LAUSR

It has been said that the NHS is overeducated and undertrained. What is meant by this is that we spend a very large amount of money educating people at the beginning of their careers but relatively small amounts of money for the next 40 years. But it is more than this. It is not just the balance between initial investment and continuing investment – it is the nature of that investment. There is an important distinction between education and training. Education helps people learn how to think, how to grow and develop and how to analyse problems, and it is therefore vitally important for everyone working in the most complex business on earth – namely healthcare. Training is a different function: it gives people the skills, concepts and sometimes behaviours needed to carry out a particular task or a policy. The epitome of an organisation that focuses on training as well as education is the military, encompassing all three of the services. They expect people to be well educated, but when a new policy or technology is introduced, everyone has to go for training, and that means everyone. The same applies in industry, and people who have met pharma industry staff will know that when a new drug is introduced everyone must go on the training course to learn about the new drug, not just those who will be directly involved. The importance of this is reinforced by the behaviour of senior management in industry. If someone does not attend the training because they are high up in the leadership team and does not see what a new drug has to do with them, then they will probably be reported to the chief executive; they will possibly have their pay affected and they will certainly be seen as someone who is not ‘one of us’ and therefore would be on their way out of the company. In the military, new technology as well as new concepts stimulate the need for training. There is no way that the military would have sought to do something like commissioning without a comprehensive plan for training everyone who needed to know, and that means everyone. They would have included every clinician involved in commissioning, even the GPs only working one or two sessions a week, as well as everyone above a certain grade in the commissioning organisation. The training would be accompanied by the introduction of a new doctrine and people would have to learn the new doctrine, namely the meaning of the new concepts and they would probably practise the new skills before returning to their units. Simulation has been adopted now in the clinical arena, for example as a means of improving patient safety, but we surely have just as great a need in management, policy and commissioning. How else can people learn to apply the skills they have been taught and to find out how their colleagues would operate under pressure. In a typical organisation responsible for commissioning and managing resources, some people are at the utilitarian end of the spectrum; others see themselves as champions of people with uncommon and rare conditions; and yet others might position themselves in the middle of the road, but are these different perspectives every admitted, discussed or harmonised? Very rarely. In developing population healthcare, we need excellent leadership but we also need training. Set out below are the ten skills and domains that are needed for each of the skills which are required and, a key principle, the actions of people being expected to carry out once they have had their training focused on the three new tasks: