The Knowledge and Skills Framework was set up to ensure strong staff skills in the NHS. In the third in our series on Agenda for Change five years on, Richard Staines reveals exclusive research on how trusts are acting on the the KSF
The Knowledge and Skills Framework was intended to ensure Agenda for Change - in addition to improving pay and conditions for non-medical staff - improved NHS productivity through better training and development.
It was meant to be a thorough system that could be applied across the entire health service and was tied into the pay system of Agenda for Change. It would ensure that the skills needed were in place to meet the demands of jobs, with the link to AfC ensuring that nurses were paid fairly according to their abilities.
The KSF was introduced five years ago as part of the AfC deal. However, unlike AfC, it was not subject to performance management by central government.
The framework identified six areas - known as dimensions - of ‘core skills’ that would apply to all jobs in the NHS: equality and diversity; communication; personal and people development; health; safety and security; and service improvement and quality. Another 24 dimensions would apply to sepcific jobs. Within each dimension there would be four levels, which would relate to the complexity of skills required and the demands of the job.
Following an appraisal, called a personal development review, staff would receive a personal development plan that mapped out their training needs.
Lack of action
There was initial success in introducing the new system in England, with organisations appointing lead officers to drive through its roll-out. However, progress was halted in 2006 by the reorgansiation of regional health authorities.
Outside England, there were delays in introducing the new system but Wales, Scotland and Northern Ireland have since opted to make the introduction of the KSF subject to performance management.
The KSF in England is no longer monitored centrally as part of the move away from centralised target-setting.
Unions and staff have long voiced concerns that employees could be missing out on training and professional development as a result - with a knock on effect on patient care.
In une 2008, health minister ann Keen wrote to all NHS chief executives urging them to prioritise KSF implementation.
Her letter asked every board to have a named board member with key organsiational responsibility for ensuring that the KSF was applied effectively. It also recommended that every baord receive regular reports on KSF implementation.
On the back of Ms Keen’s letter the National Audit Office conducted a survey on KSF during the autumn of 2008, which was published in January 2009.
The report noted that the KSF was key to realising the benefits of AfC, such as efficiency and productivity. However, it also found that only 54% of staff had received a KSF appraisal.
Nursing Times has now conducted its own KSF survey under the Freedom of Information Act.
Initially, the results seemed to be encouraging. the majority of trusts - 79% - had heeded Ms Keen’s recommendation and had a named board member responsible for ensuring KSF was applied effectively.
Additionally, 70% of boards reported that they received regular reports on the use of KSF within their organisation.
According to trusts’ records, the proportion of staff who had received a KSF post outline was 79%. Fifty-nine per cent of staff had been given an appraisal and 58% had received a personal development plan detailing their training needs.
However, in some organisations, fewer than 10% of staff had received development reviews – although some organisations said that all staff had received them.
Although the appraisal rates represented a slight increase on figures in the NAO survey, the Nursing Times survey also uncovered worrying evidence that some NHS organisations had abandoned KSF completely.
Nursing Times had already revealed in 2006 that Royal Chesterfield Hospital NHS Foundation Trust decided to use another appraisal system, claiming that the KSF was too expensive and would cost £180,000 a year to implement.
The Nursing Times survey revealed that Stockport NHS Foundation Trust, Great Western Hospitals NHS Foundation Trust, and Blackpool Fylde and Wyre Hospitals NHS Foundation Trust had also abandoned KSF.
All these organisations have used their status as foundation trusts to opt out of the AfC agreement and abandon the scheme.
Ironically, Blackpool Fylde and Wyre Hospitals was where the architect of KSF, Andrew Foster, was seconded as HR director after he stepped down from his role as NHS Director of Workforce in 2006.
The trust decided not to adopt the framework after Mr Foster left. However, in an interview with Nursing Times last month, Mr Foster said that he too had become disillusioned with the system because it was bureaucratic.
Mr Foster said: ‘[I] sat at the DH designing the overall structure of Agenda for Change architecture – but, for those in the NHS using it for annual performance development reviews, it is dreadfully bureaucratic and a lot of organisations don’t do it properly because of that.’
He said that the KSF should be changed to focus on the needs of individul staff.
‘What we have created is a bit of a monster, trying to cover everything instead of focusing on the issues that are really critical’
‘Annual appraisals should focus on the important things – people should be learning and not be forced into this multiple box-ticking exercise. We wanted AfC development reviews to be covering the important areas,’ he said.
‘What we have created is a bit of a monster, trying to cover everything instead of focusing on the issues that are really critical.
‘The KSF is … bureaucratic because, in trying to get it right, we have gone into a high level of detail. When it comes to creating and evaluating a job, the levels of detail in the KSF are good. But, when it becomes part of the machinery for annual development reviews, it makes the exercise complex and bureaucratic.’
Mr Foster said that the way forward would be to simplify the KSF process. The implementation of the KSF should then be enforced centrally by the government in the same manner as Agenda for Change pay scales, he said.
‘I don’t think you should put in performance management of a system which is bureaucratic. They should review the system and make it simpler. In exchange for that there must be some performance management to make it happen,’ he said.
Union safety concerns
Unions are sticking to their position that trusts must adopt the system to improve patient care.
‘The Mid Staffordshire hospital scandal shows that if you don’t follow KSF there is low priority given to training and development of staff and that results in lower quality of care’
Mike Jackson, Unison senior national officer, raised concerns that patient safety could suffer in trusts failing to adopt the KSF or train their staff properly.
‘[The Mid Staffordshire hospital scandal] shows that, if you don’t follow KSF, there is low priority given to training and development of staff and that results in lower quality of care,’ he warned.
He added: ‘Many low-paid staff are missing career development opportunities and their potential is not being realised.’
Trusts not implementing the KSF are also missing an opportunity to create roles to meet their own needs, he added.
‘We need to use the KSF to develop new roles to allow teams to work more effectively and achieve greater productivity,’ he said.
Josie Irwin, RCN head of employment relations, agreed. ‘There is some training and development needed to keep people up to date. That is important. The progress of the KSF framework is disappointing – those are the things that need to be improved,’ she said.
The unions argue that organisations could not know how competent employees are.
Under AfC, it is assumed that staff progress up one pay point every year until they are at the top of the pay scale. Near the top of each band is a ‘gateway’ point, where staff are assessed to find out whether they fulfil the requirements of their job set out in the KSF outline.
If organisations fail to implement the KSF, staff will pass through the gateway without their skills being formally assessed.
‘Those organisations that have dragged their feet – what are they doing? Are they not committed to principles of improving the NHS?’
Therefore, by not adopting the KSF, trusts lose opportunities to identify and solve problems that may be present at an individual, team or organisational level.
Barrie Brown, Unite head of nursing, warned: ‘Those organisations that have dragged their feet – what are they doing? Are they not committed to the same kind of principles of improving the NHS, which is dependent on what the staff themselves are able to achieve?’
Nursing Times contacted NHS Employers, which negotiates with unions on HR matters on behalf of the health service, to ask what could be done to ensure that more staff benefited from the KSF.
NHS Employers would not comment directly and referred to a review to be conducted by the Institute for Employment Studies, which will report at the beginning of 2010.
Gill Bellord, director of pay, pensions and employment relations at NHS Employers, said: ‘We are aware of the issues surrounding the slow implementation of the Knowledge and Skills Framework and recognise the importance of the forthcoming review in helping to identify where organisations may be struggling to effectively implement the framework.
‘The KSF provides a consistent and comprehensive framework for staff reviews and development but we need to know whether this is in a format that enables the framework to be used effectively to support the development of skills and competencies and ultimately improve the quality of patient care.
‘We are aware that some organisations have effectively implemented the KSF and can demonstrate the positive effect this has had on their staff appraisal and development processes.’
Employers and unions are now pinning their hopes on the review.
Although the Nursing Times Freedom of Information Act survey shows some recent improvements, parts of the NHS are failing to train and develop their staff properly.
Without more leadership from the government, the problems will continue – and staff and patient care will suffer.