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Fryer Report

Volume 461: debated on Wednesday 20 June 2007

I am very pleased to have this short debate on Professor Fryer’s report “Learning for a Change in Healthcare”, because it is an extremely important report that points the way towards investing further in our NHS staff and continuing the improvements that the Government have made in the health service.

There is no doubt that the health service has improved greatly under this Government. More money is being spent than ever before, people are being treated more quickly, and we have invested huge amounts in building new hospitals and improving existing ones. In my area, for instance, we have, to name just a few things, a new accident and emergency department, a new endoscopy suite and a new cardiac catheter suite, which I visited recently. Investing in plant is very important, especially as some of our hospitals were built before the NHS was founded. Such investment is important for staff and for patients but, as everyone knows, the key to revitalising the NHS is really its staff. How the staff are trained, their opportunities for in-service training and how they can acquire new skills as services change are vital issues as we go forward. If we are serious about that, it must include all staff—those on the lowest pay grades as well as those on the highest.

If I have one criticism of Governments, and it has been true under many Ministers, it is this: when we talk about health service staff, we often talk about doctors and nurses, but we do not talk enough about all the other staff. As I know my hon. Friend the Minister accepts, the health service works on a web of interdependence. Surgeons cannot work in an operating theatre without porters, cleaners and the technicians who deliver the oxygen. A sister cannot run a ward properly without good support staff and good cleaners. I could go on and on making those connections.

Professor Fryer’s report flags up clearly the fact that staff on the lower pay grades have far fewer opportunities for learning than they should do and that attempts to address that have been bedevilled by short-termism and a lack of consistent funding. That is a cause for concern. In fact, much of the report tells us what we already knew or at least suspected: staff on the lower pay grades often need help to improve their literacy, numeracy and information and communications technology skills. The Government’s own labour force survey showed that 40 per cent. of the staff in the NHS are qualified at level 2 or below. In fact, 25 per cent. of them have qualifications below level 2 or no qualifications at all. The same pattern appears in social care: 40 per cent. of staff are qualified at level 2 or below. That has major implications for us as we try to reconfigure services and move services out into the community.

Many people would say, “Well, what does it matter?” It matters for a number of reasons. Many of the staff are the people who come into direct contact with patients every day—they are the face of the health service for many people. At a time of change, it is important that everyone understands the changes, can contribute to them and can benefit from them. Only in that way can we benefit patients, and we cannot afford not to make the best use of the experience and dedication of many of the staff in the NHS.

As Professor Fryer makes clear in his report, however, there is a big learning divide. When he compiled his report, he discovered that 57 per cent. of managers and professionals had had some work-related learning in the previous 13 weeks, but when he went to those in semi-routine jobs, he found that it was down to 32 per cent.—I think that I have got that figure right—and when he went to those in routine jobs, he found that it was only 12 per cent. Clearly, that situation is unsatisfactory. To remedy it will require a great deal of planning and consideration of how we can ensure consistent funding.

Education and learning in the NHS often suffers from not being a priority for managers. The Minister and I were in this Chamber earlier in the year talking about the NHS and higher education, but there is the same problem throughout in respect of learning. When budgets are under pressure, it is often the first thing to be squeezed, but we cannot build a 21st-century health service in that way.

I suspect that we are wasting a great deal of talent, because one of the things that the Select Committee on Education and Skills discovered when we examined further education and adult learning, and talked to such people as trade union representatives and learning providers, was the huge amount that many people can achieve when they are given the opportunity to do so. However, we must put in place the process that will allow that to happen.

I give the Government full credit for having tried to do that, because in the three years from 2002-03, they allocated £180 million to fund learning for staff on the lower pay grades. It was pump-priming money. The problem is that there is very little evidence that that pump-priming has led to real change in the system, because once strategic health authorities take over, learning goes down the priority list again.

Professor Fryer discovered that many health organisations did not even collect data on learning. He said:

“Without such data, it is difficult to see how healthcare organisations and their senior managers can evaluate their own performance and that of their staff”.

I agree. Decisions cannot be taken without information, yet when I asked the Department of Health what it was doing to improve data collection, I received what I am sorry to say to the Minister was a standard Department answer:

“This is a matter for local employers and strategic health authorities.”

I also asked what the Department was doing to improve access to learning among lower-paid staff and I received a similar answer:

“Access to training courses or learning opportunities in the workplace is a local decision.”—[Official Report, 20 March 2007; Vol. 458, c. 866W.]

I understand the reluctance to impose more bureaucracy on the NHS, but all the evidence is that the current system is simply not delivering, and unless we make this issue a national priority, it will not become a priority for those managing the system. Changes have been introduced nationally. For example, all staff on “Agenda for Change” conditions are now entitled to an annual review to assess their personal development and learning needs and to identify gaps in their knowledge, but there is not much point in identifying the gaps unless we have a system in place that can fill them.

That is why the report suggests that there should be learning entitlements for health care staff and that everyone should have a personal development review and be helped to access the learning identified in their personal development plan. Unless we put such a system in place, health care managers will not analyse their training needs, collect consistent data and work out how to meet those needs. In addition, as Professor Fryer points out, if we are to have changes in the system, the necessary learning has to be built into the plans for change.

None of this is easy or straightforward. I give the Government full credit for recognising that in the first place, for ensuring that we have a national director for widening participation in learning, for publishing the report and for being willing to face the changes that are needed. We now have to consider how we make the aspirations in the report a reality. I hope that the Minister will tell us what is going to be done to ensure that health care managers have the support that they need to put in place proper plans for learning. How will we integrate those plans for change with plans about the learning that staff need to promote that change?

It is important that all health care organisations introduce plans for their staff’s learning and development, particularly for staff who do not have level 2 qualifications. After all, the Government are urging companies in the private sector to sign up to delivering on the target that all their staff should have level 2 qualifications. We cannot expect them to do that unless we are willing to do the same for staff in the public service.

The report suggests that learning entitlements should be introduced and that staff should receive 10 hours a year and 25 hours after two years’ service. That would be a step in the right direction, but it will work only if we start negotiations now with the Department for Education and Skills and the learning and skills councils to ensure that we have in place the right programmes for the staff who need them. The report suggests ambitious targets for bringing the literacy and numeracy skills of all staff up to level 2 over five years by reducing the number of people without level 2 skills by 15 per cent. year on year. That is a difficult target to deliver, and we must start considering how we will deliver it.

Professor Fryer also made the important suggestion that there should be a common core of learning for all health care staff. That would have great advantages and ensure that we deliver common minimum standards to patients, because support staff can make a real difference to people’s experiences. When my mother was in hospital last year, dying, I was eternally grateful for the care that she got not only from doctors and nurses, but from support staff and cleaners. They looked after her and me as well when I was sitting on the ward. I remember that the lady in the bay opposite my mother, who was being looked after by a support care worker, said, “Isn’t it wonderful? It’s just like being in a hotel,” and I thought, “That is what we want to achieve.” The staff there were well-trained, dedicated people. We have lots of staff like that in the NHS who are willing to go the extra mile and to do things that are above and beyond their job descriptions. We must ensure that they have the training to deliver.

Professor Fryer suggests that there should be a common core, taking into account the aims and values of the NHS, such as the need to secure respect and dignity for patients and the need to improve the patient experience. That would go a long way towards dealing with many of the more common complaints about hospitals. I do not know what my hon. Friend’s experience is in his constituency, but mine is that complaints often are not about medical or nursing care, but about many other things. Those things might seem trivial, but they assume a great deal of importance when one is in hospital.

The targets and aims will be difficult to deliver, but they could be delivered if all relevant Departments, employers and trade unions worked together to deliver them. There is work to be done to develop the role of trade union learning reps in the health service. They have been very successful elsewhere, and I am sure that we could do more to develop their role in the NHS. We have to deliver for the reasons that are set out in the report. We cannot deliver transformational change in the health service without delivering the learning that goes with it. We cannot expect staff to cope with change and to take on new skills and new ways of working unless they have the requisite learning to do that.

I have touched on only some of the relevant issues in the comprehensive and challenging report, which has received widespread support from strategic health authorities, training managers and trade unions in various parts of the country. We must now start to deliver what the report asks of us. That will ensure the future progress of the NHS and will show that we are serious about developing our NHS staff. It is clear that we cannot go on with a system under which 40 per cent. of the staff are not getting the learning that they need to progress. That is a waste of talent and resources, and it damages the service. I hope that the Minister will tell us how the Government intend to take the report’s recommendations forward.

This is, indeed, the second time in recent months that my hon. Friend the Member for Warrington, North (Helen Jones) and I have exchanged views on training in the national health service. I mention that because I want to pay tribute to her dedication and clear commitment to these important NHS issues. She began by saying that in our discussions on the health service we focus a lot on investment in equipment, new facilities and buildings, but that we do not talk anywhere near enough about investing in the people who make up the NHS. She is 100 per cent. correct to say that they make the NHS what it is and make it special, because their work is what people take away from their experience of NHS treatment.

My hon. Friend spoke with authority, knowledge and passion, and I hope to show her that I share some of that passion. She has done the House a considerable service by bringing to its attention the report, “Learning for a Change in Healthcare: First report to the Department of Health and the NHS from Professor R H Fryer, CBE”, who is the Department’s national director for widening participation in learning. Given that the NHS work force is so large and that every constituency has a considerable number of people who work in the NHS, the report is incredibly important for every Member of the House. We all depend on those staff, their commitment to their work and their motivation.

I also pay tribute to Professor Bob Fryer. He has produced an excellent piece of work that deserves prominence, attention and a wider audience. He points out in his recommendations that there is an onus on NHS leaders to promote and sustain

“wider participation in learning for all healthcare staff, especially those in bands 1 – 4”.

I, too, take on that challenge, because it goes all the way up to Health Ministers. We have a responsibility to prioritise this issue and to be honest enough to say when we have not performed well enough.

My hon. Friend was right to say that the Government have not focused enough attention on the NHS staff in the lower grades. I accept that criticism and believe that we need to do much more. The figures that she quoted are not impressive: we need to make much better inroads into how we train and equip our staff. Indeed, I will go further and say that now is the time to prioritise this issue and have a new drive on “Agenda for Change”. Under that incredibly groundbreaking deal, we agreed with the main health trade unions that we would introduce a structure, in all parts of the country, under which staff would not only be adequately rewarded for their work, which is obviously vital, but be able to progress and to develop their careers through the knowledge and skills framework that underpins the agenda. It is time to reconsider that structure and ask whether we are getting the full benefit from it, and whether it is bringing everything that we intended from “Agenda for Change”. We can probably say, “No. We could do more.”

It is important to place on record our thanks to Bob Fryer, who has produced an excellent report, which deserves a wide audience in the Department and throughout the NHS. He has had a distinguished career in lifelong learning and improving access to basic skills, not just in health but in a broader context. I pay tribute to him for the work that he has put before us, and I hope that the Department can make it a reality in the months to come.

My hon. Friend cited figures from the report, and it is worth putting them on the record again. It stated that almost a third

“of NHS staff, or well over 400,000, reported being offered no opportunities for taught learning…in the last year and 70 per cent., or over 900,000, said they had received no supervised on-the-job training in the past twelve months”.

The report also said that

“a quarter of all NHS employees are qualified below NVQ level two, or have no formal qualifications at all…over half a million NHS staff are currently qualified below NVQ level three”.

Just to broaden the sphere slightly, I should say that 40 per cent. of social care staff are qualified only to NVQ level 2 or below. Professor Fryer rightly concludes:

“The NHS will not reach its aspiration of becoming a world class employer and employer of choice whilst the least qualified and least well paid members of the current health and social care workforce are the least likely to be offered training and staff development opportunities.”

I agree with all those things, and my hon. Friend is right to focus the House’s attention on them. She would expect me to draw attention to the work that the Government have done in this area—I believe that she mentioned it herself. Under the terms of the Government’s 10-year NHS plan, earmarked funds were identified to enable staff with few or no formal qualifications to gain NVQs and to make use of the specially created individual NHS learning accounts to undertake other programmes of education and development.

The scheme was successful. As my hon. Friend pointed out, it was originally planned to last for only three years, but the Government extended it twice by a further 12 months. Over the four years since 2002, an investment of about £240 million has been made to develop the skills and competences of more than a third of a million support staff through the initiatives. There are signs of progress, but we have so much more to do to realise the full potential of all our staff.

My hon. Friend talked about the recent experience of her mother being in hospital. She mentioned the support staff, who, in many ways, are the public face of the NHS, and who often do far more than their job says. As she may know, I undertook a process of work shadowing in the NHS. I shadowed a porter, a cleaner and other NHS staff, and I could not agree more with her view that patients derive huge reassurance from cleaning staff and porters. That is not sufficiently recognised by the NHS at times. They help patients through what is often an incredibly stressful experience and provide direct human contact, basic care and communication. That is hugely valued by patients.

My hon. Friend talked generally about how the NHS handles complaints. On that broader perspective, I hope that in creating the kind of learning culture in the NHS that we all want, we change perspectives sometimes. We should invest and equip staff at the front door to the NHS—that direct point—so that they can show the best face of the NHS to the public. I hope that, in many ways, the development and increasing use of patient choice in the NHS will stop organisations looking up to Departments and Whitehall and thinking about what they want; organisations should think more about what affects their reputation. They would then consider cleaning, portering and administrative support staff, who have that direct contact with the public. The clever and enlightened organisation makes a big investment in the people that affect its reputation in the local community. I hope that such a culture is developed in the months to come.

It was precisely because of those issues and the need to widen participation in learning across the whole of health care, that we asked Professor Fryer to become national director for widening participation in learning and created a strategy unit to support him. The culmination of this work to date is Professor Fryer’s report. My hon. Friend is right that it has been extremely well received in the service and the Department.

The Government are looking forward to agreeing priorities and a practical, fully costed and phased implementation plan with Professor Fryer and with representatives of the NHS, key partners and stakeholders. The Government see the way forward as a matter of successful partnership. We need to build on and strengthen the good relationships that exist between health care providers, educational institutions, trades unions, professional bodies and, especially, the public bodies charged with investing in national skills and educational priorities.

To that end, I am pleased to hear of the excellent progress being made in discussions about agreeing new joint funding arrangements for support staff between Skills for Health, the Learning and Skills Council, work force directors in the strategic health authorities and the widening participation in learning strategy unit. I look forward to hearing of the positive outcome of the discussions. I am pleased to tell my hon. Friend that the Government are seeking further to strengthen our commitment to continuing staff development and achievement through learning by consolidating the work of the widening participation strategy unit within Skills for Health. We want to take the agenda forward.

My hon. Friend asked a direct question about what the Government are doing to improve access to training for lower paid staff. Some of that will come through the action plan that we agree with Professor Fryer. I agree that it is not enough to say, “It is just a local matter.” If that were the gist of the answers given, that would not be good enough, because this is not just a local matter; it is much bigger than that, given the size of the NHS work force.

I hope that my hon. Friend will be pleased that, now that we have been able to restore financial stability across the NHS, and as part of the most recent financial settlement for multi-professional education and training—MPET—the Government are requiring strategic health authorities to publish coherent strategies on the learning plan for staff in pay bands 1 to 4 by September. As part of the process in which we are engaged with SHAs, whereby we are passing that responsibility to regional level, we will get a better response to the issues that she raises.

I am grateful to the Minister for that reassurance. Will he also comment on the point about ensuring that embedded in any plan for change in the service is a plan for dealing with the learning requirements of that change?

My hon. Friend is right to raise that question, because that is often an afterthought and is not sufficiently thought through. I shall ensure that however we develop the action plan, we shall take that point on board. I stress to her that these issues are very much in my mind as we move forward on the Government’s 10-year plan in the NHS. We need to ensure that we get the most from our human resource in the NHS—

What a way to say it—human resource. We must get the most from people who make up our wonderful NHS. Lord Hunt of Kings Heath and I are examining how we can refresh and relaunch the knowledge and skills framework later this year. It concern me that the most recent figures show that only 61 per cent. of NHS staff have had an appraisal in the past 12 months and of that group 81 per cent. reported having agreed a personal development plan. We need to get more focus back on to ensuring that appraisals are part of the annual entitlement of every member of staff and that training flows from them. That would give us the platform to take forward the incredibly positive agenda that Professor Fryer has set out in his report.

I probably have not covered all the points. I thank my hon. Friend for securing this important debate and I hope that over the course of this year she will see that the Department really does mean what I have been saying.

Question put and agreed to.

Adjourned accordingly at one minute to Five o’clock.