The lack of a coherent workforce strategy, career progression opportunities and dedicated training budgets, particularly in healthcare engineering, estates and allied trades is becoming critical, warns a major NHS training provider.
Jane Renton reports.
To describe John Thatcher as a frustrated man is something of an understatement. As Cchief Eexecutive Officer of Eastwood Park, which has been supplying training to multi-healthcare engineering disciplines from a large country estatestately home set amid the rolling Gloucestershire countryside for the best part of 30 years, he has seen the consequences of too much political interference by Westminster, chronic under-investment and the complete failure to develop appropriate apprenticeships and qualifications that, as he says, reflect “the very specific vocational skills required”.”
“Eastwood Park has been involved in hospital engineering and estates training for the NHS for the past 50 years. The next phase of the training establishment’s new multi-million pound training centre is set on schedule to be completed later next year, followed by an extensive fit out, a substantial investment following the management buy-out in 2003. The facility will offer the most up-to-date simulated environments in which NHS engineering trainees can learn about very specific requirements of their jobs, including everything from hospital plant maintenance, to HAI prevention, to managing medical gases and medical equipment. But as the organisation prepares to celebrate its half-centenary, huge, unanswered questions abound over the future of training and development budgets and programmes in these specific NHS disciplines.
“The problem is that we have never been able to offer specialist nNational qualifications and apprenticeships that are fit for purpose and I find that really quite remarkable considering the size of our ‘industry’” he says.
A workforce in crisis
That inability by national standard setting and awarding bodies to devise the appropriate qualifications partly explains why the estates and facilities side of the NHS is in such crisis. An unacceptably high level of its workforce -– a staggering 70% - is locked in low-pay, low-grade bands 1 and 2 jobs. Such complacency amid a growing demographic tsunami is even more breathtakingly remarkable. Only 6% of the workforce is under the age of 25 and some 73% over the age of 40, with a third -– 34% - fast approaching retirement. At the last count there were only 416 estates and facilities apprenticeships currently in place – making up just a paltry 0.04% of the overall workforce.
As yet there is no national workforce strategy in place for the NHS, let alone one that addresses the very real issues surrounding the vital support services.
“There needs to be a coherent strategy, one that looks at recruitment, retention and development as well as succession planning -– in fact all the issues that Trusts, other healthcare employers and many of their providers are being faced with,” says John.
Encouragingly, there is considerable demand for Ffoundation and BSc (Hons) degrees in healthcare engineering technologies and facilities at Eastwood Park. Students remain willing to fund these ose courses themselves, in some cases, in order to advance their careers. These are heavily subscribed work-based programmescourses.
It is interesting that people continue to apply for them even though they are not levy-funded. That’s due in part to the under-spending of the levy by many NHS Ttrusts,” argues John, who believes the NHS should consider establishing specific hospital engineering and estates degree apprenticeships.
But there are considerable issues at the lower end of the pay grade, where opportunities for both training and advancement remain limited. This is the area where the majority of estates and facilities jobs reside and as John says, there is “simply just too little on offer out there”.”
“Job churn is far too high and no-one with anything about them would want to remain in band one or two jobs. If people could see opportunities for career advancement in the NHS and the steps are available to help them get there, they might actually want to stay,” he adds.
Problems with apprenticeships
One of the great criticisms levied, not just by Eastwood Park, but by other healthcare providers too, is that many of the apprenticeships currently being approved by the controversial Institute of Apprentices are simply regarded by employers as unfit for purpose. This is something that organisations such as HEFMA, IHEEM and their allied professional and trade organisations are endeavouring to address, but itthis will require support and funding from NHSI.
Criticism has been especially vocal from the Association of Employment and Learning Providers (AELP) which is asking the government to restore the £1bn annual budget available to small and medium sized companies before the apprenticeship levy was introduced in the spring of 2017. The organisation claims that the big employers who pay the apprenticeship levy, unlike smaller companies, are absorbing the bulk of the fund for their own schemes. But this is not generally the case in the NHS, which certainly in the area of estates management is increasingly farming out jobs, especially pertaining to PAM compliance and safety issues, to the private sector – a move that may not entirely relieve them of their legal liabilities.
“The NHS is under-spending in this area because so much of what the Institute of Apprentices has provided is really not fit for purpose for those working in NHS support services,” says John, adding that the whole funding system is predicated on getting the larger employers to under-spend, so that SME’s can get some sort of look-in.
He suggests that estates management takes a leaf out of the programmes developed for those working in the field of medical science, who are generally well-provided for in the NHS with appropriate training and development at all levels.
“They have a range of standards and apprenticeships covering all science topics at a variety of levels and yet those working in mission critical areas of hospital plant engineering, have nothing specific to their role,” says John.
So why has the national workplace strategy, which in its previous outline, has more or less failed to mention estates and facilities, been so delayed when the problems are so pressing?
“These are issues that we are not shouting loudly enough about as a sector. Government bureaucracy and control has been counter-productive in all of this, with too many clashing priorities. There is also an absolutely ridiculous view, held by the Institute of Apprentices that there are too many engineering apprenticeships out there and that we should stop developing more of them,” he asserts.
Depressingly money to send someone for training to Eastwood Park is often motivated by a desire on the part of senior estates managers to be compliant and avoid penalties and fines for safety breaches. A and all too often the funding derives from maintenance budgets rather than from training and development funds.
“There is plenty of stick in all of this, but very little in the way of carrot to encourage change. I hate to be so negative, but estates departments have been short-changed in the terms of appropriate funding,” he says.
Get on with the strategy
So what can and should be done to alleviate the situation? For John, the answer involves pressing on with an appropriate workforce strategy.
“Let’s develop it together and create a working group involving all the relevant employers, providers, professional bodies and NHS England / NHS Improvement working in unison,” he urges.
It doesn’t always involve chucking huge amounts of money at these issues, but about garnering the right level of energy and support to start designing the right courses, training programmes and apprenticeships to support and provide the broad-based expertise and skills that a modernised NHS will increasingly require.
It also involves raising the profile of the many jobs that the NHS can offer that extend beyond the doctor and nursing roles that many people associate almost exclusively with the organisation. Those other critical jobs could be made to be far more attractive than they are with the right training and development programmes behind them. The time for talking is clearly over let’s get on with it!
