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  1. 1. [Please note this is not a legal document. This transcript was provided originally as communication support. It should not be regarded as a fully checked and verified verbatim record; it has no legal standing. It was provided by a Registered Speech-to-Text Reporter. Amanda Colton 2006] Thursday 19 October 2006. QEII – Learning for a Change in Healthcare Names: Philip Hadridge, Paul Loveland, Professor Bob Fryer, Judy Hargadon, Peter Milford, Tony Chandler, Tris Benedict-Taylor, Paul Tomlinson, Wendy Lyon (Oxleas) 10.00am: PHILIP HADRIDGE: test... good morning everybody... good morning. If you can find a seat where you are comfortable? Where you have got a great... and I will start, is everyone has everyone found a space? Looks like there's one chair on the table at the back and another chair here... and colleagues over in the corner a couple of chairs in these tables and one at the front do bring a chair in and join in the central throng. I'm Philip Hadridge your facilitator between now and lunchtime. I look forward to working with you, and there are a few things we are going to cover, by way of starting the first thing um... is safety. And, we have got a little recorded announcement which I understand often causes merriment but I'm doing this seriously and also not going to do the air stewardess joke routine that often happens in conferences like this. Behind me is an article I wrote which was published last year there's a lot we can learn from how other sectors start meetings to a safety announcement. And if you look at the oil industry they have had a profound shift in the way they approach safety by paying attention to safety and I invite you to listen to 90 seconds to the safety briefing this this venue. Welcome to the QEII Conference Centre please listen to the following emergency evacuation instructions from the Westminster suite located on the first floor of the Conference Centre in the event of an emergency the following warning sound will be given - sound... an announcement over the public address system will follow - it will ask you to listen for further announcements. Take a moment now to look for your nearest fire escape sign, should an evacuation become necessary, instructions will be given over the public address system.
  2. 2. When told, you should leave the building quickly by the nearest exit. Walk, do not run. Do not stop for belongings, do not use the lifts. Your event organiser has been briefed on the evacuation procedure for people with restricted sight, hearing or impaired mobility. Your assembly point is the column across the road immediately opposite the Queen Elizabeth the second Conference Centre's main entrance. You must take care whilst crossing the road, thank you for listening to this announcement. PHILIP HADRIDGE: thank you, this article behind was probably the most controversial thing I have ever written what I would like us to do as well as paying attention to the safety note we have just heard is take two things which I think are important for us today, firstly BP have a saying they want people who come to work for British Petroleum to go home in the same or better shape, than when they arrived for work in the morning I think that is a wonderful message for considering for widening participation today we want people I think to come and leave the health service health and social care with better careers than when they arrived and take that message from it and secondly what we say and do matters that's an odd way to start with a safety briefing what we say in this meeting really does matter that's one of the lessons from the oil industry. Thank you for the safety briefing. The two other things to cover briefly: one around the purpose of today and a little about the style and agenda. The style - Mike has got where is he? And out of the room getting coffee, rule today which is about mobile phones which is if you can't switch it off please put it on silent if he hears a mobile phone coming he will ask you for £5 to go towards McMillan that's Mike's mobile phone challenge. NEW SPEAKER: Should we all leave them on? Yes if you contribute to McMillan. The purpose for the meeting to explore the issues and recommendations in the learning for change in health care report which everyone hopefully has got and with a question mark, and possibly the first step towards a proposed NSF what are your reactions to the document? And your ideas are as important from what you will hear from the front. You have the agenda and and plan and
  3. 3. running to that and some of the timings will be flexible we will definitely finish on time at that point 1.15. We are looking for a two-way conversation around these topics. Two way is to get us going. And I think it's quite important you get a chance to speak before you have to hear, and too much more from many of us at the front and invite you to start thinking about um... something I will give you five minutes on your tables to do, that is to share what motivates you personally around this agenda, this is a very personal agenda the report has got lots of words but it's about real people and real people's lives real members of staff. I recall about um... 18 months ago Bob was in the room as well and Ian Carruthers the Chief Executive of the NHS shared amazing powerful story about a gardener at a hospital on the south coast of somewhere in England in his patch in Dorset. You may have heard the story the gardener couldn't read or write and never had the chance to step up to do to get a job more senior overseeing all the gardens and have a senior role in estates. Ian shared this story powerfully and a motivator for him around this agenda, what for you are the agendas that motivate you? It might be somebody you have met in your work? It also might be um... something it your personal life I'm not sure I can claim to personally have experienced widening participation myself but my story is I struggled to get five O'levels but I had two aunties who worked as auxiliary nurses as they were and I liked what they did. I thought if I'm going to be a nurse, I need to go in as a qualified nurse that's what they told me you had to do. So, I did my A-levels and got in and did my nursing training and there was something about that first six or seven years which inspired me and encouraged me. In my mid-20s I felt able to step out of nursing and do a degree, and confident in myself and confident that I had a career I could earn money in the holidays I'm not sure that's quite a widening participation story in the way we are talking about today maybe not it was a message from my aunties about how you get on in health care. So, on your tables... I will give you ten minutes it's quite important introduce yourselves and share the stories that motivate you from your practice or if you want to optional from your personal lives why are you here ten minutes over to you... I'm Phil... hi Sarah... OK... so... and then it gets typed up on there? Right. I see... got you... I thought it was a transcript for the meeting. So, yes I'm Sarah from Hammersmith hospitals. And, um... I'm a learning and development consultant for the vocational Development Team, and we
  4. 4. recruit and develop locally we recruit local unemployed people, and so I have got a vast array of stories about giving people just giving people a chance to get into the NHS, in the first place, and then developing ways of supporting them to start the career, and had a number of people that had been getting um... promotion, as well. Sarah could I interrupt you may have decided not to do it as a whole table? Did you talk about doing this as a whole group? My instruction may have been not very clear, and my invite to you as a whole group is to introduce yourselves as a whole table, and to share the stories that motivate you around this. OK... Phil: we will have to start again... yes... I will kick off I'm probably the easiest I'm Jill from the widening participation Strategy Unit, so I'm driven by my salary, and this is what I do for a living! So, I have got a background in adult and Higher Education and widening participation. Phil: I'm Phil the National Director of education training and development for connecting for health and much despised national programme for IT, and I have got a long diverse history in this area I worked with NHS U prior to taking up this role which had a strong widening participation remit and my graduate work was all in the area of adult and community education and I have worked and learning communities and national and later on in international level in Australia, and I'm still trying to provide learning opportunities for 1. 2 million people, and other in due course, one of the obstacles we confront is people's objections to middle managers and saying you are skiving off if you are playing with computers and learning will just give you ideas above your station, get back in your box, and one of the challenges is for agency staff and people from the NHS professionals are expected to arrive fully formed and given no support. OK, yes Carmel Rooney learning and Development Manager at Acute Hospital Trust in east London Newham for the past four years' working on a skills model around learning and development for non-clinical staff, and we have done a lot of work around helping people progress through the learning available and supporting people into employment we do a lot of outreach work and community programmes for people, and I mean I'm still passionate about it I have a real anxieties and saying to Phil that in
  5. 5. the current financial um... arena that learning agenda certainly, where I'm from in my trust is probably not given as much focus and I'm certain concerned about that how we are going to carry on and maintain the impression we have been able to the past four years. I'm Sara James from Hammersmith hospitals, and I have a similar role to Carmel's in that I focus on vocational development, and we recruit people from the local community that are economically inactive, and provide them opportunity to take up band one to four roles and re-employment model that introduces them to the different roles and realistic view and challenges of jobs they might be taking up, and that's had many benefits to the organisation and it's produced recruitment and better rate of retention, and higher levels of motivation, and I do still find the same challenges that Carmel said and sorry your name Phil, yes... and said about middle managers, and we have also funded to provide learning for existing staff that's where it gets really hot issue, and interested to hear more about your Carmel your career pathways. Merfyn talking... Absolutely... Didn't both of you come to the thinking outside the box? Event? Yes you were there yes... Sarah: it was a good day. Yes it was structured day I think, and we were um... we had a session on really around um... stories, staff stories, so we started with blank sheets of paper around the walls and started to tell stories, and kind of learning, and yes it was quite good yes. Scary! But good... yes. Carmel: talking to Phil... and this is around use of learning, and disability, and it is something that we have started to think and talk about and debate - yes, and in the trust as well how we are going to ensure that the staff with disabilities, and whatever that may be, and in management. Phil: and this is... what is your colleague - what is your colleague? Amanda. This is an interesting example of technology which is actually helping people to participate in today's discussions and I had never seen that before. So that's something new... no I had never...
  6. 6. And national programme for IT. Yes... Ar... right. Merfyn: trying to promote that as a universal design for any training, or any um... and for it to be there, because a lot of people today and use English as their second language, and if that was on the board at the same time as the overhead projector they would be fully inclusive with what has been said, and hopefully it will happen one day but the problem is money. And this for half a day is £250 and quite expensive and in order to empower people with learning, but it should be used more often. PHILIP HADRIDGE: give you a 30 second warning to draw together where you have got to and make sure everyone has introduced themselves. PHILIP HADRIDGE: welcome back... got an outline of the agenda... ALL SPEAKING AT ONCE Going to explain a little bit about the agenda. Coming out of this introductions session which wasn't just me introducing and a chance for you to introduce yourselves as well was it interesting? Yes... lots of stories? Can make it personal? Yes. Invite to you keep that sense to make it real through the rest of today particularly for any point and theoretical? Which is good theory is good let's keep it real too. And personal too. In a moment, Paul Loveland is going to give us a welcome and orientation from the Department of Health and presentation from Bob we will not take big question and answer after each either of the two they will come back at panel three for questions and answers if there are questions that don't get resolved as we move in and out of the small group and our two earlier panels let's keep a lot of those and pick them up with Julie Paul and Bob at the end of the day then run through the agenda more on less back on time in an hour or so and do what it says there and hopefully it's interesting and keeps us engaged and energised through to late lunch, and the chance for a quick stretch, a one function break at 11.20! LAUGHTER
  7. 7. So this is not a chance to try and have a chat do a mobile phone call grab a coffee and go to the loo, pick your most important of those four! LAUGHTER Getting your attention just to introduce a voting technology nor playful there are four ways I could get your attention, I can do what I do start talking to you which is ask you to put up the blue cards, we have three votes per table, alternatively you might want to hear the energy chime you might think it's energising! Or the little Tibetan chimes or a piece of music... MUSIC If you hear that then it gets louder in a minute, you have four choices there - atmospheric music - this is really just to introduce the technology we will use which of them do you want in three votes at the table, 15 seconds to decide how to cast your three votes, a vote counts as putting a single card uppermost, that would be a red vote. 15 seconds to decide how to cast your three votes? What... are we going to cast our vote? So we either use chimes... or show me your vote? ... And the Tibetan bells are in the front at the moment. We have three lots of those. Do just hold one colour up so people can see... PHILIP HADRIDGE: I think the chimes and bells have got it, hold one card up so people can see... great. I was thinking we should have a visual way... I think we didn't participate... PHILIP HADRIDGE: this is a second vote, and again to introduce the technology, and later on, you will have a chance to put really controversial propositions to the group and think of a really controversial question you would like to test in terms of this meeting you may have guessed I haven't come to do a London-styled chaired meeting as a table what sort of meeting would you prefer I will take the feedback if you want to sit as a boardroom and chaired style and try and have a go at that, thinking of this meeting what are the most important elements you would
  8. 8. like, three votes again and 15 seconds to decide how to cast the three votes what is your mix. Jill: I think I'm an orange really... yes... Carmel: I think... um... Sarah:... Passionate feeling? ... Yes? ALL SPEAKING AT ONCE Do we get three votes the table. I will sneak blue in... five seconds more... Two, one... OK, LAUGHTER PHILIP HADRIDGE: a lot of passion mixed with rational and there's a strong sense of yellow and some tables which didn't vote which is various hypothesis and you really can't be bothered or didn't understand or didn't hear, whichever it is we will be coming back to these later think of provocative questions we could ask and test group opinion with. We have got going and started talking with and engaging with topics and invite Paul then Bob to orientate to us the day. Paul: well, hello, um... first of all I would like to thank Bob Fryer for the work he and his team have put into learning for a change in healthcare, I think it offers probably the most detailed analysis of learning in the wider work force we have and also shapes what I believe is going to be a very important debate. In her response to the Healthcare Commission's annual health check, Patricia Hewitt noted that the NHS had made big improvements in health care, for example, in waiting times, cancer treatment, community Mental Health Services, and in adopting a more patient-focused approach and also noted that there were more improvements needed. Part of this I think must be to embed widening participation in learning, in the core business
  9. 9. of the NHS. And when I said the NHS I don't mean some sort of nebulous concept I mean each and every NHS employer. The Healthcare Commission's core standards touched directly on widening participation, for example, if I can quote health care organisations should support their staff through organisational and personal development programmes which recognise the contribution of and value staff. And also, they should ensure that staff are appropriately recruited trained and qualified for the work they undertake, and more importantly perhaps, and participate in further occupational development commensurate with their work throughout their working lives. I think they are very important principles which have been applied to the way employers provide for their staff. I don't want to undervalue the work of health professions and the challenges reform has for them but the message is clear, if NHS organisations have to deliver the service patients demand and deserve, they have to harness the potential of the entire work force that means widening participation. Health reform means working in different ways, different settings, a willingness on the part of individuals to take on new skills and new roles. And, equally, a willingness on the part of organisations to invest in their staff by offering training pathways, and indeed careers instead of jobs. Here, I think is where we do need to make further progress and there's a lot more to do. We have some initiatives on the go and I think we are making solid progress for example, we have got some well established work around defining competencies and curricula for assistant practitioners and work on transferring national standards. There's the burgeoning work of skills for health and a push to incorporate the needs of staff in local training plans, and also to relate a that to the knowledge and skills framework. But there's some embedding yet to be done and Bob's report gets down to the basics where provision is patchy for example, around numeracy and literacy. I hope then that Bob's report stimulates a wide response and a wide debate, but more than that, we need to build on the case for widening participation and build on the understanding of what that means and get it into local business plans. This means making the link between what the NHS and the wider health care sector need to deliver, its service needs and how it develops individuals and teams across the work force to support its goals. That means a clear business planning, based on a buy-in to measurable learning benefits. I think this conference today is an important step towards doing that, and I wish it every success. Thank you.
  10. 10. APPLAUSE PHILIP HADRIDGE: Paul, we look forward to a chance to pick up further conversation around national policy whether it's enough? And if you think it's too much, we will pick up that later, and think of what it is you are going to be wanting to ask Paul, jot it down if you think you are likely to forget a question so you have got that for later. PROF BOB FRYER: thank you very much indeed. I think I need the little thing for my slides, and can I add my welcome to you all it's good to see both familiar faces and some new ones. And can I start by a big thank you. I need to say publicly thank you to my immediate colleagues in the Strategy Unit who have worked incredibly hard most of them have only been working with me for the last seven or eight months, since they came into post at the back end of last year or the beginning of this year, and I had had the pleasure of working with one or two of them before. I need to say a very big thank you to them for the work they did. And the work they did with some of you in the task groups, that worked hard to produce their reports. Beyond the task groups in discussions and meetings and e- mails, correspondence we have had, it's not only been people in the NHS and healthcare more generally in social care, people in the department Paul's directorate and his colleagues have been nothing but supportive. Also people from the Department for Education and Skills, Work and Pensions from the devolved administrations we have had input, and people in further and Higher Education where this very tricky, and demanding issue of widening participation has long been something which they have been struggling with. So, I need to start by saying thank you, thank you for helping us get started, and one of the big messages I want to give is that we are only just starting. I think one of the issues that we need to think about today is what are the kind of staging posts? What's the way we can carry this forward? We have got a lot to do to win hearts and mind and a lot to do to get a real practical grasp an how we can begin to move this forward, both Philip, and Paul, have used the word embed it's a powerful word. Sadly, appropriated by the coalition of the willing. Never heard such a misnomer for organisation in Iraq, a coalition of the willing. But the coalition of the willing use this horrible word embed what they did to journalist which was in fact to disarm of course, but we do need this to become part of the normality of health care planning, and business, and it's a long way from
  11. 11. it, not because of any fault of health care. You will hear me say it now, and whenever I speak, because there are challenges ahead is not a reason for either us beating up health care, or healthcare beating itself up. Actually by comparison with the rest of British industry, health care does rather well on learning, including on widening participation. But it's not good enough for health care it doesn't measure itself by the relatively poor international standing where learning is concerned of British industry. It measures itself by its own highest standards. So we mustn't get into a situation because we know there are challenges, and because articulate those challenges of either being pessimistic or getting into a situation where we drive healthcare into a defensive position. That would actually be a recipe for disaster. We need to win people, we need a word used round our table in the initial conversation by three of the contributors we need confidence, to build confidence in staff and managers so that they can do it. That's a huge task, and I think is a responsibility not just for me but for all of us. You have all had thrust into your hands the I would stress it's the penultimate version of the report, things you say and influence today may well need to be incorporated into the final version. This is an opportunity and not just today hopefully one or two of you will read it perhaps going home on the train or in one of those moments you might get to have a look at it. If you have thoughts please e-mail them in urgently I think Mike has popped out again but Kylie there I think we want to put this to bed by the end of next week right? If you do have further thoughts, what a friend of mine a long- standing friend Bill Gilbey calls the sliding tackle of policy intervention, please feel free. We have got this report, it is only the first report that I have made and you notice the report is to ministers to the Department of Health, and to the NHS. It's not from the Department of Health. It's not the Department of Health trying to tell everybody else what they should be doing we are not in that era there are messages in there for ministers, for the department, and for the NHS. You see the focus is on bands one to four of the NHS pay and career frame work, although we are interested as you will see in the report, on progression beyond those levels. But the principle focus is on those women and men working in bands one to four in the NHS or their equivalent in other health care settings. As you will all know in the NHS alone we are talking about just shy of half a million people in that category. In health and social care generally, much closer to one and a quarter million people. Health and social care accounts for about 10% of the UK's work force.
  12. 12. It's been estimated that you could not walk down any street in the UK with more than a dozen houses in it and not encounter somebody whose job was not involvement with healthcare, either directly or perhaps indirectly in teaching etc. If you like the report is largely a stocktake, where are we now? Let's take our bearings? Where do we stand in what are the issues? What have we achieved? What can we build on, where have we got problems? How can we move forward? I have mentioned it was informed by the task groups and I do commend the task group reports to you as well. There are some wonderful material in those task group reports, and those task group reports remain important, and valid not just for informing my first report, but in moving us forward to the next steps and many things in those task group reports we still need to action. We as you would expect, I sent this out to a number of critical readers before I sent it into ministers only just a bit before, and I had been amazed people have said this begins to look like the first extended attempt at a business case for widening participation. Now there's a powerful moral case, there's a powerful almost civil rights human rights justice argument for widening participation, and none of us would ever recile from that. But the case of widening participation made in this report is simple but powerful. Widening participation requires attention, commitment and achievement because without it, the huge transformation in health care on which we are now embarked will not be achievable. It will not happen. As we move increasingly with the growth in longevity, changes in lifestyles, with shifts in expectations and patterns of socialability, of how we live our lives as increasingly long-term conditions out of hospital care, self-care, intervention by the so-called third sector, as increasingly the boundaries between health and social care represent artificial divisions, then this work force becomes absolutely crucial. Many people in this room have heard me say this before if you don't believe what I'm saying go and read the book about Chicago, the Chicago heat wave in 1996. A brilliant analysis of what happens in moments of crisis if all the elements of a care system do not cohere. I'm a great Franco file, I love and adore France, if you look at the review of the 15,000 people that died in Paris in the heat wave of three years ago, you will see how crucial was the fact that the people who provide the care to the elderly, and the vulnerable, at these moments, are precisely the people who are in bands one to four in this country in health care - Francophile. It becomes more important as patterns of family life, patterns of leisure and consumption change, and if we don't have the people who are the frontline everyday workers, I will take nothing away from the excellence
  13. 13. and the brilliance of clinicians, doctors, nurses, allied health professionals, health care scientists, absolutely vital. Nothing in the report is to take anything from that. Quite the contrary. And actually, in the last ten years of your life, the health care workers, they work in bands one to four most of the time. So we have to invest in that. That's the business case, quite a lot of recommendations, hopefully Philip, along the way as the conversation extends through the service, what will happen some of those will get discarded and some refined but above all, people in health, people who work in health, be patients and service users, and carers, will tell us what their priority is. Is their priority - it's their priority not what I think is a priority should win, of course I will try and influence their conception of priority. I hope it's the first step towards a new kind of National Service framework, why do I say new kind? I'm a great admirer of the National Service frame works, by the way what's been achieved through some of those National Service frame works is quite breathtaking. I recently had the opportunity to be talking to Jeremy Paxman about the health service I was telling him just giving him one example or two examples of what had been achieved through some of the clinical National Service frame works, the fastest rate of improvement in coronary care anywhere in the world with a prospect of most aspects of coronary heart disease being eliminated within 15-20... he said I have never heard this, why? I said well I can't answer that question, maybe you don't want to hear some things. But those clinical frameworks have been fantastic in mobilising focusing, coordinating, energising inspiring, focusing activity, but we are in a slightly different era than when most of those came out. For us we are in a different era because we don't have the level of science and evidence, and data that had been accumulated through generations of scholarship and expertise, and professional practice that there's in the clinical area we are a long way back. Secondly the NHS has moved on, social care has moved on it's not for us to be telling people, not that most of the service frameworks do, what to do, but the kind of service framework we are talking about is one which I aligns ourselves with national standards such as those that Paul properly referred to. I thought that was very helpful Paul. But also that there must be room for a lot more local initiative, variation, application, so if there's to be a national framework, what kind of a national framework, is and my colleague Ed Prosser has done sterling work that beautiful table in which
  14. 14. he tries to align what we are arguing for with what exists already, I really commend that table to people it's a serious piece of intellectual work it's out for discussion. It's about conversation we are not even Philip at this stage going into formal consultation, we think the time for that will be when there's a proposition of a framework. At the moment we want to stimulate debate, argument, interest, inquiry, ideas, suggestions. Next slide. Just to remind you about the three dimensions I guess you know about the three different dimensions of widening participation we mostly focus on the first in this report, but of course, they are all three intimately related, and you might argue in the end, that the third is the sine qua non of one and two, if you can't really eventually tackle the third we are always going to be quick against the one and two. It's always going to be difficult actually of course the third is the hardest of all, and again, I would be very interested in thoughts and ideas that you have on that because we wanted to do further work on exactly what is meant. You notice the plural in learning cultures, there's no such thing as a singular learning culture. Learning cultures will reflect other elements of local cultures and they are as diverse as other local cultures are, what they have in common is that they champion, and celebrate and reward, and encourage, and stimulate and above all they inscribe in everything that you do in an organisation the virtues of learning, and learning of every shape form, and kind that you can imagine. Informal, passive, self- directed, ad hoc, short-term as much as systematic rigorous and often extremely demanding and as one of the colleagues on our table said. You know some of the key facts in many respects health care does fantastically, it would be exemplary if taken against other areas of employment - fantastically. Most health care establishments offer learning to their staff this is the largest single concentration of professionally qualified staff anywhere in the world, phenomenal resource, a wonderful, wonderful resource. Very large numbers of people still working for formal qualifications while they are employed, more than 20%. Nearly 30% of people, this is the regular study that the DfES does, Dennis Carrington from the DfES is here today to tell us how they do these studies but more than a quarter of people engaged in job-related training in the last 13 week census period and the national average being 16%, very much higher. Many of us regret that learning accounts have not been ring-fenced for a further period. What I think workforce directorates - I think what work
  15. 15. force directorates did and NHS Directorates did, leads on learning and employee development all sorts of different people did with staff, and magnificent but just because they have not been formally continued at national level doesn't mean they should die, or mean that we should not celebrate what's been achieved, colleague Ian Basher has been closely associated with this, this is a phenomenal achievement, 20,000 odd isn't it Ian, a further 100,000 or so on NVQs. Fantastic achievement. There's much to celebrate. Much to celebrate. On the other hand, some of the key facts should cause us some worry. Here are some of the key facts - slide. For those of us who think the future is in work-based learning 70% say no supervised on the job training which is actually even more worrying than the first statistic. Reading from slide... Against the third, 28% have half say no which is quite worrying. Quite large numbers of people qualified only at Level Two or below or with no qualifications at all. That doesn't mean they don't have skills or competencies, above all it doesn't mean they are not doing a very good job, but one of the things that qualifications does in health care and one of the things that formal learning does in health care, it sends out a message of reassurance to patients and users and carers. You can see that Paul this is the work you did for us, it is not for those in bands one to four, and we haven't made perhaps as rapid progress as we should like with appraisals and personal development planning, although the fact that about a quarter of all staff have not only appraisals got a personal development plan and have had the learning for it, represents a terrific start. We mustn't think 25% is not a good start. Lots of strengths. Wonderful strengths we are not starting from scratch, some outstanding policy and strategy documents and some of the authors of those are in the room I know. A very growing Cadre of experienced and committed staff many of you in this room represent those I'm worried that the current reconfigurations and so on and the uncertainty risks losing some of those tremendous staff. The fact that they have established the post I think is important, I think we have got an agenda for change and the knowledge and skills framework, wonderful tools which are
  16. 16. fantastically valuable in our task, we have got skills for health having been established which is fundamentally important, and increasingly they are putting WP in their agenda at the centre. We are very well aligned with Government skills strategy and the Leitch report, and they are going to emphasise very much what this report emphasizes - coming out in December. And there are lots of partners, I have mentioned skills for health, but I could talk about Higher Education, and further education, I could talk about the Healthcare Commission, we are not on our own. Of course, there's some challenges. I don't want to talk about financial constraints but they are real and serious and have to be understood. There's the danger of losing momentum. There's this point which Ed Ellis' task group emphasised there's something like an inverse law of learning opportunities in the NHS like the inverse law of care, where social inequalities are concerned. As Dave Arnold's group pointed out very sharply we don't have very good evidence and very good data we need much better data and evidence if we are to know what we are doing, and know what the impact is, know if we are making progress. There have been some wonderful initiatives but they are very vulnerable often on funny money and short-term and depend upon the enthusiasm of a few people if they move on it falls to pieces etc. The pedagogy we need for widening participation and work-based e- learning for self-directed learning is underdeveloped by comparison with traditional ways of learning and teaching. I'm hesitant talking about this as one of the world's experts in the room with Phil Candy here, it's great it see you here, this is work we need to do with you I think particularly now with connecting for health coming on stream and the e-learning road map being developed. I think it's great. We haven't got learning, this is probably the most difficult thing and the thing I have expressed in poorest fashion I think in the room we haven't got learning fully inscribed into policy and strategy. I don't think learning should be thought of after you think of strategy. I don't even think learning should be aligned with strategy. I think learning has to be a core feature of strategy, and in the best businesses, they will tell you that it's learning that gives them competitive advantage.
  17. 17. It wouldn't be the Director of Learning or the HR director that told you that it will be the Chief Executive and the finance director that's my ambition. And, finally, let's not forget and I think again on our little table we touched straight on it the NHS health and social care more generally is simply a product of the rest of British society, we can't expect to correct the rest of British society simply the NHS, and we are in some centres if you like an epiphenomenon of the wider problems of learning and inequality in our society if we can become an oasis and exemplar then better and we are in some centres and to put it mechanically at the end of a supply and value chain over which we can only have limited influence we can have some influence and reach out into communities we can reach out into schools, we can work with the trade union movement to open opportunities, and to challenge the status quo, let's not kid ourselves that somehow we are separate from the rest. Remember as we have discussed what learning is all about. I still think this is the most brilliant simplification, and I'm always interested in simplification, elegance, the Delors simplification of what educational philosophy is about, learning is about one or more of these four dimensions. To read Government policy at the moment it's a narrow version of two. A narrow version of two. Actually if you think about what we do as jobs in health and social care, what patients need and want as their priors, what carers families, loved-ones, communities want, they want to know all the other things don't they? How could you ever have a so-called patient-led NHS if we hadn't all learned how to live? Not possible, logically unobtainable. How could we ever get towards a celebration of the rich diversity of our staff, and our service users, if we hadn't invested in three? It's a very important notion, of course, if anything, if health care is about we have had some research done, and Dave has been working with Cathy in the west midland with some colleagues on communications, and they came up with a very I thought exciting simple slog an that what we were about and health is about about had one thing in common is getting better. Getting better. And it's about if you like the autonomy and sense of dignity of who I am, as an individual, as a member of a family as a partnership with some other person living in the community, a sense of myself, and why shouldn't workers have a sense of themselves? So I do want to have a rich and not a narrow conception of learning, because you put those things together and what you give people is that sense of critical
  18. 18. independent thinking, that sense of responsibility, that sense that through learning, we can engage with our everyday lives. It's an exciting prospect but a very challenging one as we live through what I think currently is a kind of hollowing-out of what we mean by education, and learning. So the NHS yet again should lead the way. Where do we go from here? Share the report. Be issuing a few initial guidelines and support for the service this year, we have got further work being undertaken in each of those areas that you see there, if there are any you would like to help with us, please, please get in touch because all of this needs to be shared and worked with the service. I suppose above all, what I hope this represents today is the beginning not just of a conversation, that conversation is a vital element of the beginning but of a long-haul towards a radical programme which over time will again put health and socialcare in the forefront so people say if you want to know which employers know most about how you not only get your staff and service users involved in learning but how it changes the quality of the experience of those patients and service users, go to health and social care. As somebody said I went to an inspiring lecture at the Royal College of Physicians last year on health and social inequality. They ended it by saying you have got to have a dream he said. What we any of us remember that wonderful Martin Luther king speech if he had said I have got a ten point action plan! LAUGHTER And this World Health Organisation commission on health and inequality, one of his commissioners said something brilliant back to him I will end with this and borrow it from last night's lecture, he said: you can dream a plan, but you can't plan a dream. I thought it was the most wonderful way to end, if you get a chance to read that lecture inspirational lecture on health and inequality. I just thought that every sentence I said he could have substituted learning and inequality. So let's dream, and let's actually plan to implement that dream thank you very much everybody APPLAUSE Thank you Bob as we invite the panellists for the reform panel two things to do individually write down any things from what Bob said could be
  19. 19. celebrated or challenged and pick those up in the panel later think of where you are at with what Bob said and as a table think of how you will vote on this assertion, the assertion is about system reform, that widening participation has a huge role in taking forward system reform if you agree it will be green, if you disagree red, a bit of both maybe, yellow, if you have got no idea - blue. System reform will have a huge impact, widening participation in taking forward system reform, we will vote when the panel are here and get them up here - Sarah: it's um... Useful to have this, red if you disagree, and yellow... no yellow if it's maybe... How do you guys vote? Well the optimist wants it go green - yes, and certainly something I will use as a driver in my report to link what we do to Department of Health, and strategy and Jill: yes drivers I would imagine in terms of business planning, Sarah: it depends and caught up with the other strategies. Jill: and as well... if you say it... ALL SPEAKING AT ONCE PHILIP HADRIDGE: OK if we can see your vote results against this assertion, I should be using this shouldn't I take the feedback from earlier - using chime - once once bit of both I will mix and match next time the better bell for those who are sad at that point. Right so the vote is widening participation, will have a huge role in taking forward system reform shown in green if you agree or red or no idea blue... what do you think? Put one up... There's a few yeses... A lot of people aren't sure how to vote. I think... ALL SPEAKING AT ONCE Can you choose
  20. 20. What do you think Merfyn? Yellow? Yes,... PHILIP HADRIDGE: a mix... so from that it seems that there's no red or blue, a little bit of blue... NEW SPEAKER: Audience: whether the unconverted see the case the converted in the room see. PHILIP HADRIDGE: I declare myself I would have put up blue in the document here if you are not sure what I mean by system reform you might want to look at page 79 in the report, and the top right hand side of your table, and from the policy directory in the Department of Health. We have three speakers who are going to explore this issue of system reform and widening participation and coming to this with a blue mind, and curious and really interested to hear where we are going to go five minutes each... Judy. Noise of microphone. Sorry I will come here the light is bright on my face there. I wanted to talk to you about an interesting article I found yesterday on waste management, and energy saving, and full of loads of ideas about how we can make sure we don't waste the earth's resources and something we are all interested in at the moment is there anyone here who hasn't over the last three or four months done something to increase their eco-status? If you have lived in London you have done something to reduce the use of water you couldn't possibly not with the amount of information we are all terribly busy dealing with not wasting the earth's resources yet as part of a health care system we sit on the waste of human resources massively. Now I feel a little difficult saying it to an audience like this because everybody here is actually committed to the agenda, and part of what we have got to do is find a way of getting the message your comment that some people aren't yet convinced out to other people. I think one of the best ways of doing this is talking about waste management. Most people don't like waste, they think that waste is a problem, and when you point it out to them they feel horrified about it, it's working very well with us all on the ecosystem at the moment my view about system reform is that system reform is about reducing waste and inefficiency, so that you get better outputs, better outcomes going back to Philip's colour cards this
  21. 21. morning, I'm being absolutely rational and logical? The approach I'm trying to take and don't disagree with any of the comments Bob made about moral ethical issues justice social issues etc, but I'm coming at this angle from the need to convince the people we have to change. They are people who will need you to present in their language rational and logical arguments I'm delighted to see so much of the focus in this report as being about that. It's about waste management, and I talk with three hats on: my first is I used to run the new ways of working programmes in the NHS Modernisation Agency and prior to that I was a Chief Executive a large part of my job was knowing and learning how to convince other people. One of the things we did a lot of work on is the who does what question the changing work force programme many of you will be familiar with. In virtually every example, I can think of as I look back of work we did in that five year programme with initiatives coming from the staff on the ground and the patients that they work with, nearly every time we ended up developing the role of people in the categories the one to four, the so-called support worker, and one of the things we tried really hard to do was get rid of the title support worker, and find lots of other titles. I won't go into titles today what's happened in health care from the 90s on really is we have ended up over well I think often overqualifying but certainly giving higher and higher qualification levels to many of the professional staff, and then working completely inefficiently to use the skills of the rest of the staff, sorry for being managerial but inefficient is a word that will work when we try and convince people, and where all the range of nursing roles there used to be got dumped into health care assistants and all the ways in which housekeeping and catering staff were part of the workforce got dumped into the lowest-paid contractor. What we were doing was wasting the skills of the ones we had trained expensively and wasting the potential of the ones we weren't using effectively. There's been a lot of change and loads of examples and work we did on medical secretaries creating a career structure and enhanced roles and learning and assistant practitioners etc you can find all sorts of examples they all show about how this kind of agenda the widening participation in learning may enable people to learn will reduce waste - one minute more. My second hat is I'm Chief Executive of the food school trust there's a good example of how we are wasting the skills of people. People who used to cook perfectly happy in their own homes go into worn in a school setting and get forced in many of them, certainly not now, but in the past to empty things out of a pact and put them on a tray and put them in the reheater. A massive agenda and the consequences of that are very significant if you look at the obesity and children figures I know it isn't just school food but a big part of it my third hat part of London South Bank University as a visiting professor
  22. 22. there, one of the things that I believe is very important is that education bodies have a very important responsibility in this area, a role to play responsibility for some of what's gone wrong in the past and role to play in taking it forward for the future, and working with further education and Higher Education and schools to make it easier for people to enter the learning network thank you very much. It is... APPLAUSE Peter: I think I will stand down here as well the light is shining, what I will say is not necessarily system reform open to debate, but for the past few years I have been Director of Workforce and learning for a Strategic Health Authority in Devon and Cornwall I want to share some of the things we have done and my thoughts on this. We explain Devon and Cornwall a little bit to you there we have some of the best schools in the country, and some of the worst. Some of the best if you look at the top 20 state schools in the country you will find five or six in Devon and Cornwall in there. If there was a list of the worst 20 I'm sure we would have five or six there as well. My father left school at 13 and went to dig roads and my grandfather left school at 13 to work gutting fish and subsequently became a trawler skipper if you look at some of the kids that leave school at 16 in my part of the world they are doing the same thing and leafing school at 16 to dig the roads instead with few qualifications and that's the raw material that my trusts have got to work with in order to continue to deliver health and social care for the future, it's not easy, we are working with a system that is dysfunctional to a considerable extent, what have we done? For the last few years and Bob has alluded to this already we have had considerable success in terms of numbers of people going through the system accessing learning accounts, and developing NVQs and we have put 11,000 people through LAs, and 6,000 of the staff through NVQs and one in three staff in the target groups have participated in this form of learning since 2002 I think that's pretty good you could say two in three haven't but I'm a glass half- full person at the moment still that's a good success story I think. What has been done largely has been grounded in PDPs, personal development plans. That's also a good thing. Where it gets trickier though is to what extent do the personal development plans reflect the true needs of the businesses and I'm less than clear about that, so you could argue that what has been done may not be directly connected to what health and social care organisations need.
  23. 23. But we have achieved more than anything else we have developed a robust learning support infrastructure using the funding that's come our way all of our trusts have got a very strong infrastructure of support staff, NVQ assessors learning managers in place ready to ensure that we can take the widening participation agenda forward. This is a risk there's no doubt about that because our trusts have become dependent upon external sources of funding, and when that fund something taken away they begin to look at this as something they can start to dismantle I'm concerned and worried about that how sustainable is the infrastructure two years down the road I'm not so sure there's other sources of funding available we have managed to get funding through the national employer training programme that may well lead to more success in the future. But it's an issue other successes - I would characterise had in terms of reaching out and giving opportunity because in order to ensure that you have a workforce in the future, in Devon and Cornwall our organisations have to reach out to the potential workforce we have managed to do had in two interests ways and engaging the young workforce strategy we have built strong links between schools and employers and cadet schemes we have also supported existing staff through the widening access scheme through developing an open opportunity programme for health care - university programme, and I have already alluded to the NVQ ILA programme we have moving towards foundation degrees there's a lot of success out there. I go back again to whey said earlier, what is success? If we tried to do this in terms of productivity and numbers and outputs I think we will get probably nowhere to me what is much more compelling about this is the ethical moral argument that it's important because it's important and the idea that out there there's a label market that is has been through a system that's dysfunctional in order to access that market we need to ensure we develop employment strategies that will get us a proper workforce in the future. Finally about the leap of faith and I have used this way of describing it locally and at national meetings what is more compelling is some of the individual stories and I found two going back through the annual reports as you know we have been reorganised and my organisation has been taken over by another and it's been good to look to see what we have achieved I found two a lady called Sue from Plymouth went on a baby massage course, now I don't know what that is, I'm a... father of two children but I'm afraid I have never come across baby massage in my life. What she has done she has developed a clinic which has some very significant service benefits to the people that have been through that programme. Secondly Kate has progressed from being a cleaner to managing 25 staff to accessing a range of personal development programmes and NVQs and there are many such stories I worry when we try to quantify all of that in terms of this has achieved a
  24. 24. 5.6% growth in productivity that doesn't feel right. The key messages for me in this area are firstly employer responsibility, employers are responsible for developing their staff and their potential staff. I need to stop for two minutes... APPLAUSE Tony: - we have heard Judy's waste management and how it can make a difference to performance and Peter if I will polarise the emphasis on stories and narrative and Tony curious? I have been asked to try and articulate the views of the unions in general and Unison in particular on system reform and learning and jotted down a few points first, the Unison absolutely supports the case for reform as it's laid out in our LSA and no question about Unison's position in terms of any support for the modernisation process and reform process and the first point I want to make. In terms of system reform of course, agenda for change which has been mentioned by Bob, and KSF which is related is absolutely crucial to being able to enable modernisation, and change and enable people to develop new roles and ways of working, so the union was critical to the development of that quite successful example I think of partnership and how things should be doing it's hopefully going to enable us to be able to engage and broaden the way that learning operates and is available to bands one to four as we have heard. And obviously I want to come back to that in a minute, and the problem that I think the unions and the union has got and I'm sure most of you will be aware of it is not we are against the notion of change and developing reform it is because the pace of change is too quick there's the danger that the service will be destabilised as a result. That's one problem that we have got and also the union's position is that really and truly the ethos of the public service and NHS in particular is really critical to the way in which things get done, and that we believe that collaboration and working together is a better way of encouraging and developing and achieving change than the fragmentation, and competition that private markets and so on will bring. Those are the two points that I wanted to make about the union's anxieties about the way that things are being done. But back to learning: it's absolutely crucial to the union, the union over the years, Unison in particular I think we were able to say that, and played a leading role in developing the union role in learning and we have had the return to learn programme a flagship programme from Unison and its unions which people will know about, and we have been involved in trying to develop skills escalatory and progression pathways approach long before it was taken on as a major plank of learning policy we are proud of what we
  25. 25. have achieved there. That programme as well as being deployed through engagement with employers as many of you sitting here will be aware have been part of, lots of work, working together and with open university and us in Unison and also delivering with employers and partnerships work is crucial to this agenda. We have as well supported what's been mentioned many times the NVQ and individual learning accounts and skills for life frameworks policy initiative from the word examine and heartily involved in helping to actually deliver that and the learning that comes from it, so I know people Bob has mentioned it, just to add another statistics, 6 5 million quid was spent in the last year on this which represents if my sums are right about 1.8% of the entire MP ET? Budget. It is or was the only dedicated fund for bands one to four as far as I'm aware and really important and created all these beneficiaries that people have talked about and I don't need to go on about that, it's also underpinned a lot of the ability for people to start to engage in new roles apart from the number of people that have gained NVQs and I take Bob's point people without qualifications don't have skills or competence but one would hope the learning would enable people to deliver care in a more considered and slightly higher quality way if they didn't go through that process of study it's important that people do get to do their NVQs in terms of patient care and improvements and health care assistants a piece of work I'm doing have been funded through their progression route into pre-reg nursing and into assistant practitioner roles through IL ANVQ funding and really important in terms of delivering reform people being able to be competent to take on new roles. I think that's a great scheme, but the as we would all agree here but as people have said, the funding is in danger, and series almost of accidents has casualty of deficits and cuts in MP ET and the devolution of funding decisions to SHAs all of which are not necessarily bad or wrong things but it has left us with a situation in which the crucial element of funding and learning in band one to four is actually being dismantled as we speak it's worrying, and to wrap up think about reform and how we take it forward if we can't put this right and needs to be done quickly and I know it's on ministers' radars and I think we will find a solution to it and union will do all it can to help engaging people in that discussion to make sure however we do it that funding continues for bands one to four, and what will happen if it doesn't, if it doesn't happen and we are not successful we will end up with a much reduced progression into new roles, and as Bob said, how are we going to deliver the new NHS? 30 seconds... no funding for KSF in people will have their expectations raised about their learning who will pay for it, how? Massive problem if we don't get it right. And NVQs in care, I have mentioned no funding for those and quite potentially a serious matter we have to sort it out and the union I can say and unions in
  26. 26. general and Unison in particular stand ready to be able to make our contribution, which is immense and growing army of union represents and can't do it without investment that's... all I will say thank you APPLAUSE A couple of things you get a chance it take your one function break and said which function you need the most and go for it, you can come back and as a group in the next 12 minutes, and by 20 to you have a great question or comment or challenge why your table and we will do our best in the 20 minutes to hear from every table and get the panel responding to the issues you bring up so don't all rush for coffee at the same time or there will be a queue and see if we can manage the queue and start back together at 20 to by that clock at the back thank you NEW SPEAKER: We had a number of staff last year, and what impact has that had on health services in terms of whether it's reform or whether it's experience of participation, and I haven't really been able to do that and I would look to something coming emerging from this, and I think we need some kind of support or freedom to begin to evaluate the impact of learning. PHILIP HADRIDGE: take a moment and make sure you have a question or challenge. Phil: I think there's a total lack of evidence based management in the health service and no amount of evidence is going to change people's behaviour, and very few people who pay attention to, I don't know how influential it is in terms of clinical practice but I don't think it affects most managers at all. And simply directives, and a regrettable tendency to just be reactive to instructions that come from above which means that the importance of modelling, and constant repetition by senior... heads is unavoidable and I would like to think you could make the case and been doing it for 32 years but believe it's not as much difference as people being told to do things our funded to do things differently and build it into existing KPRs for example, and maybe you need a movement that appeals to their hearts and minds and wallets almost. Jill: I think patients have a big role than we have ever given them any credit for really in terms of getting sorry because I'm eating, and about support and involvement really... PHILIP HADRIDGE: chimes... is that better...
  27. 27. OK. ALL SPEAKING AT ONCE Welcome back. PHILIP HADRIDGE: we have 15 minutes to have as many - are we altogether? 15 minutes to have as many interesting conversations as possible, as many contributions to you as well as reflections from the panel and pick on a table to start with to see what you have got as a topic, and think what's likely to keep us energised and get to the heart of the matter and what's really interesting, and so I was going to come to table eight, you seem to be hard at it. What is going on there? Table eight: who is going to be responsible for this agenda in the restructuring of the health authorities, PCTs etc? Who is going to be responsible because we are losing knowledge, and intelligence from organisations now whilst they are still undergoing change and my fear is I think somewhere on the table we will lose people who have these networks and the Skills Councils and LFC etc, who is going to be responsible? Did another table have that other something similar as your issue as well? Looking for the single issue that was really important on your table, anyone else? I guess Peter? Are you best placed to answer this? PETER: Happy to have a go I think the new strategic health authorities have some responsibilities in this area no doubt the new strategic health authorities are responsible for ensuring local systems are capable of delivering health care and the local population needs for the foreseeable future, in broad terms, the PCTs are the organisations that we are responsible for commissioning health care from providers, they are also interested in workforce. I think if the SHAs abdicate responsibility from this absolutely, I think that would be a mistake because they will not then be able to ensure that the system is sustainable for the long-term and if you asked me who is ultimately responsible for this it's the employee organisations in my book has to be. Judy: over and over again since we restructure I would like to locate responsibility somewhere where things aren't going to get changed so often and it seems to me that responsibility lies in the hands of every employee in health care who is working with other people who are not using their potential and skills to the full. That means trying to get the
  28. 28. professional bodies to play a big leadership in it making sure the trade unions stay actively engaged in it and making sure it makes common sense to do it so it not yet another external initiative somebody is expecting us to do on somebody's agenda and so mainstream to the way of thinking and so ingrained in the thinking of staff, and the people who represent them, that it will happen despite the system rather than because of the system and I don't deny somebody in the system has to have... PHILIP HADRIDGE: great as many different topics covered as we can and take this further and really interesting question, and how confident you would be in the answers would be my come back, and we won't do that we will go to table five what's your big topic? Table five: - we are using the microphone for the recording and audio - as far as we got to a question it's tied in with hats been discussed how do you persuade the chair or board or chief exec of the board this is their day job and they must put resources and effort behind it? PHILIP HADRIDGE: I will ask each person who speaks if you could say who you are - I'm Peter Gramis and I work in workforce for the Department of Health. So to the top of the agenda Tony? Tony: I agree with what Bob has said in his report that there's a need to actually provide business case, and I don't think we need to shy away from that we absolutely need and will need to fear that and do need to be able to make the argument for this learning, and the argument is there to be made and I think it's absolutely clear and been said many times that you can't deliver the new NHS without learning for everybody, and the whole workforce approach including band one to four. We do need to be able to make that business case and it has to be underpinned by evidence and a big job of work to be done in order to make sure there's evidence to persuade people. That's one way of tackling it I think and the other way of course is that the unions will be there encouraging organisations and chief executives and boards to take this up it's crucial for our members to be able to develop themselves turn their jobs into careers and be able to you know what Bob referred to address some of the social justice and inequality issues that are wrapped up in this agenda, unions will be there encouraging. PHILIP HADRIDGE: Peter? I guess there's the thing about how convinced everyone is that it's possible to get it to the top of the agenda that the economic and moral case can be made?
  29. 29. PETER: For me it's critical to recognise that employing organisations responsible for delivering healthcare through competent staff and the key is competent staff, we have got a whole regulatory apparatus that the Healthcare Commission uses to look and expect and check on us, initial inspect and check on us and make sure we can reassure ourselves that our staff are competent to deliver. That's an area where some organisations have been less than strong over the past few years, and I provided that the Healthcare Commission keeps this high up the agenda, then the role that the job of ensuring that the staff are competent to deliver health care rests with the Chief Executive, and if we find that the staff are not competent it's the Chief Executive's head that's on the block and straightforward in my view. PHILIP HADRIDGE: and old technology for voting with your hands, if you are not well, how many people are convinced it is possible to get it up enough up the agenda, if you are convinced put your hand up it's possible, getting to maybe a half, and hand up if you have serious reservations about getting it up? NEW SPEAKER: Audience: I think it depend on the Chief Executive... use the microphone - yes I think it depend on the Chief Executive we have had a change of chief exec over the last couple of years and the previous incumbent had an interesting view in learning and development, and was for it but the perhaps the resources were for the there to meet it the current Chief Executive has a different view, and is very keen to ensure we have a competent and developed workforce. However there's still the issues of meeting all the other targets and that's one of the biggest problems of getting it high enough up the agenda to make it happen. That's one of the issues. PHILIP HADRIDGE: ob let's take another topic, a different issue Mike? Please say who you are in Table seven: yes I'm Mike head of health literacy Department of Health the issue I want to raise is for the business case is the links between participation in education, and health and well-being, and NR DC the study and benefits of learning are demonstrating there are such links for example as a correlation between participation and giving up smoking. Why is our workforce so different? A learning workforce would be a healthier workforce with better sense of well-being and do absenteeism, lose it and turn over and business evidence the benefits of healthy living programmes in workforces and part of the business case and not generic
  30. 30. learning not just work and task-related learning also has a business related benefit. PHILIP HADRIDGE: the question? How can we better make that argument I don't know if there's very much in here about the relationship between health and well-being and learning and part of the argument and all organisations within the health service what do we make of that. Another table? Have a topic near that at all? Judy? It's particularly interesting for me because in the new work I'm doing really became aware become aware of how few people can cook any more and everybody loves watching cookery programmes but it deskills them and they sit and each a take way while they watch it! LAUGHTER And I really think that the whole business of life skills which you are absolutely right is broader than just the learning you are doing for the job it's back to the gardener, I quite would like to use cookery as a main way of dealing with literacy and numeracy without doubt people who better aware of those kind of well-being issues are better able to look after themselves. It does then show itselves in reduced absenteeism greater energy and morale at work, and a business case to be made and hard to make in each individual trust, and that's why I think the stuff about gathering evidence and good practice, giving people locally the arguments to use based on studies that other people are have done is one of the ways we can help the local chief exec and worker, trade union person, professional whatever be able to make change I think it's a really relevant argument. Tony: it's interesting and I came across a project I can't remember exactly where it was taking place but it was fascinating and people were going out from the health service into the community to try and engage with a lot of people that are elderly people who are having falls and what they discovered by the way was a lot of people who were having falls who were widowers and hadn't been told thousand cook and brought them together through a programme and create add network of citizens, and they started to engage in cookery classes and became self-sufficient and better nourished and it's fascinating and meant those staff when they were
  31. 31. talking about the way they had to change in order to deliver and support that sort of care self-care out of hospitals care, was also interesting, and that I think involves a lot of different types of learning for people, a lot of people that will be doing that are now going to be hospital-based. To move out it seems implies learning around developing different skills and also being able to problem-solve themselves and that ties. We have got the panel going? Peter? PETER: There's carrot and stick here, the carrot is plenty of evidence that happy well motivated workforce delivers better and is off sick less there's plenty of documented evidence that trust chief executives and HR directors can put their hands on to prove that and demonstrate a link they are fools if they don't and the stick bit is that the Health and Safety Executive have become increasingly interested in recent years, and the state of well-being of employees in organisations. And particularly occupational stress, and all the features that are associated with that, and I think employing organisations ignore that at their peril. To me they should do it because it's right they get benefits and secondly if they don't they will be in trouble. PHILIP HADRIDGE: a couple more minutes to the panel, and if we say the system reform is about two things, choice, that we will pick up in the second panel in a moment and diversity plurality of provision, privatisation third sector etc. I have made an assumption that might have been a hot topic, what is privatisation and use of the independent sector, third sector do to the career and life chances people who are at the bottom of the career ladder. Did any table get into that or is it just me? Might just be me, is that relevant in Yes it is. Phil: Phil... we have got a new director general of workforce coming in from Tescos and probably has a view on this I expect she has. We didn't tackle that topic directly but we did owe bleakly, and Jill suggested patients might be a lever to get a consciousness about learning, there are two elements - probably two elements, one is the work about enhancing health literacy the capacity of patients and general educational level of patients with respect to health issues, and a colleague I work with Sir mural grey has done a lot of work about empowering patients and we have also got a connecting patients project within the national programme
  32. 32. for IT then a sort of second issue which is if patients do have choice, will they vote with their feet? Will they choose health care providers who actually have more, a better educated more constructively oriented workforce and therefore act as a fulcrum to change the attention span of people who are able to make decisions I'm Phil candy from connecting for health. I will put this as a final question to wrap up for the panel and privatisation, good or bad use of the independent sector heaven or hell? For widening participation? LAUGHTER Tony: no brainer! Judy: I think that anything that forces people on the ground to think really creatively to how they use their staff to best effect has potential, ie we develop their potential and help them learn while at work. I think that too often we try to centrally manage these initiatives and don't allow those locals natural incentive mechanisms to work, so I feel concerned that it might not, but in theory it should work. PETER: I have spent half my career in the private and half in the public, speak up please - there now, I spent half in the public sector of my career, and there are risks in both sectors and public sector organisations that treat their staff appallingly, there are private sector organisations that treat their staff appallingly I have seen a lot of models of good practice in the private sector where it's recognised that you get benefit for your organisation out of having well educated employees. So I mean frankly I don't think it matters who owns the organisation, what matters is what it does. Tony: there are good and bad examples of good and bad practice in all sectors and that's fine and I would agree, but in the issue I think for the union is that there has always been a place for third sector organisations that bring expertise and no problem as far as the union is concerned about that, the difficulty the union has is with this notion is that markets solve the problem that we have got. The problem is that it's going to actually lead to a lot of disruption and fragmentation of the service, and a loss of the critical thing that we all treasure which is NHS ethos, why people want to work for the NHS. Working for a private company is different we are anxious about that, and anxious that there's a difference between
  33. 33. people who already have a contribution to make and there's nothing with that and a difference between organisations being set-up in order to take on bits of work previously provided through the NHS and final point but if that is going to happen, then we would need to ensure through contract compliance that learning is done because learning will be needed by those organisations as much as needed by the NHS. Thank you to all the panel for keeping us informed and entertained and show our appreciation. APPLAUSE PHILIP HADRIDGE: and, as we exchange panels now, Bob we have time maybe... PROF BOB FRYER: I wanted to pick up on this table here because in a sense... lots of interesting points and I would like to hear a bit more about where we see the patient voice, patient action, patient choice, experience, figuring now, one of the interesting things I'm quite interested in organisational theory strange person I know I am, but one of the interesting pieces of work that's come out from organisational theory in the last 15 years I suppose since the beginning of the 90s is that really modern organisations have very, very fuzzy boundaries. In fact, to understand how really effective modern businesses work, the notion of that clear-cut boundary between the organisation, and its market or its community or its partners misunderstands effective business organisation in the modern or late modern world and in globalised world, and health care seems to me to be exactly in that position Philip. And, the fuzziness needs now to be in that boundary, and it's absolutely there isn't it in our health care our say as it was had choosing health. And between the patient and her or his ownership of their health. It's their health doesn't belong to the NHS, or a clinician when you go for a consultation a discussion, an action with a health care professional, it is not a market transaction, it is not an exchange of commodity you already own your health. It is your health. The transaction is actually between someone whose ownership is established, and yet much traditional practice behaves as if it wasn't. That is much bigger than payment by results much bigger than bringing in private providers, and the boundary shift between clinicians and patients that's what I guess is in this clumsy phrase patient-led. It is a clumsy phrase and doesn't quite capture I wanted to invite Jill to talk about how important it is in the widening participation agenda that the voice and the
  34. 34. experience and the engagement of patients is something that we should not overlook, it's not a separate territory, the partnership now between health and social care providers and the wider community, is part and parcel of how a modern organisation should work. PHILIP HADRIDGE: give you a chance to respond and then on your tables you will have a minute to decide as we go on the panel on patient experience is widening participation is likely to improve, Jill in Yes thank you Bob! LAUGHTER You knee about this. No pressure there then. I think it's three fold and Bob has mentioned the issue about the patient and the clinician and empowerment, and Mike kindly at the back talked about health literacy and people being empowered to take more control over their own health and decisions about their own health I think secondly we still forget that stronger voice that the whole thing around local authority involvement in health services, the scrutiny function, the duty of care over healthy communities, is actually a really important part of system reform. It is another area of responsibility, and people were talking about responsibilities before, and the way in which patients organise themselves either in patient forum which aren't going to last much longer but around community groups voluntary groups and they will link into that system and have a powerful voice, stronger voice is part of system reform. The third bit I get the most passionate about is we have made great strides in terms of involving patients in learning for health care professionals and there's some wonderful examples in the expert patient programme, in the OSCIs the objective assessments that medical students do if there were Higher Education providers here they could talk about this more eloquently yet we don't have that kind of creative learning opportunity for the support staff or the grades one to four, for me it's the patient involvement (A not only saying it's really important for grades one to four to have learning opportunities when I have done work in the past and talked to patients about people in the service that are putting their hand on them and undressing them and washing them and making lots of clinical and nursing interventions, do not have qualifications, patients are shocked. They are really shocked and I think we need to build on that and to get a real critical mass among patient groups and I think our support
  35. 35. staff would really, really benefit from having patient involvement in their learning, and development of the learning and also in the actual learning practitioner. PHILIP HADRIDGE: thank you and on your tables now 30 seconds to decide the proposition is widening participation will have a huge impact positively on the patient experience, green yes, red no, yellow mixed blue no idea. Please decide... Sarah: good considering you put it together at a minute's notice! Phil: and talking to Jill... Jill what now? Patient experience? Sarah: yes... Widening participation in patient experience. Phil what was the question the same again, and Jill... He will keep asking us this till we have green! And I propose we go green now then go and have lunch! Jill: I think... OK! Have you moved! Chime noise... Still on yellow... PHILIP HADRIDGE: see where we are with the votes? Show me... So investing in widening participation and improve patient experience... this table? Should have three colours and can you use all your cards if you want. Yes. Yellow is maybe... PHILIP HADRIDGE: ... green is... PROF BOB FRYER: is that a yellow or red Dave?
  36. 36. PHILIP HADRIDGE: mixed Bob, the greens just have it... a couple of blues... OK, fantastic, and we are now going into the panel and see what they have got to say and whether they help to inform this more, and starting off with Tris. Tris: thank you very much right I will put this down here... good OK... Tris: well hello I'm Tris, and I was asked here to come and talk about the role of well, basically why involving patients in the learning process is good, and er... yes. And about some other things which that's been cut! LAUGHTER Tris: so the I have been involved in the patient mentoring project for a few well, quite a long time now, and although it's with clinicians, I'm just going to stick to that because I know how it feels sitting in the audience I'm overloaded with information, so I'm going to stick to that, and um... please question and ask about the application of it to support staff. I think it will go. Anyway, right... I'm not comfortable just doing a stand up and talk, so I will possibly ask for some pantomime style participation! So... OK, right, participation of mentoring programme, it had some of you are probably thinking that's good, it's staff mentoring patients an how to best deal with their conditions no strike that reverse it as Willy Wonka would say, it's patients mentoring staff on how to improve their enjoy their jobs more and do their jobs better working in long-term conditions. Patients with long-term conditions who have been through the Expert Patients Programme, and are therefore qualified in self-management which is one of the big aspects of chronic disease management, they may also be tutors in that programme and qualified in group participation, and they are qualified and experienced people. I have been managing the south east bit of the programme which has just finished, and most of the participants have been community matrons, and other nurses, and a care manager from social care, and was across health and social care at a pinch. So, pantomime participation, would you like to hear what one community matron wrote to her mentor after four mentoring meetings? Yes! It's behind you! LAUGHTER Oh no it's not!
  37. 37. Disruptive influence! Has to be at the top of an organisation. LAUGHTER Feel the same way myself. Right. Hi. X my mentor, this is I'm talking as community matron 1130 fine another meeting, I found the meetings valid and I think an awful lot has come out of our meetings and by being in a relaxed atmosphere we were able to be truly open and honest, the main challenges were how do get patients back to taking responsibility and control of their illness to promote independence and yet offer a support network, you have given me a great insight into how a patient is able to take back control of their illness without being dependent on the nursing or medical profession your expertise allowed me to see a broader picture I have given me the knowledge to be able to empower the patients her patients, to make informed decisions regarding their management options. For a little while I walked in your shoes and could see the difficulties you had overcome to become independent and take control of your illness that is what I have learned and been able to share with some of the patients with chronic conditions. Initially it was difficult to put into operation, patience always think it's easy for a health professional to give advice when they have no experience of the illness themselves and this is the thing that the nurses were coming up consistently and patients work with chronic conditions, and saying you don't know, you might know the theory but not the practice of my life. Which is quite right. Through sharing your journey I have been able to guide some patients towards a positive outcome when all they could see is negativity and I have gained a vast knowledge of support networks and more empathetic and other people are interested about the Expert Patients Programme and taken your expertise back into practice to share with colleagues and patients and it was unprompted and a reflection from a participant, and in very emotional terms you know what comes through for you guys shout out? What comes through for you listening to that testmonial? Do you get a sense of the feelings of the, perhaps I haven't delivered it very well. Audience: deep learning... yes great. NEW SPEAKER: Needs to go through the system it's no good just having a matron with that experience, it has to go from top-to-bottom left to right.
  38. 38. For me it's passion, that's what I would call it and a lot of people with those red circles earlier on today. So tiny projects really, a tiny project in which we had - we only ran six relationships and we ended up with four mentoring relationships at the end and even with those small numbers we had a patient going outside for the first time in six months, a patient mentor feeling useful for the first time in years, changes to services implemented and uptake of key organisational aims around chronic management and patients professionals relating to each other as people now I know that's been a long preamble, but... 30 seconds...! LAUGHTER Jill: great story! But really, what I want to say is the process of actually forcing people into the situation of getting together, where you have the patient as a mentor, and it forces gently forces the genuine partnership working between patients and staff. That can happen with support staff who may have less barriers to break down than clinical staff and removes the traditional power balance and opposition and puts it to one side and allows people to respond to one another as people and humans first and foremost and how that relates to what you could do with support staff, and I have made some suggestions and another piece of work for George I would be happy to talk with anybody about individually, is that you can get support staff and patients to lead a project, to negotiate their own service improvement project, constituted as a learning programme, and take both learning out of that, and efficiency gains, so you meet both the moral and ethical and business case agendas. My structure has gone out of the window! LAUGHTER But please, I'm not in the documentation, so please take my number and e-mail which is it's You can be simple, and there's a simple way of doing this - thank you very much. APPLAUSE PHILIP HADRIDGE: Wendy a ten minute double act here between her and Paul.
  39. 39. Wendy: my day job is head of partnership working for Oxleas foundation trust and the head of partnership working covers lots and lots of different roles and one of the really nice ones is working with learning and Development Team to try and get people to participate in learning so Paul? PAUL: Thank you Wendy. I know most people have stood up to speak and I think nerves prevent me leave thing chair! LAUGHTER So I will have a go at speaking from here! LAUGHTER Just to give a an overview to keep within time, our roles, how we have been trying to widen participation for learners at Oxleas and career pathway opportunities we have been trying to build and some of the challenges ahead and think of Bob's report and some of the things we have been talking about today and think about how we have been involving service users to develop practice. One of the things Wendy and I felt concerned about in being asked to come here today is talking on a platform of improving patient experience neither of us are clinicians however in the roles we have got we think that these are some of the connections that we have got to improving patient experience. Really developing the workforce and we can't do that, what we try to do is provide opportunities so that the workforce can develop to deliver and improve patient care. We try particularly around Wendy's role to increase involvement of staff to develop the service and points were raised earlier about if we want to have whole organisation change and systems change we need involvement of everybody and the contributions from across the organisations to do that. We also want to engage more staff in learning to increase the skills levels in the workforce, and again, it tend to be the professional staff that get most of the opportunities that once they have taken off in their career and things about finding opportunities for that large body of workforce in the bands one to four, and finally thinking about how we help staff to progress in their careers to ensure the organisation has the skills it needs which comes back to delivering patient care. As a side point we were having a discussion earlier, and I think the need for direction of support does go into professional staff groups they do have most of the opportunities or lots of opportunities, but people do still need guidance and to develop, and not always immediately apparent
  40. 40. to them how to get that and do that we need to pay attention to that area of the work as well. How we have tried to include people in learning. From the brief opportunity I have had to look at Bob's report, development reviews and the KSF yes I agree and as we continue to embed that make that work and happen, and I think that would be really key to make sure everyone is engaged and has the opportunity to improve their contributions to patient care. One of the things we have tried to do at Oxleas and I think we are not unique is to help managers to recognise inclusion and recognise people have got skills for life issues or where they are not quite clear how to help in terms of traditional learning opportunities that are available. We have tried to help managers with that and help them recognise the skills for life opportunity what we do recognise is that some managers won't find this an easy question to make and still going to be a number of staff who don't fully participate in the case and development of views things we have tried to do until the day comes this process is fully effected one of my team I have created a role of life and learning coordinator so she can pull together all of the agenda around skills for life. We have done this by or she has done this and it's a shame Cathy is not here today she's gone to India lucky thing, I wish I was there! And she has done this around learning information and guidance and maintains contact with education providers, and with recently proud to say we have achieved a matrix of accreditation for her work, and we realise that Cathy can't do all the work herself and providing guidance and directing and we have developed a learning advisers network. It is a complex role and learning adviser, and between myself and Wendy we jointly chair a learning adviser Steering Group, support their work to bring together, and so they have got a point of contact so that the learning advisers network who are engaging people in learning, and discussions about this feel safe to talk about their needs and signpost on to Cathy and then to our services. And happy to talk about that more in questions at the end and apologies if I have gone over that quickly. We think it's key to have this approach to bring people into learning who aren't otherwise included or don't otherwise feel safe to talk about their needs with and what we have done around development pathway staff and said about the information advice and guidance and safest route of entry and done work around basic skills provision and lots of staff who have been doing NVQ 3 and care and considerable resource for ha in the health service and this has been positive for us and we have used this as a pool of candidates to move into nursing secondments which have been support by the WDC and many of
  41. 41. you will find that their funding has been dramatically reduced and our trust has continued to support the replacement costs to do secondments for this year, and how that will pan out in the future I don't know, and I suppose the big question for the NHS has more generally is how do we value this pathway, and how important is it to us to be able to develop staff to get them into professional roles or into more skills roles perhaps assistant practitioner roles. What we have tried to do a relatively small trust about 1700 staff – 1800 staff, and we have a narrow range - Some skills for life and you need 12 delegates together and running for 12 weeks and that sort of thing, that can be complex, and getting 12 people at the same time or more, we have tried to work with low volume providers where people can work in ones and twos with facilitators and trainers and make that very individual learning too, and people can work at their own time and own pace with that through NVQs and through the local colleges and e-learning. Also within this we have tried to support other trust projects like the connecting for health project that we are going through and realise there have been people particularly around IT with low level of I it skills, and engage in that training until they have had initial support, and also tried to work with trust change initiatives to provide specific requirements for staff so they are able to deliver the service once the changes take place. Challenges we have got ahead and not unique in this: service delivery pressures on release time mean people find it difficult to get away from work. And we need to find new ways for people to learn and means they have got focused and poignant activities when they take time out of work or find other ways to learn that's perhaps closer to their place of work. Also providers tend to focus on delivery and say you find 12 people we will put up the course, and getting people to talk about their needs that's the difficult bit we need focus on the inclusion and participation, and as well as provision, and again, something that has become more challenging over the last year and 18 months is that funding for provision generally is less abundant than it was a few years ago. Two or three years ago if I said it's all about inclusion and provision is great, and now I need to say we need focus on provision and the money is not there to the extent it was, and I agree in time the ideal position is that we need to have this