Design and Delivery of Training in the Changing Health Care Profession - Essay Example

Design and Delivery of Training in the Changing Health Care Profession Introduction There have been significant changes in the Health Care Labour Market. These changes have important ramifications with regards to the skills needed to adapt to the changes bringing us to the concept of skills gap. This paper aims to analyze the canges in the labour market of the National Health Service (NHS) of the United Kingdom and use this information to come up with an efficient training mechanism to address the skills gap. The Medical and Health Care Labour Market in the NHS With 1997 as the baseline year extending up to the end of the year 2004, there has been a 23% growth in the NHS workforce in England while the other three UK countries (Scotland, Ireland and Wales) also registering a percentage increase but is lower than that of England. The doctors and allied health professionals grew by 25% and 30% respectively. The NHS sector which increased the most was the Health Care Assistant workforce which almost doubled. Running second is the health care managers at a 68% increase. Figure 1 summarizes data based on whole time equivalents (w.t.e.) or the registered pooled service time of all the nurses. Fig. 1. Growth in NHS Professions (1999-2004) (Source: Department of Health, 2004) Although Nursing auxiliaries have the lowest registered growth, they still are three times larger then the population size of HCA's in the year 2004. Within the realm of nursing, there has been differential increase and decrease in specialization. Those with positive growth are the nurse managers sector, first level/ registered nurses and Registered Sick Children's Nurses (RSCN). The midwives and health visitors sector grew with an inconsequential amount while the district nurses and second level nurses showed negative growth. This may have been the result of upgrading of status to 1st level nursing. Figure 2 summarizes the observation. Fig. 2. Nursing Types Change (1999-2004) (Source: Health Care Commission, 2005) The figures show that there is indeed a major transformation happening in the health care market. As a rule, whatever is in demand in the market is also the prime choice for employment and study. The rise in healthcare assistants and the nursing profession translates to more people enrolling in those fields because they are assured of employment. As a consequence of this preference, it can be rightly predicted that there would be less people studying in other medical professions. The Concept of Working Differently To further complicate matters, there have been a range of policy-led initiatives and external factors that are changing the work definitions of nurses and health care professionals (Buchan, 2005). These involve changes in the roles that nurses and health care assistants are performing, in the skills that they are developing, and in the ways that they work alongside and with other health care staff. The policy initiatives are the following: Changing workforce programme (O Dowd, 2005) Extension of nurse prescribing (RCN, 2003) Implementation of National Service Frameworks in England (RCN 2003) Establishment in England of NHS Direct (NHS Board, 2003) Extension of protocol-based care (NHS Board, 2003) Skills and competency development work supported by the Care Group Workforce Teams (CWGT) in England. ( NHS Board, 2003) Introduction of clinical networks in Scotland (Health Committee, 2005) External pressures include dealing with the impact of the European Working Time Directive. (Department of Health, 2004) The Wanless review, which formulated plans for the improvement of the NHS, forwarded many alterations in the distribution of roles of NHS professionals. The study suggested that nurse practitioners be made responsible for 20% of the work currently under the responsibility of General Practitioners (GPs), physicians and junior doctors. To be fair with the nurses, 12.5% of their current workload will be relegated to HCAs. Instead of a GP working full time, 1 to 5 nurses will take his position while he tends to other clinics. Wanless noted this would entail a 10% increase in nurse staffing. However, Wanless goes on to suggest that instead of increasing the nurse workforce, they can be filled with the increase use of HCAs - for every nurse replaced, 1.5 HCA will fill the position. Taking the review seriously, England's Department of Health implemented measures to increase the number of health care assistants by 27,000 in 2005 from the current population of 2002 (Buchan and Dal, 2002). By February 2003, 840 nurse consultant posts had already been approved. In the year 2004, almost 1,000 posts have been added. (Charlton, 2005) The European Working Time Directive (WTD) has set that doctors who are currently pursuing further training be given extra time to focus on their training. They are entitled to a reduction to 56 hours a week of working hour reduction by August 2003 and 48 hours by the year 2009. The consequence of such a reduction is that the role of the nursing staff and health care assistants will encompass the duties and responsibilities of the doctor as they are usually those staying in the clinic. (Department of Health, 2004) Training for Working Differently As can be seen, there will be problems brought about by these developments in the provision of health care. The focus on the nursing and HCA profession due to the 'sure employment' understanding and the widening of roles and duties of nurses and HCAs entails problems associated with their skills and training (Buchan et al, 2001). Nurses need to be trained to be able to assume the duties of a GP even for a certain degree. Health Care Assistants must be trained to acquire the skills that nurses and doctors have acquired in their study and work experiences. What then could be done to address these concerns Perceived Solutions There will be two approaches in addressing the skills gap. The first one concerns those who are already in practice while the second would concern those still studying in the collegiate level. For Those Already in Practice To be able to respond to the new roles, the nurses and HCAs must be trained as their academic background will be insufficient compared to doctors who had obtained enough skills throughout the length of their study and work experience. However, it must be realized that these people will be working and some of them will have families to take care of. As such, the training that they will receive must be deigned with this in mind. Another factor that must be considered is the age of the trainees. The following figure details the age distribution of the nurses in the UK. Fig. 3 Age Profile of UK Nurses (Source: OME, 2005) It can be seen that majority of the nursing workforce belongs to the age range of 35-44 years old while those in their early years comprise only 30% of the total workforce. As the popular saying goes, "it's hard to teach old dogs with new tricks". Although this is quite inappropriate as to be quoted, it fully captures the concept that the older people becomes, the less they can comprehend new materials. With all this in mind, the following procedures can be adapted. These procedures incorporate all the factors to ensure that the training can have positive results. Seminars The seminars would be scheduled on weekends where most of the nurses and HCAs will have a day off. Since it is expected that the class will be comprised of different age groups, the seat assignments will be designed so that the group will be evenly distributed in terms of age. This mechanism will also be followed in teaming people for group activities. It is expected that the student has read the module before coming to class so that the power point presentations (for ease in the flow of lecture) can be easily understood. The speaker/lecturer would be those with appropriate credentials. If the topic is about dentistry, then the lecturer must be a practicing and well established dentist. This is because he is the more credible source of technical knowledge rather than a general knowledge medical lecturer. Course Modules The information contained in the module must be presented in basic terms so that the reader can easily appreciate the lecture. The organization and flow of ideas must be presented in a manner which is easy to follow. What is forwarded here in this paper is that the content must be procedural. The reason behind this is that the nurses and the HCAs need not necessarily have an in-depth knowledge of the subject as what the doctors have (although this is desirable). They are there for immediate relief and extraordinary cases will be referred to the doctors. As an example, the modules about podiatry must be divided into separate topics which contain the symptoms, the disease in detail and the treatment in bulleted form. It is assumed that the nurses and the HCAs has enough background in anatomy and pharmacy such that they have a knowledge of the medical terms in the module. However, just to be sure, an appendix containing the definition of terms will be included in the module. The module must also contain the list of medicines that is appropriate to heal the patient. Information Database Technology has gone a long way especially in the field of information dissemination. The use of these information technology systems can address concerns regarding accessibility and availability of time for study. It can address accessibility because the trainee is just one click away from a very large trove of information. It can address availability of time concerns especially for those who can't attend the seminars due to personal considerations and responsibility. They can now learn from their home or during office hours when they are not too occupied. It would be desirable that an information database accessible thru a website for the whole of the country of the United Kingdom be developed. This would require collaboration with the academe, hospitals, and health centers with the Department of Health as an overseer. The database would include an online copy of the training modules, case studies and contact persons. The website would include a forum wherein questions and clarifications can be posted by a student and be replied upon by a designated specialist. This would ensure that the student has the opportunity to fully understand the topic. The information database will provide the necessary details but it is advisable that they still attend seminars especially when practical applications are required. For Those Still Studying To enable students to have skills for the pervading conditions of the labour market, additional units must be integrated into their curriculum. This will cover specialized topics - units usually found in the Medicine degree - but will be simple enough so that they can gain at least a basic understanding of the topic. Conclusion From the foregoing discussion, it can be seen that there have been changes in the medical profession labour market. Nurses and Health Care Assistants are given responsibilities previously undertaken by doctors and specialists. For sure, they can attend seminars to eliminate the skills gap but these training must be designed in such a way as to facilitate the learning process. When designing their training, it is important to take into considerations their availability as a function of work and family responsibilities and comprehension as a function of age. Reference: Buchan, James (2005). RCN UK Nursing Labour Market Commentary 2004/5. Royal College of Nursing : London Buchan, J., and Dal Poz, M., (2002). Skill mix in the health care workforce: reviewing the evidence. Bulletin of the World Health Organisation Vol 80 (7). Buchan, J., Ball, J., and O'May, F., (2001). If changing skill mix is the answer, what is the question Journal of Health Service Research Policy Vol 6 (4 Charlton R, Knapton A (2005) Workforce Supply in 2009 - some predictions and issues to tackle. National Workforce Projects, Workforce Review Team. 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