News and Features

What killed NHSU?

by Adrian Snook, Operations Director, The Training Foundation
11 February 2005

Empty promises, vested interests, heel dragging and much more, argues Adrian Snook, in this article first published in the February issue of 't' magazine.

Adrian Snook
Contents:

Great expectations

The concept of a National Health Service "university" was a centrepiece of the 2001 Labour Party manifesto, announced with high hopes and with great ambitions. In the autumn of 2003 NHSU was formally launched under the leadership of Bob Fryer, previously the head of an adult education college and an influential figure in trade union and Labour party affairs. The new organisation had access to significant resources and a wide remit to teach people entering health and care employment for the first time, returning to work in health and care after a break and already working in the NHS.

Dead on arrival

Just over a year later, on November 30th 2004, it fell to the current Health Secretary John Reid to announce the humiliating decision to scrap NHSU and merge it with the NHS Modernisation Agency as part of a timetable to save £500m by 2007/08 by reducing the number of Arm's Length Bodies. The work of both former organizations will shortly be taken over by a new NHS Institute for Learning, Skills and Innovation, employing a much reduced workforce of just 300 people rather than the current combined staff of 1,500. Bob Fryer will move to a new role as National Director for Widening Participation in Learning for the NHS.

As the corpse of NHSU lies cooling in the morgue and awaiting dissection, the time is right to start to ask the question: What killed such an apparently vibrant organisation in its infancy? - Let's examine some of the issues in an effort to determine the true cause of death.

Rivalry?

At the outset the advocates of NHSU insisted that the new organisation should be a "genuine" university. "One of the traditions in which we stand and want to continue is the notion of providing a university standard for working people," Fryer was quoted as saying. He cited the precedent of the Oxford extramural study tradition of the Victorian era, the Cambridge university extension movement and day-release courses provided by Sheffield, Nottingham and Leeds for working people. "-We don't want to devalue the coinage and say we are not a real university", Fryer insisted.

Sceptics with long memories recalled the alternative prededent set by Gordon Brown's aspirations for a "University for Industry", subsequently neutered under pressure from mainstream education and now operating without University status as plain old "Ufi learndirect".

The frontier country between the health service and higher education is highly competitive and the insistence on University status triggered all kinds of warning bells amongst institutions and and agencies with deeply entrenched vested interests. The proposal generated hostile reactions from within the NHS, from stakeholders seeking control of education and training budgets and from universities, alarmed at the prospect of losing students and highly lucrative research funding to a more muscular new kid on the block.

The plans for University status were swiftly undermined. Almost at the outset it was pointed out that the formal status of "university" could only be granted by the Privy Council. Critics also highlighted the fact that any new body would need to have the equivalent of 55% of students on degree-level courses, a state of affairs that would not be achieved by the proposed "NHS University" for many years. Finally the new institution would only be able to award its own degrees after years of oversight leading to approval from the Quality Assurance Agency.

The universities took more concrete steps to neutralise any threats to their medical schools and health awards. The result was a memorandum of understanding in late 2001 that gave protection to existing university degrees. This stated: "Universities will continue to undertake pre-registration education for nurses, midwives, allied health professions, pharmacists, doctors and dentists, working in partnership with the NHS. The NHSU will not establish pre-registration programmes for these professions."

The practical steps taken by hostile rivals in the learning space were not enough ensure the still-birth of what became 'NHSU', and certainly fell far short of infanticide. However NHSU was born in a more confused and far weaker state than its parents had envisaged thanks to hostility from a wide range of rivals. We need to look elsewhere for the final cause of death.

On the credit side NHSU received a significant amount of public support through 13 partnerships with consortia of universities and further education colleges. Many of these partners will no doubt mourn the passing of NHSU and will be looking to developments at the new NHS Institute for Learning, Skills and Innovation with interest.

Failings with technology?

It is hard to overstate the sheer scale of the logistical challenge that NHSU was seeking to address in developing the skills of over 1.2m people working in the health sector. Almost from the outset the potential economies of scale offered by e-learning were seen to be an essential component in the future success of the NHSU mission.

Since NHS Trusts do not have a common IT network the most straightforward route for the central deployment of NHSU e-Learning inititiatives was an Internet hosted portal. The cornerstone of the NHSU e-Learning Strategy was the Virtual Campus, an online platform and gateway designed to provide NHS staff with 24-hour access to knowledge and learning resources. Following an extensive e-learning procurement exercise IBM and LogicaCMG were shortlisted for the contract for the necessary technology provision.

Alas developments at UKeU, the government's ill-fated online learning project for the higher education sector brought the future of the whole Virtual Campus development project into question at a critical moment. In July it was revealed that the £9.9m bespoke online learning platform already commissioned with public funding by UK eUniverities (UkeU) was likely to be scrapped. Searching questions about the viability of NHSU's e-Learning strategy were then asked at the highest levels. A review was carried out by Professor Keith Baker to consider whether events at UkeU carried any significant lessons for NHSU.

In August 2004 it was revealed that NHSU had decided to terminate the original Virtual Campus procurement in favour of simply purchasing a learning management system (LMS) to 'support the management, support and tracking' of students.

NHSU was left in a very vulnerable state and without a delivery mechanism for scaleable e-Learning initiatives as the government review of all NHS of Arm's Length Bodies progressed.

Inappropriate parenting skills?

The concept of an organisation that would "offer programmes of learning for everyone from cleaners to consultants ... from dentists to drivers" was part of the unique appeal of NHSU as originally envisaged. This broad remit involved addressing a very wide spectrum of learning needs, ranging from basic health and safety, or hand-hygiene training for many thousands of health and care workers to the lofty heights of further development for consultants.

When Chief Executives of NHS Trusts are asked about the learning needs which concern them most, they focus on issues that are essentially mundane and operational in nature but which occur across large local internal audiences exhibiting very variable levels of prior educational attainment. These are the type of initiatives that NHS trusts instinctively looked to NHSU to provide at the outset and which future e-Learning services provided via the Virtual Campus might have targeted.

Whatever the official status of NHSU the dominating culture essentially remained that of an Higher Education Institution. The internal processes adopted followed a 'push model`, ie structured curriculum development over an extended period, followed by a campaign of direct student recruitment. Like most academic processes these operated to long term deadlines imposed by a minimum timescale unit of an academic year and in the case of NHSU were just getting into their stride when spending was frozen pending the outcome of the government review led by Sir William Wells.

This traditional academic approach contrasts starkly with many successful corporate functions branded 'Universities'. Whatever the external marketing gloss, the management of these functions recognises that they essentially earn their living by centrally addressing the training needs of the organisation's business units in a timely and efficient fashion. This alternative 'pull' model of operation is directly regulated by the demands of the business units.

Verdict: Death by Misadventure

A combination of bad luck, lack of clear focus and unhelpful interventions by third parties prevented NHSU management from achieving the mundane but significant short-term 'quick wins' that would have provided little kudos for an HE institution in waiting, but could have make a real operational difference within NHS Trusts. As a result, when NHS managers working at the front-line were asked to evaluate what contribution NHSU had made in exchange for the estimated £50 million pounds spent to date the response was predominantly negative and in some cases scathing. To this extent the final outcome of the review carried out by Sir William Wells was perhaps predictable.

The sad thing about the outcome of this saga is that so many major challenges still remain to be addressed. With 1.2 million staff, the NHS spends £3bn a year on education and training but still faces a need for constant up-skilling in relation to specialist medical knowledge and modern techniques. At the lower end of the skills escalator, the problem is even more pressing. NHSU's annual report published in September 2004 pointed out that around 230,000 people in the NHS still lack the necessary functional literacy and numeracy skills.

Effective learning remains a matter of life or death in the NHS.