and further education A competent, well-trained workforce is essential to the continued success of health and social care. In order to ensure a strong workforce, the health and social care system needs a continuing supply of properly qualified, high quality trainees and staff from further and higher education. It also needs to continue to develop its staff and the education sector will have a part to play in this. In both the health and education public sectors, large-scale reforms are taking place to allow effective partnership approach to deliver high quality, cost effective services and better face current and future challenges. Throughout the transition and after the reforms are completed, it is crucial that education and health work well together and interact in a way that drives the quality of the workforce and, ultimately, the quality of health and social care services. Support for innovation and research opportunities should be preserved and developed across disciplines and across specialties. 17

18. Funding Issues Running Costs Running costs of LETBs are part of NHS management costs and, as such, are subject to the efficiency requirements set out in “The Operating Framework NHS in England 2012/13”. The expectation is that overall running costs will be one third lower than 2010/11. DH workforce is working with SHAs and DH finance to agree, by February 2012, the definition of running costs to apply to the education and training system to exclude costs varying closely with volume of education such as those related to quality assurance of education programmes. DH and SHAs will agree an approach to capping overall management costs of LETBs and the new education and training system, by March 2012, to inform plans for the development of LETBs. MPET flexibility Proposals for flexibility in the use of MPET to allow LETBs to invest in innovative approaches to education and training for the existing workforce will be developed by May 2012 18

19. “ My ears pricked up on the subject of money when the noble Early said there would be “robust analysis”. I am willing to open a book on how far south of £4.9 billion the Government end up …..[with respect to MPET]” Lord Warner Lord’s debate 14 th Nov. 2011 19

20. What is far from clear? 20

21. DtHW highlighted a “duty to co-operate by all NHS funded providers”; this may need additional legislation Will health and Social Care Bill be further ammended? Will further (next session) legislation be needed/allowed? Will MPET be genuinely protected? 21

22. Will the government pursue both a national tariff and levy for healthcare and training or either? How will potential conflicts of interest be resolved (for example; LEPs as commissioners and providers of E and T)? 22

23. Programme Plan- Overview 20122013 Q1Q2Q3Q4Q1Q2Q3Q4 E&T publication HEE Development Establishment of HEE HEE established as SpHA (June 2012) HE Board Recruitment HEE Chair, CEO and NEDs appointed HEE commences in shadow form (October 2012) HEE Shadow Running Medical Education England decommissioned (October 2012) HEE fully operational (April 2013) HEE Operational Running SHA LETB Sub-committees Established (April 2012) LETB Shadow Running (under SHA Sub-committees) LETB Authorisation LETB Evolution LETB Operational (or transitional arrangements in place) HEE/LETB People in Transition Policy published Draft Education Outcomes Framework published 23

24. Additional Note: Medical Schools and PG Deaneries need to work together, be seen to work together and to agree (where possible) to have a common agenda and ways of working with respect to the medical education continuum The question is how and with respect to what (priorities)? Does the creation of HEE in England offer a platform for some specific, early work? What about the UK? 24

25. Similarly, The GMC, PG Deaneries, Colleges and Faculties and Medical Schools, together with the BMA, need to work ever more closely to ensure pgme has a genuinely secure future 25

26. “ The Government are clear that the education, training and continuing development of the healthcare workforce are fundamental in supporting the delivery of healthcare services across the UK” Earl Howe Lord’s debate 14 th Nov. 2011 26