[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.

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

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

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

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...

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

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

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

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.

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

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.

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

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

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

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

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.

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

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

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

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

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

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.

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

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

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

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...

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

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?

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

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

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

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

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

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

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?

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!

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.

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 tris@dmop.co.uk.

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.

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

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

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

work mainstreamed into trust funding priorities but we are not there yet

and I think support does need to be identified for specific projects.

And, we do need to identify some priority areas and possibly ring-fenced

fund to go drive this agenda forward to get it mainstreamed and develop a

new culture of learning where learning is more focused around the work

and on the service we delivered and one of the inhibitors like core

training and mandatory training there's a requirement we deliver this

through courses and we say we would like learning to be closer to work

then we say on the other hand you have to go on a course to deliver XYZ.

Some of the things that have been positive we have had a number of

patient-focused developments which we think have been powerful in

terms of developing patient care in terms of some patients we have used

service user focus groups to help us develop the content and include

perspectives in programmes that we have run, and we are developing a

Steering Group to look more widely at programmes we run, and the

content that's contained in that and indeed look at the curriculums where

possible, and in some areas where mental health and learning disabilities

trust, we have been able to include service users in staff courses and I

think particularly recruitment and selection of training we provide to our

staff where we wanted to bring service users in and we think this is

powerful and helps staff understand the needs of service users, and helps

them understand the types of questions we need to be asking with this

potential new recruit and helps them understand the answers and when

asked could you put on special courses and said absolutely not, this is

about integration in the separation, and if service users are going to be

involved in this process they need the same support as our staff do and

that's a principle they want to expand into other areas of training. We

have also developed a number of team-based initiatives to focus on local

issues customer care and care planning etc so people can have an input

yes and provide central input and core struck cure but to work in teams

and have local facilitate, - facilitation so the discussion and work can

focus on local issues and initiatives and we believe we will drive forward

the patient experience in that way.

To conclude: we need a focus on provision as well as participation, and

changing the nature of learning and perhaps less reliant on courses and on

hard cash, and but there does need to be identification of priorities with

funding to help embed that process, and there needs to be clearer linkages

to patient issues and than there perhaps has been in some of the earlier

initiatives of the last few years. I think that's basically all I wanted to say

thank you very much hope it's on time and made sense

APPLAUSE

Thank you very much and where are your offices? South-east London -

what sort of trust? Mental health. OK great thank you we will take ten

minutes now as a group to think of some great questions, challenges for

the panel and suggest two things we do in this ten minutes for the first

couple of minutes look for somebody you know, or don't know who is not

on your table, and go and have a word with them and what's the question

or issue they have got and come back to your table for the remaining

eight minutes and come one a great question or challenge. Two minutes

find somebody you know or don't know somewhere else in the room then

come back to your table have a stretch...

Phil: no-one will be there because everybody will be walking around!

That was the best I could do for designing in a break if that's OK...

So reason for getting everyone to do ha is to give the two of you a break...

So if I'm making you type...

PHILIP HADRIDGE: two minutes more to come up with a great

question as a table...

Noise of chimes...

PHILIP HADRIDGE: welcome back everybody...

Jill: did you hear the chime...

PHILIP HADRIDGE: we are going to aim to get into our final panel and

bit ahead of 1.00pm, so you know where I'm going with this, we will take

time with panel two then look to make a fast transition ahead of 1.00pm

into panel three when we invite Judy Paul and... back up here and a

couple of you have got some great and somewhat challenges questions

for them so hold those for panel three, and we are staying with the theme

of patient experience and I have been tipped off that table seven has a

great question!

Paul: not difficult one I hope!

Table seven: Ed Young from the People's Republic of of the north-east

of India! Laughter... in the last two years, you may want to move from

this table we have had a bad time I have lost two sisters my dad has been

in hospital and I have, and you talked about qualifications and artificial

competence and Bob has got in his strategy about having everybody with

a Level Two, and I disagree, and it's based on how do you measure this

with the four pillars, when I was in hospital, I woke up at 5.00am and

washed a health care assistant, and... a patient with mental health

problems whose balance had gone to the toilet and I knew she cared I

don't know whether she has NVQ two or masters she cared. And I also

had lost a sister earlier this year died on the operating table and I had the

surgeon explain that he killed her but I knew he cared because of the way

he explained she would have died anyway but the way he explained it I

cannot believe there's any qualification that you can measure how they

care and I would like to know in terms of patient experiences how you are

going to get patients involved who can tell thaw staff care, and don't have

to have NVQs and I don't know whether it's well put but it's that sort of

thing patients know when people care and when they don't. It's not

whether, we there's things about qualifications for safety measure but at

the bottom-end it's do they care? We know when they care. So...

I will stop rambling now, thank you.

NEW SPEAKER: Wonderful.

Tris? Right... I... I think I mean, in a way I want to say something pithy

but I don't know if I have got, I don't think you and I are going to disagree

in the slightest, I think that people care about other people, and that in...

I'm a person that does subscribe to the logical rational kind of way of

going about things, and from my point of view, the Patient and Public

Involvement responsibility, you know legal obligation on statute book is

put there to force trusts to try and humanise the relationships between

patients and professionals. And a blunt tool. So, I to try and be short

about it I think that it's... if you can have if you are talking and talking

about trying to describe a learning programme involving patients which

promotes understanding of patients and people who work in the NHS,

patients and carers, people who work in and for the NHS, and people to

people, then I think that I have seen from the patient mentoring project I

have been involved in and involvement projects that can you get to that

stage of human to human understanding if and I'm not an educationalist

and not wear that hat if you come at it from a point of view of having a

negotiated curriculum, I feel bad when people say let's do a patient

experience module I will go off and write the content. You know. Balls...

To check Tris my assumption would be that and you could take

somebody who has lost their way in health care had the passion once and

burnt out or never had the passion and they could be reconnected to it

through the experience you are describing? Tris: I can't speak for

anybody but the best chance you have got of human connection is

engaging with one another as partners, with a common goal. Can you do

that in a learning programme, you could take anything, from for example,

out of the patient survey 2005, there's comments about appointments

being changed in outpatient departments, you could have support staff

you know, could be receptionists, could be managers, and could be

schedulers working with patients who might be shift workers and who

have difficult times of booking things off and working together on a

service improvement project to reduce changed appointment times that

would give them as a by-product understanding of working together

common goal the human interaction, have I made sense at all?

NEW SPEAKER: I haven't tried to make sense...

Paul or Wendy?

PAUL: I agree with you and it's something we can't write an off-the-

shelf course and say there you go do that I believe most people who work

in health care, health and social care are caring and I think sometimes

people get too bound up in the mechanics of delivering the service to

deliver the service if you see whey mean.

I think this is where service user involvement and consultation is

particularly important to help people our staff, understand what people

need and at difficult times and help them reflect on their practice and

thinking about projects we have worked with in the last year, and one in

particular where we had had a video produced of some of our service

users talking about their experience of using services of our trust. And it's

quite a powerful tool when you work with groups to say look you might

say your practice is fantastic in reality this is what people are saying, and

you know can we use this as an opportunity to reflect on what we do? So

I think really programmes that are focused on getting people to engage

with service users and look at their own practice and think about what

they deliver is what's needed.

PHILIP HADRIDGE: OK... looking around the room if there's anyone

maybe with a particular take on this from a support staff level four... one

to 4%pective that would answer Ed's question about the compassion at

the heart of health care how to get it and examples please wait for the

microphone and somebody on table two here...

Sarah: hi, Sarah from Hammersmith hospitals, I think it's about looking

starting with your recruitment process, and recruiting people for their

attitude, and then developing their skills once you have got them in the

workplace,, and re-enforce that throughout their careers, so, aligning your

performance management with the values of the organisation. Also

having the values as a common theme throughout your training

programmes and learning and development.

Performance management? Sacking people?

No, not necessarily about... re-enforcing when you see people delivering

a good service, and living the values, but also not being afraid to

challenge people when they are not.

PHILIP HADRIDGE: thank you other examples? ...

Another... table two, anyone else with examples, table two then on the

back table again.

Carmel: from Newham University Hospital trust, I guess the only thing I

wanted to say sometimes we are, we get too hung up on NVQ

qualifications, and I think we need to look at what does a qualification

mean? Should we not be looking more about opportunities for learning

and development and so that we capture people's ability to work with

people, communication, customer care etc rather than an NVQ Level Two

which may not mean that person ends up caring?

PHILIP HADRIDGE: or a registered nurse or doctor may not end up

caring thank you.

Ian from the National Institute for Mental health in England: and the NI

AM national workforce programme, I reemphasise your point really, our

approach has been to help develop with service users and carers and it

was largely them that developed the materials around the potential care

capabilities which hold value statements behind practice, what we are

trying to encourage people to do, it goes back it is about recruitment and

retention and - recruitment, and around curriculum design. We can train

people as much as we want and something about that humanness in health

care that we need to get back to. Some of that is driven entirely by values.

And the essential capabilities are things that service users and carers told

us are missing from the workforce. Just ten simple things that would

make a dramatic since to the care that they experience. So... you know

there's something and there has to be something around getting back to

the core of what health care is about, and that's about you know caring is

a human activity.

PHILIP HADRIDGE: that list of ten things missing have you got it with

you or a website or address on the flip-chart.

Yes I can put a website and can you down-load the learning materials and

there's a host this.

I will ask to you write that on the flip-chart by where you are sitting

fantastic look for another great question...

Tris: I have collected my thoughts Ed! One sentence on it which is who

know how current this is and not an educationalist but I thought you

could help people to learn knowledge, skills and attitudes, caring is about

attitude, it seems to me, and there are certain things you can focus on

which are listening skills and empathy which I know from what happened

in our programme that having the opportunity to learn with a patient

reinvigorated listening skills and you can recruit for attitude but it goes

can go in bureaucracy sometimes.

PHILIP HADRIDGE: question here? Yes, this is to I think colleagues

from Oxleas, you talked I think very powerfully about the way in which

you had used the KSF and implemented that to bring about change

through learning. I happen to be one of the people who negotiated agenda

for change, and it's been be talked about I think here in different terms

and often talked about as agenda for change and the KSF and actually the

same thing, you know the staff of the NHS are all with the exception

obviously of the medics signed up to that overwhelmingly and the bits

that have been implemented by and large are the bits about pay and

conditions you know the job evaluation bits etc, all very difficult, and

probably still be doing that in Northern Ireland I suspect in ten years'

time. But, that's mostly happened certainly in England now, the bit that

hasn't happened largely through I think lack - largely through lack of

investment and lack of will in many respects as well is the KSF in the

way in that can change the interrelationship between professions and

support staff can change services etc. I would like your views about the

lessons that others could learn were your experience, and I think your

experience has been very good about how that becomes a higher priority?

I think one of the things we have seen too much of in the NHS in recent

years is this constant change which means that actually the good things

that everybody buys into, and are prepared to implement actually get

forgotten about. I can see that happening with the KSF and I would

welcome your views.

NEW SPEAKER: Looking to see if any other table has a question

similar to that, Paul?

Paul: OK I think the KSF is a powerful tool for us and perhaps over

egged the pudding in terms of how I put it forward there I think people

are implementing it and I think we still have a way to go, what we

expected in the my learning and Development Team and other colleagues

and trusts was an explosion in demand and really flurry of activity around

someone having to commission lots of new learning activities that didn't

really happen. I think we realised a lot of things we were doing clustered

well around the KSF already another part is getting people to learn

differently and doing things in different ways because of the KSF ask

something that's powerful is these examples of application providing

evidence that you can do what you say you can do. This comes back to

the point in the last question about the importance of having an NVQ, and

I don't think it's important particularly that you have an NVQ or whatever

qualification you like the important thing is what you do with it once you

have got it. And I found from the training that I have specialised in my

time in the NHS people will talk a lot about setting objectives and often

clinicians will say I have an objective to go on a course whatever that

might be and spend time in an acute trust and say what the objective to

for this member of staff is and what do you want them to do it for? To

say they have done the course and certificate or something about patient

care? And it's about making those connections and the KSF is starting to

do that the more we can get people into the culture of learning that says

my learning isn't just about courses and not just about the money or

funding for it and it's about the tasks I'm given and opportunities to do

that and how I internalise the learning from that experience, and how I

shared that with others, and develop the practice of me and my team.

Does that seem OK? Yes.

Wendy: no I think I'm also staff side agenda for change, and it's been

difficult and I think KSF has been seen as the nice part of it. And that's

something we have given the message out loud and clear and embrace

this this is your time now to have one of the things is going to do is

enable people to say actually you have achieved much easier, much more

concisely and more regularly, and I welcome that.

PHILIP HADRIDGE: thank you... one more question? Yes? I think we

will... last question at the moment table one

(A FEMALE VOICE): I think we shouldn't be satisfied with saying

NVQs don't reflect what we want the reason we have sector skills

councils is to make sure an NVQ has the skills knowledge and

understanding we need in the sector as sectors change. If we want NVQs

to actually do that caring bit that the girl at the guy at the back was

talking about eloquently we have to speak to sector skills councils and

make sure those NVQs do the jobs they are supposed to. Whatever their

current limitations NVQ 2 is the jumping-off point for actually going

upwards, across, and being a really active person in the labour market. So

I think we shouldn't throw them out completely. We have to work with

them and make sure they do what we want them to do.

PHILIP HADRIDGE: a question for the panel? No an observation... but

I have got a question!

LAUGHTER

(A FEMALE VOICE): It's this: I think there's nothing more motivating

to those who are working on their literacy, numeracy, IT, or on low level

vocational qualifications than seeing their union learning rep, their

manager, their colleague, their friend, their peer, doing a qualification

themselves. And my challenge and question to everybody in the room

including to myself, is what are we doing in terms of modelling lifelong

learning? So for example, I have managed very big budgets in my time,

and I didn't get O level maths. I know that what I ought to do is take the

Level Two national numeracy test. I really have got to do that. My boss

who is very senior in DfES has just taken the IT qualification at Level

Two. She is talking about it openly, even though it's an NVQ Level Two

and she has a PhD etc, my question and challenge to us is what are we

going to show people who are still working on their literacy at Level One

and two that we are also working on our profile and filling in our skills

gaps.

NEW SPEAKER: Well spoken...

APPLAUSE

PHILIP HADRIDGE: a question for the panel, you may disagree with

my assumption or have an answer to the question and in the last couple of

years my nan was in a nursing home for a year then died and my father-

in-law has been in one of the major teaching hospitals of this country for

most of this year. And the thing I see in both situations is support staff

upholding the spirit of the servic and young support staff trying hard and

looking over their shoulder to see who is going to be watching them and

looking out for the nurses and what are they going to say and I see older

support staff who maybe have lost their way a little. You can disagree

with me. My question here is what can we do and building a bit on Ed's,

what can we do to help support staff really enshrine the spirits and values

of the service and have confidence in the system that's very hierarchical,

and very much about a power food chain. And, if you agree with my

hypothesis what's your answer to how we empower them to challenge, to

serve, support, and put patients first.

Wendy: one of the things we do very well in Oxleas is try to engage

people from all levels of the organisation, at the point that we are going to

make those changes. So therefore, if we are going to do an organisational

change, we put everybody a selection from of everybody that will be

involved in that, that includes the service users. It's about making them -

about including them in these changes, and about sage yes you have got -

saying yes you are sitting around this table and you have an equal voice.

PHILIP HADRIDGE: Paul?

PAUL: One of the things that's important about what you have said

Phil is that if people are fairly new or junior in organisation, and may not

have a particularly strong professional background is they have effective

supervision and are supported in what they are doing, I think that's the

provision that we talk about, and value and importance, something that I

have started to talk more and more about and thinking about a colleague

there talking about the KSF and a core dimension for everybody is people

and personal development. I know a number of people because they feel

they are very, very important and have tried to make their case and

outlined there's the highest possible I have to be level four, well if you are

a Level Two three or four you have got clear responsibilities for

developing not only yourself and your colleagues and the service you are

in. We need to be saying to people if you put this down and say that's

what you do tell me what you are doing to evidence that. That sounds

kind of like a performance management base route but you know I think

we need to be expecting people to do what they are saying they are going

to do and in their terms and conditions.

Tris? OK I think first of all I think if you know the old saying about if

somebody attacks you, the first thing you need to do is run... I think that

if you are if it's a difficult place in which to challenge authority, then I

honestly think don't bother, keep your head down and go about your job

because it's well personal experience and experience of other people I

have worked with if you are in a situation where your immediate manager

is you can't get on with, and like you know, if you can determine that by

Ed's reference to can you see it in their eyes that they care, if they don't

care about you and don't want you to speak up, then don't. However...

OK... that would be, that's I think unfortunately it's only if you are

working with good people...

PHILIP HADRIDGE: what's the however?

Tris: if you are working with half decent people, who are good people,

then the key is to and I'm presupposing you can't rely on others, the key is

to get in the same room as those who are to be challenged by you, so to

get and that relies on the people who are to be challenged making

themselves available for doing something together, and they need to be

doing something together as equals and not coming to it as different job...

PHILIP HADRIDGE: possibly a huge conversation we will have to

leave there now as we get ready to swap over panels and go into our final

panel, three, like to thank this panel and think of what is your big

question for the group who are goby to come onto the stage thank you.

APPLAUSE

Take one minute on your tables...

PROF BOB FRYER: to pick up one thing... I want to pick up what Ed

Young said at the back because there's a kind of burning question Ed, and

I want to ask Ed Ellis to say a word or two about competence and when I

talked to you about the back you said is there a competence? I don't think

there's a competence in caring, and I wanted Ed has written the most

eloquent report on learning, and one of our task group reports and I

wanted Ed just to talk about competence, if you could say a word or two

as we move into the last session there's a microphone there...

Thank you ever so much Paul!

LAUGHTER

Ed: er... I'm not at all sure where in fact to start with this my response to

Ed was to say or think at least that having a caring attitude is incredibly

important, and it is necessary but not sufficient element in the delivery of

care, and the problem with just being caring, is that if you are not careful

that caring can be misdirected and misused, and I mean like you I have

also been involved in quite a number of hospital visits over recent

months. And one of my experiences corresponds to yours that is that I am

absolutely convinced that the various staff I have seen in the hospitals

that I have attended, have been caring but unfortunately the way in which

they display and express that caring attitude has been profoundly

injurious to myself, and also to the people who I have been with.

So caring in itself in other words, it's not sufficient in fact to be caring

you have to be able to mobilise that caring attitude in ways that are not

destructive in ways that are not destructive and ways which do not injure

the patient. I'm sorry to say that certainly in terms of my experience there

have been quite a number of occasions in which that has been case where

I have been injured and where people I have been with have been injured.

That if you like is I think a plea for sticking to NVQs. I actually think that

NVQs are extraordinary important in so far as they build on that care

which as you say is so fundamentally important, I'm not even going to

attempt actually to deal with Bob's question it's much too difficult... thank

you for that Ed really interesting balance we have got 12 minutes before

we end and we will take questions.

PHILIP HADRIDGE: can I have my slide up? And invite you to think

of what would be a great question and we will only manage to hear from

a couple, look at these characters, what would they say that's interesting,

and I will offer Merfyn a chance if he has a question he may want to

share we rehearsed it earlier that could be a very provocative one?

And just checking whether... and if you would like that we will bring the

microphone to you...

Table two thank you.

[Merfyn talking about the DDA here]

Merfyn: Also the question I would like to ask is... I think I have lost it...

When we spoke earlier, the question that I remember was looking at both

sides, what is it that this report can do to improve the care of disabled

people as service users? But also what about from a diversity point of

view staff at the bottom of the pile who have disability themselves, and so

looking at both from the staff point of view of people with disability, but

also from a service user and seeing you nodding, so that's the question to

Bob?

PROF BOB FRYER: Very struck by the point that diversity is a kind

of big generic concept that we often use, and which actually fails to grasp

the subtleties and the differences, including the individual differences that

lie within that. And I think there's always a danger it's a danger in

learning as much as in so-called human resource management that these

big words actually serve more as barriers, than as gateways. I just want to

reflect on that, and think about the implications of that, I think that's a

very tough, and brilliantly expressed message. I think the second point I

would make is to reflect a bit on customer care, I must admit when a

minister said I still worked for NHS U, a minister said that he wanted to

see every member of staff in the NHS going through a customer care

programme, it sent a bit of a shudder down my spine. And let me tell you

why it sent the shudder down my spine and why I rethought my position.

Because... I don't think patients and service users and carers, are

customers. I expressed earlier I think the relationship between people

working in health care, and people making use of those services is not

one of a customer relationship. And that got in the way of me thinking

about the second word - as I reflected on this I thought why am I being

so resistant, I really know what he means? And I know what he really

means, what he means is that in those what is it, a million transactions

every 36 hours? We say in the NHS, the thing that patients of every

shape, kind, background, level of education, age, sickness or ability say,

is they want to be treated with dignity. They want to be treated with

humanity, they wanted to be recognised as an individual. Now, we have

got another word which is in danger becoming one of your big categories

and therefore empty and cynical as you say and beginning to talk in

public services about the notion of personalisation, and actually, the

notion of personalisation offers us an amazing opportunity because of the

new form of communication, for example, data capture through electronic

systems, we can actually profile individuals much better than ever we

could with paper systems.

PHILIP HADRIDGE: thank you Bob and bring in on the issue Paul,

Judy anything?

PAUL: Well... a short answer is I don't think Bob's report has all the

answers but following the debate generated I hope we will come up with

some of the answers but I think this very much links back to what's been

said in the past 20 minutes is really what people have been talking about

is a concept of professionalism really as it applies to people who aren't

commonly regarded as professionals. It's about professional ethos, and

really how we set standards which reflect for the wider workforce the

kind of going a step further that we expect from professionals. And

communications is one aspect of that where communications isn't talking

to people, it is reflecting backwards in your transactions. That's the

importance and sort of the standard in which we need to apply to the

whole workforce, and not just the doctors or nurses. Judy? Going back

into my other slot where you put me before in terms of the business thing

it makes common sense to run an organisation with staff that reflect the

population you are serving, it makes you much more effective, why don't

we do that all the time? Understand it? I haven't experienced having a

disability, and being categorised like that, I certainly was the only female

manager on an all male management team for a long time in my early

career, I know that's not the way it is now but it used to be then. That got

me very involved in something called "take our daughters to work, which

was the business of getting young people geared up and ready to take

opportunities that could be available later on. One of the thing I don't

think we do enough of is help a wide range of people while they are still

at school do the things they need to do at school to then on able us to help

them you know access the traditional ways of learning. So many ways a

lot of the stuff we are doing with our workforce now is a catch-up. I think

we need to be doing and I'm hoping the report will help again on this is a

lot of work about joint work between I said before between Higher

Education, further education, and schools, to get people on the track for

the skills they need and certainly something we are doing at London

South Bank working with all sorts of people around and real success and

again there's lots of examples of success around the country, but we do

need people to be working on that.

PHILIP HADRIDGE: on the same topic disability, they are looking for

one quick question for Paul, and put the guy from the Department of

Health on the spot then ask for observation, what struck you most from

each of our three panellist then end last

(A FEMALE VOICE): I wanted to say something that reflects what

Judy says and what the man at the back said earlier, in that what we are

doing we are working on a project in the Black Country which is called

health and social care career ship for young people at school, one of the

key issues that makes it different from the current health and social care

learning they do is we have developed a personal qualities framework

that they have to achieve in order to progress through the programme,

whether they are academically able or whether they are less academically

able, they still all have to develop and demonstrate these personal

qualities that they expect our health and social care people to display

when dealing with patients and customers.

PHILIP HADRIDGE: thank you very much and quick things, has

anyone got a question maybe in the style of one of the characters on the

screen for Paul? Yes...

Cathy: NHS West Midlands, Paul, this is a question for DH rather than

you personally, notwithstanding the comments that have been made about

dependency culture and the employer responsibilities to develop their

staff, I do wonder - culture - I wonder whether the current impact review

is looking at the implications of the KSF what's happening across

organisations I know of is people are reaching the gateway and having to

go through. We either pay and train people and promote them or we

promote them because we haven't trained them and either way there's cost

pressure and why don't we get the learning and I'm wondering to what

extent in DH the implications of the KSF have been brought into the way

education and learning funding is being channelled in the future.

PHILIP HADRIDGE: a quick answer?

PAUL: No long answers... yes we are thinking in terms of the KSF and

the problems with MP ET? Funding over the years is it's been applied to

the NHS via some formulas, and those formulas have been ignored as

much as they have been followed and the simple question is do we

replace them with a lot of formulas which people will ignore or come up

with a new way of doing it which isn't about giving people instructions

down to the last pound but it is about helping - holding them to account

for what they do and in some way establishing a clearer more open and

honest transaction with SHAs and individual trusts about how to support

learning.

I think that's the best way forward because we do have a policy called

shifting the balance of power, if you shift the responsibility without

shifting some of the responsibility for the money then you haven't really

shifted the power. You have just shifted the blame.

As we go into the ending two things I will ask you to do for those who

would like to give feedback to those of us, we would love your comments

there's a set of questions for the DIY evaluation form on the screen just

scribble down your answers against these questions and hand it in on your

way to lunch. And for multitasking I will ask the panellists to share with

them the one thing that struck them today A short sound bite Judy in? I

think too much of the way we train staff is dominated by funding and the

only way we can fund it is for NVQs and therefore whatever their value

some of the stuff we want out of them doesn't work I like your point get

in there and shape what's happening with the training that's available.

Paul? It's something that's been mentioned today but we have not dwelt

on it I think is the role a really effective appraisal system for all staff in

driving the learning agenda, if employers sign up to development and the

employee signs up to development there's a bargain to do something

about it and it's important we get that right and haven't so far.

PROF BOB FRYER: I think what's come through in lots of the

discussion and comments is that widening participation in learning is a

Chief Executive's agenda, and though there are wonderful people

working at all of the levels our joint task is to make this really the point

Peter that you first made and lots echoed it and got to get all of these

issues as core elements of a Chief Executive's agenda. I would like it to

be one of the criteria that are used in appointing future leaders of the

NHS. What are you going to do about widening participation in learning

and what do you think the biggest challenges are.

PHILIP HADRIDGE: we are done, please complete the form enjoy your

lunch and all deserve including the speakers a round of applause well

done.

APPLAUSE