Creating a strong IT workforce

Learning has always been an important part of the National Programme for IT (NPfIT); in fact it is difficult to conceive of a successful roll-out that doesn’t involve the end-users and ensure that they are both confident and competent with the new applications before they are deployed ‘in live.’
Since the responsibility for deployment is local, it stands to reason that responsibility for training and other learning interventions is likewise local. However, there is a great deal that can, and indeed should, be done nationally, with a view to ensuring common standards, reducing duplication, realising economies of scale, and building a shared infrastructure for ongoing learning.
As a result, the National Education, Training and Development (ETD) team supports NHS staff in learning about and using new systems and services by providing interventions and approaches that strengthen capacity for learning for all, and enhance the readiness of front line staff for the implementation of the NPfIT. The team work closely with our key stakeholders in the Strategic Health Authorities (SHAs) and Trusts to identify what is required and best delivered centrally, and to align this with what is being offered at a local level, both in the short and long term. This has led to the creation of a new joint initiative between the National ETD team and the SHAs titled ‘Connected Learning’.

Connected Learning  
Connected Learning consists of four key principles, all designed to support the NHS during the implementation of the NPfIT. As mentioned above, the National ETD team portfolio of projects is focused on only delivering programmes and resources that are best implemented at a national level. These are a blend of tactical solutions - quick wins with benefits that can be realised either immediately or in the very near future - and strategic enablers that will benefit the NHS and the wider ETD community throughout the NPfIT rollout and indeed well beyond that into Business as Usual. The four principles underlying Connected Learning are as follows:
Principle one – Connecting to deployments:
It is vital that learning be 'connected' to actual systems deployments. This means that both NHS Connecting for Health (NHS CFH) and local deployment teams must be aware of the learning needs created by the implementation, that such learning should be synchronised with the timetable for rollout, and that deployment support teams should automatically factor in the need for learning as part of the lead up to ‘going live.’
Principle two – Connecting to stakeholders:
There must be a collaborative relationship not only between the National Team and colleagues in the wider NHS, but also between the suppliers and the health communities in the important endeavour of producing appropriate learning materials and then supporting learning. Thus the word 'connected' also refers to relationships between and among different partners and participants.
Principle three – Connecting to processes:
Learning must be linked to business processes and priorities and to existing approaches to learning and development. Sometimes the introduction of new IT is seen as a somewhat ‘alien’ activity, unrelated to the normal work of a Trust and unconnected to its business of providing high quality patient care. In fact, the whole purpose of the programme is to directly support high quality patient care and thus, rather than being seen as a separate, marginal and relatively unimportant aspect of organisational life, learning for ICT must be 'connected' to the business processes and systems in use, as a vital precondition to successful uptake and impact of new approaches.
Principle four – Connecting to technology:
It is increasingly apparent that one of the most effective ways of supporting learning is through the use of technologies - via e-learning, distributed communities of practice, and even through embedding learning into the technologies themselves, as context-sensitive performance support. In all these senses, the learners are 'connected' to the learning resources and opportunities, and indeed the learning applications are ‘connected’ to the functionality being implemented.  
The new initiative is made up of a number of projects designed to enable NHS CFH, the Strategic Health Authorities (SHAs) and the wider NHS to work according to these principles both now and in the future.

Essential IT Skills Programme
It is key that front line NHS staff - those expected to make use of the new systems and services that are being implemented by the NPfIT - are sufficiently prepared to operate them in a confident, efficient and secure manner.  High quality, timely and comprehensive system specific training is obviously key. Just as much consideration, however, must be given to what skills NHS staff require to prepare them before taking systems training, what we term ‘essential IT skills’.
The Healthcare Commission NHS staff survey for 2007 found that nationally, roughly one third of NHS staff in clinical professions had been given no training in either IT skills or in the safe handling of patient information. Through extensive NHS consultation, the National ETD team and the SHAs have produced, and are now offering, a new integrated training package focused on the need to provide clinical and other staff with training not just in IT skills, but also in their responsibility and accountability for their actions when using IT systems in the NHS.
The new Essential IT Skills (EITS) Programme was launched in March 2008 showcasing two bespoke qualifications developed specifically for the NHS: NHS ELITE (NHS eLearning IT Essentials) and NHS Health (NHS eLearning for Health Information Systems). Both are fully accredited by the British Computer Society (BCS), NHS ELITE focusing on raising general IT skills levels, with NHS Health designed to educate NHS staff regarding using health information systems in a safe, secure and patient focused manner.

A central system
While there are benefits to be gained from purchasing the tools required for training programmes at a national level, the same can be said for offering a central place for NHS staff to access these resources. The National Learning Management System is currently due to be made available to NHS organisations through the Electronic Staff Record (ESR) in late October 2008. This will be a free resource that will be made available to all NHS organisations; once fully implemented any NHS member of staff will be able to access a central repository for all national e-learning modules via this one single platform.
It is estimated that 800,000 NHS staff will require some form of systems training as a result of the NPfIT. With so many National Application Service Provider (NASP) training programmes required to support the implementation of national systems, the ability to coordinate NHS staff booking onto these events through one central scheduling service is vital.
Since 2006 the National ETD team have provided the NASP Training Scheduling Service, which has proved instrumental in ensuring that NHS staff are coordinated to assure that they take the right training at the right time. This allows NHS organisations to plan and back fill where appropriate, whilst also enabling the deployment teams to ensure that systems training is provide nether too soon nor too late.

The right environment
There is plenty of evidence to show that people learn best when they have the opportunity to familiarise themselves with a new piece of equipment at their own pace, and preferably in or near to their workplace. For obvious reasons, however, it is unsafe and inappropriate to use live clinical systems to train NHS staff. This, coupled with the fact that the clinical systems developed by each Local Service Providers (LSP) are slightly different, creates a dilemma. How do you provide training that will mirror the scenarios that the live system will produce, bearing in mind that this will contain tens of millions of unique patient records?
The answer is the Training Messaging Service (TraMS). TraMS provides a data repository for centralised PDS training records and initially holds 1,500,000 realistic records. By linking with the functionality provided by the LSP training systems, it will allow users to learn basic tasks including trace, create, update, merge, un-merge, resolve duplicate records, and so on. BT London is currently rolling out its RIOv5 system training using TraMS, which utilises the pre-loaded artificial patient records in the same way that the PDS database would when using the live system.

National Standards
Since completion of the NPfIT Local Ownership Programme (NLOP), the responsibility for the implementation of the National Programme has been more actively and explicitly delegated to the Strategic Health Authorities. However, there is a still a key role for the National ETD team to provide some central quality standards that can be used to guide the SHAs when developing their local training programmes.
The question ‘What does good ETD look like?’ is highly likely to elicit a number of different answers from different people, therefore it was required that we work with the SHAs to look at each aspect of the training lifecycle and define a set of national ETD Standards. There are currently 14 ETD Standards, such as guidance around training needs analysis and design, training plans and implementation, right through to post training evaluation and assessment. The ETD Standards are continuously revised and updated; currently more work is being done on ensuring that e-learning resources and materials demonstrate best practice, and that locally developed programmes will be able to operate on the new National Learning Management System.  

Training Quality Improvement Programme
While the training needs of the user are paramount, we must also ensure that the people who deliver the training are suitably qualified, supported and valued. The National ETD team have a number of initiatives underway that provide support to trainers, with more projects currently being developed to drive up the quality and consistency of training across the board throughout the duration of the NPfIT.
The Training Quality Improvement Programme is working with the SHAs, local Trusts and NHS Employers to agree central ETD Practitioner job descriptions, person specifications and career pathways. This project will be supplemented by the NHS Training Centre Accreditation project, which is working to procure an awarding body to accredit NHS training departments offering training in NPfIT systems, to ensure that quality providers of training in these systems are suitably recognised.  

Future plans
The National ETD team have forged extremely close relationships with our colleagues within the SHAs, and are striving to create similarly strong relationships with suppliers and service providers.
As the NPfIT progresses we will continue to work together to deliver our existing portfolio whilst also identifying and developing new requirements for the future. There will inevitably be many challenges that need to be overcome in future years, the continuation of the collaborative approach between the National ETD team and our SHA colleagues will be crucial in the delivery of first class learning not just for the NPfIT, but for all aspects of technology deployment and use in the NHS.

Dr Philip Candy is National Director of Education, Training and Development at NHS Connecting for Health

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