The NHS Long Term Plan sets out aspirations to upskill staff and create new roles to deliver a health service with a different focus. The demands that such aspirations place on education providers are significant. Greater involvement of the third sector – voluntary and community organisations – and lived experience workers offers an opportunity to provide novel and relevant placements whilst also shifting the balance towards a more inclusive understanding of health and wellbeing.
More staff, new roles and additional training – catalysts for education innovation
A wide range of new initiatives have been put forward to address health and care workforce challenges with plans for an additional 1,500 doctors, 5,000 nurses and 2,000 physician associates by the early 2020s. Additionally, the existing workforce, including nurses, pharmacists, associated health professionals and psychologists, will be have the opportunity to undertake further education, requiring additional supported placements, to learn the skills to develop as Advanced Practitioners. There are ambitions to create new routes into health and social care, such as associate programmes, apprenticeships, outreach programmes and peer working. Collectively, these initiatives represent a massive investment but will make enormous demands on those with the responsibility for providing training, supervision, support and placements in an already pressured system, where the provision of more traditional placements is already proving challenging.
This new workforce will need to be able to deliver on the ambitious transformation agenda of the NHS Long Term Plan in line with the developing Integrated Care Systems. Their training will need to equip them to work in a different way: to work across traditional boundaries and address the triple integration agenda; to collaborate with professional and non-professional experts in statutory and non-statutory sectors; to understand the challenges of change and improvement and to appreciate the shift in power inherent in developing a more person-centred approach to care and wellbeing.
The Interim NHS People Plan acknowledges ‘more of the same will not be enough’ but it is also time to think differently about the type of training and experience needed to prepare our workforce for this. Third sector educational placements and co-produced learning experiences could be part of the answer with the potential to increase the quantity and repertoire of teaching and training placements, catering to the evolving workforce.
Case study: student placements in the third sector
The development opportunities of the third sector are already being recognised by tertiary institutions. Sheffield Medical School has a mandatory 4-week social accountability placement for third year student doctors. The intention is to provide students with practical learning experiences away from clinical settings. They can see how a variety of people collaborate to address the health and wellbeing of local communities. Furthermore, they have an opportunity to experience the intersectionality of illness and the wider determinants of health, as well as the innovative frugality and fragility inherent in working in the third sector. The programme currently depends on this being a mutually beneficial experience. Student feedback is that such experiences are deeply meaningful and unique, demonstrating such methods are worthwhile inclusions in education programmes.
Co-production as a means for improving quality
Students and trainees working alongside patients, service users and carers, as in the above example, has a positive impact on culture. The patient experience is more accessible and better understood, and the first-hand recognition of the value of peer support is invaluable. Co-production also stimulates quality improvement, through techniques including experience-based co-design, and expert-by-experience led management of health conditions.
While clinical interactions are always co-produced to some extent, this can be amplified. There is evidence that co-created interventions and health systems can deliver personalised care, empower patients, improve outcomes and increase efficiency in health care settings. Now is the time to consider whether we can achieve the same benefits by co-producing learning experiences with patients, users and carers by working more closely with the third sector.
Case study: co-produced learning experiences
Lived experience educators are increasingly utilised in education and training. Mental health and psychiatry students in South Yorkshire routinely benefit from such educators. They help students develop skills of empathy and engagement, encourage them to challenge stigma, and promote compassionate care and therapeutic optimism. However, this practice is patchy in mental health education and even more so in physical health education. Another example of co-produced learning experiences is through recovery colleges where education is co-delivered by professionals and experts-by-experience, in an egalitarian way to students, staff and patients together. These developments are happening in many other areas, but there is little research evidence about how to do this, what good practice looks like and how embedded this should be in routine educational programmes.
Cultural shifts, spread and scale
A major cultural shift in the relationship between the third sector and learning institutions is required to enable these new types of learning to grow. There are examples of these relationships working positively across the country. However, to ensure all learners are exposed to these opportunities, power and resources will have to be exchanged, shifting the relationship between statutory and voluntary services, and unlocking the potential in our neighbourhoods and communities. The recognition of the value co-produced and personalised care could help not only in the delivery of services but also provide novel and innovative learning experiences which will influence how students go on to practice and develop.
To meet the workforce challenges set out in the NHS Long Term Plan and implement the large scale shifts needed, we need to change our pedagogic practices, our regulatory frameworks and our funding streams. We need to examine the risk appetite of our institutions and challenge them to be brave and think differently. Universities and colleges need to partner with third sector organisations to develop the relationships and foster the trust necessary to work together. We need to recognise that educational resource and support should follow the learner as they move into communities and neighbourhoods. The workforce challenge provides an opportunity to activate a parallel shift in educational practice necessary to ensure that we build a workforce who will not just survive, but thrive, enabling communities to do the same.
Dr Helen Crimlisk (@helencrimlisk) is Deputy Medical Director, Sheffield Health and Social Care NHS Foundation Trust and Psychiatry Teaching Lead at University of Sheffield and a Health Foundation GenerationQ Fellow.
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