CONTINUING PROFESSIONAL DEVELOPMENT
A collaboration between the NHS, the voluntary sector and academia has produced new advice for commissioning training on sustainability.
F
or the past 60 years our health system has successfully negotiated periods
of financial constraint without the need to fundamentally alter its architecture. The three key tiers (national, intermediary and acute-focused provider) have contracted or expanded, but the goal of an integrated, primary care focused service that manages demand through prevention rather than incentivising activity has so far proved elusive.
Today, the convergence of an ageing, grow- ing, less active population with high expec- tations for health outcomes, competition for natural resources from emerging econ- omies and a changing climate all lead to the same conclusion: reshaping the health service to be financially, socially and envi- ronmentally sustainable. The secondary care focused approach to healthcare that has prevailed since the NHS started is not sustainable; that is, it will not allow us to meet current needs without compromising the needs of future generations. Training and continuing professional development will play a key role at several junctures in the transition from an unsustainable to a sustainable health system.
Stefi Barna
University of East Anglia School of Medicine
GPs Commissioning Competency Frame- work includes sustainability as one of the five foundations for effective commission- ing. Commissioners are expected to show “commitment to the sustainable use of resources, including the natural environ- ment, NHS finances and the time and spirit of staff”. Guidance for leading improve- ment and innovation includes a number of skills, attitudes and behaviours that should come through many training avenues, not just those on waste-reduction or carbon- reduction, for example.
James Mackenzie NHS Sustainable Development Unit
RCGP Commissioning Competency Framework
Dr Frances Mortimer Centre for Sustainable Healthcare
All professionals should: • Appreciate the role they play in the stewardship of natural, human and financial resources; • Seek ways to reduce the inappropriate expenditure of time, natural resources and money.
Additionally, practice leaders should: • Routinely identify opportunities to improve the sustainability of their services;
Figure 1 - NHS financial shortfall, oil production shortfall and carbon reduction requirements until 2020 (NHS Sustainable Development Unit, 2011)
• Use systematic approaches to streamlining processes in order to improve sustainability;
• Procure products and services in keeping with principles of good stewardship.
Additionally, commissioning leaders should:
• Include the principles of sustainability in all service evaluation and design activities.
Additionally, commissioning directors should: • Create a culture in which quality and value are understood in natural, human and financial terms; • Be accountable for the consortium's stewardship of resources.
Commissioning CPD
All too often, training and CPD provision are developed without alignment with strategic plans. The new Royal College of
42 | national health executive May/Jun 11
Commissioning teams should: • Build capability in measuring, predicting and improving the use of resources in the local health economy.
Tips for trainers and commissioners
A network of clinicians, managers and educators in the NHS, voluntary sector and academia have come together to respond to the multiple demands of developing a sus- tainability ‘perspective’ in training.
The Sustainable Healthcare Education net- work has developed teaching modules for medical students and registrars that devel- op knowledge about the anticipated con- straints of 21st century healthcare as well as clinical, management and leadership skills to respond to them. We recommend that training on sustainability includes all of these following components.
Step 1 - Changing mindsets
Helping health professionals understand why the system needs to change is crucial. Our priority-rich, time-poor environment draws us to become so task-focused that we lose sight of the wider financial, envi- ronmental and social implications of our activities. Yet health professionals at all levels can work more efficiently when they understand the bigger picture.
For example, NHS employees need to un- derstand how the anticipated health effects of climate change will affect their profes- sional duties, work behaviours and the tremendous potential for implementing sustainability strategies that can improve population health in areas currently seen as most intractable.
Training should encourage members of each professional group to think creatively about how changing work practices within their role can help deliver the broader sus- tainability agenda of carbon reduction, waste reduction, improved quality of care and workplace satisfaction.
Strategically-focused training can tend to be pushed down the list of priorities in fa- vour of more operationally-focused devel- opment. Good training sessions will allow for sharing new knowledge and also time for individualised activities to help set new mindsets that will support the transition to a sustainable health system.
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