Our response focuses on the following questions that we have asked of NHS employing organisations:

2 Brewery Wharf Kendell Street Leeds LS10 1JR Tel 0113 306 3000 www.nhsemployers.org Apprenticeship Targets for Public Sector Bodies Consultation Department for Business, Innovation and Skills Bay C, Level 2 2 St Paul s Place 125 Norfolk Street Sheffield S1 2FJ 3 rd March 2016 Dear Sir/Madam, As a national organisation in the health sector, NHS Employers is pleased to provide this response to the consultation on the Government s proposal to introduce apprenticeship targets for public sector bodies. This response has been compiled following engagement with employing organisations across the NHS in England. In addition, we have encouraged individual NHS organisations to respond directly on the detail. Our response focuses on the following questions that we have asked of NHS employing organisations: Should NHS organisations with a headcount of more than 250 employees be in scope of the 2.3% apprenticeship target placed on public sector bodies? Should the NHS be considered as a whole for the purposes of the target? Is headcount the correct basis for setting the target? What are the potential barriers to delivery of the target? In reviewing this response, we urge Government to consider the points raised in conjunction with other areas of developing workforce policy applicable to the NHS. A myriad of factors has resulted in supply shortages in certain parts of the NHS workforce, which are causing challenges in meeting safe staffing requirements and have led to increased reliance on overseas recruitment and use of agency staff to fill shifts. NHS organisations are already taking steps to address each of these issues and are committed to investing in the training and development of skilled healthcare professionals. The recent announcement on plans to introduce a nursing associate role is something that employers in the NHS see value in and, whilst they have some questions as to the regulation of this role and the potential confusion between the duties of the new post and those of existing 1

assistant practitioners, they largely support the proposition that an apprenticeship pathway could be used to train this new staff group. The further announcement in the Comprehensive Spending Review on plans to remove bursaries for nurses and allied health care professionals is another change which will likely impact on future workforce supply. There is recognition by employers that we need a training system that is more flexible and capable of meeting the increased demand for registered nurses; employers feel that removing the cap on the numbers of training places has the potential to increase applications for nurse training. However, at the same time, it is important to stress that employers feel that introduction of a loans system may impact on the numbers of applications received from those from more disadvantaged backgrounds. In support of the widening participation agenda and encouraging applications from mature students, who bring with them life skills and experience that enhance ability to deliver compassionate patient-centred care, employers recognise the benefit that introducing a degree-based higher apprenticeship in nursing could bring. We re aware that discussions are currently taking place around the design of a standard for a degree-based higher apprenticeship in nursing and NHS Employers are working with colleagues in the Department of Health and Health Education England (HEE) to ensure there is sufficient employer representation on this trailblazer group. As the nursing profession employs a large proportion of the NHS workforce, there are good opportunities to expand apprenticeship delivery via the use of this new standard. However, as referenced later in this response, the funding cap applied to the standard will be a key determinant of the credibility of this pathway to support the training of registered nurses within the NHS. NHS Employers, speaking on behalf of employers across the NHS, would therefore urge the Department for Business Innovation and Skills and the Institution for Apprenticeships (once established) to ensure the pricing of apprenticeship standards reflects the true cost of delivery. NHS Employers will be submitting separate responses to HEE s consultation on the proposed introduction of a nursing associate role and the anticipated Department of Health consultation on changes to the funding of nurse and allied health professional training. However, in submitting this response, we felt it important to stress that these are interconnected issues, which represent an opportunity to scale up the delivery of apprenticeships across the NHS and consider apprenticeships as a solution to addressing supply challenges across the broader workforce. This acknowledgement aside, it is clear from our engagement with employers that they view the current proposals around introduction of the new levy system and the proposed public sector apprenticeship targets to represent a challenge. Whilst the opportunities to deliver increased numbers of apprenticeships in the NHS certainly exist, timescales for the proposed changes are not in step with the availability of the required apprenticeship standards and architecture to scale up delivery to meet Government s ambitions in the immediate term. We would be happy to discuss the content of this submission in more detail and work with colleagues in Government to further develop policy that meets the desire to deliver increased apprenticeship opportunities across the public sector, in a way that boosts productivity and develops sustainable solutions to supply across the NHS workforce. Should NHS organisations with a headcount of more than 250 employees be in scope of the 2.3% apprenticeship target placed on public sector bodies? The majority of employers we spoke to have agreed it is reasonable that the NHS, as the largest employer in England, should contribute to the expansion of apprenticeships across the public sector. Moreover, it is clear that NHS organisations greatly value the apprentices they currently 2

employ, are supportive of the opportunities these posts create to improve diversity in the workforce and the invaluable contribution this can make to the delivery of high-quality patient care. (NB. Whilst employers were largely on board that the NHS should contribute to the delivery of increased numbers of apprenticeships across the public sector, scaling up delivery is not without its challenges some of the key barriers are highlighted later in this response). Employers feel that primary care (GP surgeries and dental practices) should be included within the NHS target. Much work has been undertaken in recent years to deliver increased numbers of apprenticeship starts in these settings. Furthermore, in support of better join up across the health sector, it is felt that we should be looking to develop systems-based solutions to the delivery of services; excluding primary care from the target is viewed as a move away from this ethos. For similar reasons, many of the employers we have engaged with have expressed a desire that community pharmacy be included in the overall target as they are a key component of the NHS architecture, with numerous opportunities for the delivery of apprenticeships. The need for policy that better supports integration between health and social care was also a key theme that was highlighted in our engagement with employers. There are some great examples that have begun to emerge in the delivery of rotational apprenticeships across health and social care and in support of a one workforce approach, it would be desirable to have policy that supports continued collaboration, rather than reinforcing silo working. Whilst the majority of CCGs currently employ fewer than 250 employees, it has also been suggested that they too should be in scope of the 2.3% target. This leads us to the next issue for consideration on whether NHS organisations should be grouped together for the purpose of reporting against the target. Should the NHS be considered as a whole for the purposes of the target? Whilst views were somewhat mixed, the majority of employers we spoke to saw a value in the NHS being grouped together as a whole for the purposes of reporting against the target. Such a grouping would be supportive of the aims of the Five Year Forward View in developing new models of care and training a workforce equipped to deliver care focused around the needs of patients. Such a grouping would allow flexibility in the use of apprenticeships to best meet the needs of local health economies; however, there would need to be systems in place to ensure that all individual organisations took collective responsibility for delivery of the overall target. In localised settings, pooling of targets between health and social care organisations is also something which could support more joined up working across the system, although due consideration would need to be given in these instances to how levy monies could be drawn down by potentially more than one organisation to fund the training of these apprentices. If NHS organisations were grouped together as a whole, then this raises the question of governance in terms of where responsibility for reporting to Secretary of State on progress against meeting the target should fall. Many employers believe there could be a role for HEE in this regard and, in the interim at least, acknowledge the support that HEE could provide in developing workforce plans to allow employers to gain the most benefit from their contributions to the apprenticeship levy. This grouping in the short term would also help to put the required infrastructure in place. Employers also questioned whether grouping together could potentially allow more flexibility in how the levy is used. However, our discussions with employers have given a clear indication that they wish to have individual control over their levy contributions, rather than an arrangement whereby an 3

organisation, such as HEE, exercised control over a central ring-fenced pot. Employers felt that such a centralised arrangement would add a needless layer of bureaucracy. Furthermore, given the commitment already shown by the NHS to the delivery of apprenticeships, national pooling of NHS levy monies would be a move that would undermine the ability of employers to take true ownership of skills development and use apprenticeships in a way that best meets the needs of their workforce. Further discussions with employers about the future role that they would like to see HEE and its regional LETB s play, revealed a number of other key themes: Support for the system to ensure employers make best use of their collective buying power. Negotiating to prevent regional inconsistencies. Monitoring and advising on quality of training providers to ensure best return on investment. Mapping the new apprenticeship standards needed in health, and support for employers in developing these via the employer led trailblazer process. Liaison with HEI s. Encouraging the spread of best practice, particularly around new higher or degree-level apprenticeships (as these are developed). Financial support for infrastructure costs to aid delivery of increased numbers of apprenticeships. Help where a small number of specialist apprenticeships for each trust (e.g. estates, science, and paediatrics) may not make it viable for providers to deliver. Is headcount the correct basis for setting the target? Our engagement with employers has revealed that they feel strongly that full time equivalent (FTE) is a more appropriate basis for setting the target than headcount. For the NHS at least, the Electronic Staff Record (ESR) should provide easy access to FTE figures, so setting the targets on this basis should not be problematic and would give due regard to the large numbers of part time employees that work across the system. It is felt that a headcount figure creates a disproportionate challenge for the NHS with its high number of part time workers. What are the potential barriers to delivery of the target? Discussions with employers have revealed a number of key challenges to the NHS in its ability to meet the proposed 2.3% target outlined in the consultation: 1. Outsourced services and shrinking support workforce In recent years, many NHS organisations have substantially reduced the numbers of staff employed in the support workforce. Much of this has resulted from the outsourcing of services (e.g. estates, catering, HR), which has had the knock on effect of reducing the available opportunities for delivery of entry-level apprenticeships. The employers we spoke to believed that in these instances, service level agreements should be in place to allow apprentices employed in these outsourced functions to count towards NHS targets and there should be the option available to be able to draw down levy funds to pay for the training of such apprentices. In addition, it would be desirable if employers were able to use 4

their levy surplus to fund apprenticeships in their supply chain but this should be an arrangement that was at the discretion of employers at a local level. 2. Lack of higher and degree-level apprenticeships There is a clear acknowledgement that to be able to recoup the costs of the apprenticeship levy, employers in the NHS need to consider apprenticeships not just for entry-level positions but as a solution to addressing supply challenges across the broader workforce. However, at present, a distinct lack of options exist for higher and degree-level apprenticeships suitable for delivery in the health sector. Given the long lead in time for the development of new apprenticeship standards via the trailblazer process, employers are concerned that they won t have the required options available to be able to maximise use of levy funds and deliver sufficient apprenticeships to meet the targets laid out in the proposal. Feedback from NHS organisations who have been involved in previous trailblazers has also indicated that the process is time and resource heavy and there are concerns as to the capacity of sufficient numbers of employers to take on this responsibility, given the numerous other pressures currently facing the NHS. Given this situation, we would suggest that a phased approach to introduction of the targets might be a more realistic ambition for the NHS, which would still result in the delivery of large numbers of apprenticeships by 2020 but would show consideration for the current lack of suitable standards in health and the multitude of other challenges currently facing the service. 3. Uncertainties on caps for each apprenticeship standard In order for organisations to fully assess the extent to which apprenticeships fit within their workforce plans, more information is needed on the caps on the level of available funding for each apprenticeship standard. Whilst we know that discussions on the development of a degree-based higher apprenticeship in nursing are still at an early stage, our initial engagement with employers on this alternative route into nursing has suggested that they see some favour in this model, particularly in light of the changes to the funding for student nurses and allied health professionals. However, in order for this to be a credible model, the funding cap would need to be set at a level to ensure the employer wasn t liable for extra costs to cover the training of nurses via this route. An additional point worth noting here, is that there needs to be sufficient safeguards in place to ensure the further education sector doesn t inflate the cost of apprenticeship training provision, in the knowledge that public sector organisations are contributing to the levy and have targets to deliver increased numbers of apprenticeship starts. 4. Infrastructure costs Scaling up the delivery of apprenticeships to the levels Government are aspiring to presents a significant challenge to the NHS pay bill, in terms of the levy contributions and apprentice salaries but also the infrastructure (i.e. increased demands for mentorship, employee orientation programmes, integrating apprenticeships within workforce plans, and succession planning capability) that needs to exist to ensure the delivery of quality outcomes. Many employers have suggested that in the beginning they should be able to use some of their levy contributions to fund the infrastructure needed. Alternatively, this funding could be 5

allocated via HEE but without some form of upfront investment, substantial concerns exist about the practicalities of achieving the proposed targets. 5. Losing sight of purpose of apprenticeships Employers across the NHS are committed to investing in the skills and development of their workforce and view apprenticeships as a good opportunity for doing so. However, the imposition of recurrent annual targets may actually reduce options for career progression in the support workforce, as apprentices may be employed on short 12 month fixed-term contracts and then replaced after this period by a new batch of apprentices. This situation would be counter to the idea that apprenticeships offer stability in the workforce and foster the creation of loyal workers with skills aligned to those required by the sector. Furthermore, a desire to meet annual targets may also discourage employers from making best use of higher and degree-level apprenticeships, that would take longer to deliver, the start figures for which could only be included in one annual reporting cycle. Monitoring not only starts data but also the destination of apprentices following completion of their programmes would provide a better benchmark as to the whether the new policy was having the desired effect in terms of boosting the skills and productivity of the workforce. However, the design of reporting arrangements would need careful consideration, so as not to impose an additional burden to employers. CONTACT If you would like to discuss the content of this response further, please contact Lisa Atkin lisa.atkin@nhsemployers.org, Programme Lead, Workforce Supply, NHS Employers. Yours faithfully, Daniel Mortimer, Chief Executive, NHS Employers 6

ABOUT NHS EMPLOYERS The NHS Employers organisation is the voice of employers in the NHS, supporting them to put patients first. Our vision is to be the authoritative voice of workforce leaders, experts in HR, negotiating fairly to get the best deal for patients. We help employers make sense of current and emerging healthcare issues to ensure that their voice is front and centre of health policy and practice. We keep them up to date with the latest workforce thinking and expert opinion, providing practical advice and information, and generating opportunities to network and share knowledge and best practice. We work with employers in the NHS to reflect their views and act on their behalf in four priority areas: pay and negotiations recruitment and planning the workforce healthy and productive workplaces employment policy and practice. The NHS Employers organisation is part of the NHS Confederation. 7