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National Audit Office Press Notice

Educating and Training the Future Health Professional Workforce for England

HC 277 2000-2001
1 March 2001
ISBN: 0102840016
Price: £10.50

• Full Report (759 Kb) 
• Executive Summary   (149 Kb)

The Audit Commission and the National Audit Office today published the results of their comprehensive joint review of education and training for existing and trainee nurses, midwives and other healthcare staff. Getting the development of these staff right is fundamental to meeting patients’ needs, improving services, reducing risks and modernising the NHS.

The reports make significant practical recommendations for improvement which the NHS is encouraged to address as a priority.

Sir John Bourn, the head of the National Audit Office, said today:

"Educating and training increased numbers of nursing, midwifery and other health professional students is a key way of overcoming the shortage of such staff in the NHS. The NHS and higher education institutions must continue working together to improve value for money, to ensure more students complete courses, to reduce the constraints on providing practical experience, and to invest in new capacity where needed. Healthcare professionals provide much of the service that patients need and expect, and a cost effective world class education and training system must be the foundation for delivering this."

Sir Andrew Foster, the Controller of the Audit Commission, said today:

"Healthcare staff are the lifeblood of the NHS. Developing their skills and abilities is vital both to the quality of patient care and the modernisation of the NHS. We need to actively manage and plan for the training of our nurses, therapists and other staff. Everyone, from front-line staff to trust board members, must show commitment to a culture which values and expects training and learning."

The Audit Commission’s Hidden Talents report focuses on the existing healthcare workforce and looks at how trusts can get the best value from their training and development activities. The National Audit Office’s report to Parliament, Educating and Training the Future Health Professional Workforce for England, reviews the effectiveness of arrangements between the NHS and higher education institutions for educating and training pre-registration health professional students.

The detailed findings of the two reports are set out in the attached annexes.

Notes for Editors

1. The Committee of Public Accounts is expected to take evidence on the National Audit Office report on 4 April.
2. The Audit Commission report Hidden Talents: education, training and development for health-care staff in NHS trusts (ISBN 1 86240 270 1) is available at www.audit-commission.gov.uk/hidden-talents/ , or from Audit Commission publications (t: 0800 502030).
3. The NAO report Educating and Training the Future Health Professional Workforce for England is available for download at www.nao.org.uk or from The Stationery Office (t: 0845 7023474).
4. A separate report by the Auditor General for Wales, entitled Educating and Training the Future Health Professional Workforce for Wales, has also been published today and is available on www.agw.wales.gov.uk
5. The Audit Commission for local authorities and the NHS in England and Wales is an independent body under the provisions of the Audit Commission Act 1998. Its duties are to appoint auditors to all local and health authorities and to help them bring about improvements in economy, efficiency and effectiveness directly through the audit process and through value for money studies.
6. The Comptroller and Auditor General, Sir John Bourn, is head of the National Audit Office employing some 750 staff. He and the National Audit Office are totally independent of Government. He certifies the accounts of all Government Departments and a wide range of other public sector bodies; and he has statutory authority to report to Parliament on the economy, efficiency and effectiveness with which Departments and other bodies have used their resources.

Press Notice NAO/AC/01/01
All enquiries to NAO Press Office:
Tel: + 44 (0) 20 7798 7400

Audit Commission Annexe

Hidden Talents: education, training and development for healthcare staff in NHS trusts

Patients expect healthcare staff to have access to the education, training and development that they need to provide a modern and responsive service. However, the Audit Commission’s ‘Hidden Talents’ reveals that this is not always the case.

Some services in England and Wales do not actively plan for the training needs of nurses, therapists and other healthcare staff. And the availability of development opportunities varies widely, depending on where staff work, and what they do.

Findings include:

• One third of staff had not agreed training needs with their managers in the last 12 months;
• Some NHS trusts spend five times as much as others on training per healthcare staff member;
• In a minority of trusts, over a quarter of the post-qualification nurse training places are not being used;
• Some groups, such as part-time staff and nursing auxiliaries and assistants, can miss out on training compared to colleagues.

The Audit Commission found many diverse examples of innovative practice around the country, and presents case studies from which others can learn. The Commission recommends that trusts should:

• better identify the implications of service developments for staff training;
• review how much they spend and in what ways;
• develop more flexible training to improve access for all staff; and
• work with Higher Education to better match training to service needs.

National Audit Office Annexe

Educating and Training the Future Health Professional Workforce for England (HC 277)

Today’s National Audit Office report highlights the importance of educating and training increased numbers of nursing, midwifery and other health professional students as a key way of overcoming the current serious shortage of such staff in the NHS.

The NHS Plan (July 2000) proposed a number of measures to overcome the shortage of healthcare staff of which a fundamental one was a large increase in the number of training places (an increase of 5500 nurses and 4450 therapists and other health professionals entering training each year by 2004).

Sir John Bourn, head of the NAO, has concluded, however, that delivery of this planned expansion in the numbers of new staff undergoing training depends on increased investment in teaching staff and accommodation at higher education institutions; achieving improved value for money in the provision of training courses; a reduction in student drop out rates; and a larger number of good quality practice placements.

The National Audit Office report found that the numbers of new students entering nursing and midwifery courses each year had grown by 50 per cent since 1994-95, with concerted recruitment campaigns resulting in more applications for NHS funded courses. Although the number of healthcare professionals qualifying had increased markedly, the National Audit Office report also found:

• acknowledged problems in NHS workforce planning had contributed to current staff shortages;
• higher education institutions had accommodated year on year increases in student numbers since 1994-95 while maintaining quality but there were indications that the institutions were now beginning to reach full capacity;
• about 1 in 6 students did not complete their courses, in line with the average for all university courses;
• the need for sufficient practice placements is a constraint on expanding student numbers and the NHS and universities need to work together to develop and implement joint strategies, involving more innovative approaches for identifying and using placements, if the quality of the student’s experience is to be maintained and/or enhanced;
• further improvement in value for money and the contracting system was possible: while the price per student has gone down in real terms, the costs and prices for similar qualifications at different universities varied greatly; many course contracts failed to specify outcomes; contract monitoring could be improved and the recovery of overhead costs was less than for non-NHS contracts;

Sir John found many examples of good partnership working between the NHS and higher education institutions. However, he pointed to the need for joint responsibility for providing practice placements, working to reduce drop out rates and facilitating more investment.

The NAO report acknowledges that the Department of Health has taken a number of initiatives to address these problems. They include in particular the workforce planning consultation exercise and implementation of subsequent recommendations, and also their work with the UK Central Council for Nursing, Midwifery and Health Visiting and the Quality Assurance Agency for Higher Education to improve quality, and with the English National Board for Nursing, Midwifery and Health Visitors on practice placements.

However, the report makes the following key recommendations:

• to improve the skills of personnel and improve, at local and national level, the common data and planning systems used for workforce planning to achieve better estimates of future education and training needs;
• to share good practice to reduce student attrition from courses, monitored using a standard definition;
• to move to a more collaborative approach to contracting with: greater sharing of information on costs; consideration of generic pricing and standard price benchmarks; and greater focus on outcomes within the contracting process;
• together with the Higher Education Funding Council and the Vice-Chancellors and Principals of universities in England, to examine the current framework for the treatment of capital and research in contracts and, if necessary, develop and issue new guidance;
• to involve higher education institutions at all levels of planning of education and training, with shared responsibility for recruitment, selection and retention of students; and for identifying and managing practice placements;
• to ensure that the new Workforce Development Confederations implement proposals for effective partnership working with non-NHS employers, higher education institutions and, where appropriate the relevant professional bodies, and develop effective arrangements for identifying and sharing good practice.

Notes for Editors

1. In 1999-2000, the NHS spent £705 million on pre-registration training places and student bursaries for some 50,000 student nurses and midwives and 14,000 health professional students. This training is provided under some 100 or so NHS pre-registration contracts, by 73 higher education institutions and leads to degree, and, in the case of nurses, degree or diploma, level professional qualifications.
2. Thirty-nine NHS Education and Training Consortia determine the number of places to be commissioned, based on workforce development plans from NHS Trusts, health authorities, social services and other employers of healthcare staff. From April 2001 these will be replaced by 24 Workforce Development Confederations which will take on a wider role for developing the existing and future NHS workforce.