VOL: 102, ISSUE: 32, PAGE NO: 36
Lillian Neville, MA, DPSN, RNT, RN, is senior lecturer, strategic lead for lifelong learning, University of Salford
Agenda for Change (Department of Health, 1999) outlines career and pay progression for all NHS staff that came under the national agreement in November 2004. Pivotal to this is the NHS Knowledge and Skills Framework (KSF), which defines specific knowledge and skills that staff need to deliver high-quality care.
The KSF comprises 30 dimensions, six of which are included in all NHS posts:
- Personal and people development;
- Health, safety and security;
- Service improvement;
- Equality and diversity.
The remaining 24 are more specific and are grouped into four themes:
- Health and well-being;
- Estates and facilities;
- Information and knowledge;
Only some dimensions will be included in individual job outlines and no theme is more important than another. In this sense, equal value is placed on various types of work. However, there are four levels to be achieved within each dimension, each with descriptors and indicators of the knowledge and skills required. The levels are vital to each job outline and most NHS staff will now be aware of the dimensions and levels within their own post outline.
Driving the changes across the NHS requires staff to learn new knowledge and skills that are focused upon improving patient and service outcomes. This was emphasised in Working Together - Learning Together (DH, 2001) and Liberating the Talents (DH, 2002). The commitment to lifelong learning is restated in the KSF. In the related developmental review process every member of staff has a development review as part of a continual cycle of review, planning, development and evaluation (AfC Project Team, 2004). Benefits to the individual include:
- Clarity about the knowledge and skills they need to apply for the post;
- Access to appropriate learning and development;
- An understanding of how their work relates to others in the team and beyond;
- The chance to identify the knowledge and skills they need to develop throughout their careers - to be specified on a personal development plan (PDP);
- A set structure and process through which the NHS can invest in people’s learning and development throughout their working life (AfC Project Team, 2004).
The school has a long history of partnership working with NHS colleagues. Of particular relevance is the well-established link between our 12 local NHS trusts, PCTs, Greater Manchester Strategic Health Authority (GMSHA) and academic staff.
Each trust has a specified person with responsibility for coordinating education across their organisation. Although these roles vary, in that some have strategic level responsibilities, while others have less responsibility, these people are the vital link with the school. They ensure that our educational provision is commensurate with their needs.
This group has specific terms of reference and meets four times each year to drive the mutually beneficial lifelong learning agenda.
At national level, strategic health authorities commission higher education institutions (HEIs) to deliver a specified number of study days, modules and programmes to NHS staff. Trusts are allowed access to this provision by an allocated number of modules to spend with one or more HEIs.
At Salford, although we link primarily with 12 NHS trusts, including PCTs, all NHS trusts across Greater Manchester can also utilise our educational services.
The trust education coordinator serves as a gatekeeper for NHS staff to access modules. Not all staff are accommodated by the contracted modules and many self-fund at least part of their education.
In recent years, these contracts have involved specific criteria that HEIs must meet, and processes for quality monitoring have been put in place.
The way forward
Continuing professional development (CPD) has been defined as: ‘A process of continuing learning and development for all individuals and teams, which meets the needs of patients and delivers the healthcare outcomes and healthcare priorities of the NHS, and which enables professionals to expand and fulfil their potential’ (DH, 2004). Many educational opportunities are available for staff including:
- Reflection on practice;
- Professional networks;
- Work-based learning activities;
- Study days;
- In-house or trust-based training;
- Formal modules and programmes of study.
Any mechanism that can help staff to link these opportunities to their own PDP is likely to support staff to make appropriate choices. Furthermore, managers are more likely to support staff who wish to study if they see how this links to job purpose and the needs of the service.
Linking the KSF to CPD
Educationalists are familiar with mapping their courses against specific criteria, level descriptors and required benchmarks. For those involved with the NHS, this has also included links to national service frameworks, national occupational standards and professional body standards such as Preparation for Mentorship (NMC, 2005a) and Extended and Supplementary Nurse Prescribing (NMC, 2005b). But the KSF posed a more challenging task as this pertains to almost all of the school’s educational provision (Table 1).
At Salford, this process began a few years ago when AfC was proposed. This coincided with a comprehensive review of the school’s post-qualifying and postgraduate portfolio, from which a specific recommendation required us to map all educational provision against the KSF.
Many of the trust education coordinators have also been assigned the ‘KSF lead’ for their organisation. They recognised quickly the mutual benefits of mapping courses and study days against the KSF and were generous with their time to help the school to analyse the implications of AfC on lifelong learning. Together we sifted through draft documents, job evaluation outlines and work from pilot sites for AfC and the KSF.
When managing change, a quick fix is a good motivator. Our quick fix was linking study days to the KSF. Topics for some of these were negotiated with the school and trusts as they are part of the education contract with GMSHA. One trust education coordinator identified the need for a study day on ‘communication in complex situations, KSF level 3’. Consequently the topic areas were all identified in this way and learning outcomes for two study days were directly related to the specific dimension of the KSF at the required level (Table 2, p37). In this instance, the learning outcomes were written around the KSF. However, the huge challenge was to map existing modules and programmes with their established learning outcomes against the KSF.
Preparing academic staff
The KSF was discussed with staff at committee meetings and key staff, for example programme leaders, were involved in planning this initiative. Presentations on the KSF and its implications were given by a trust education coordinator on staff development days. Staff were encouraged to discuss this with clinical colleagues and to access resources such as the electronic KSF (e-KSF), DH website and documentation relating to AfC and the KSF.
All module leaders and programme leaders were sent information, which included:
- The reasons we needed to map against the KSF and the perceived benefits;
- Resources relating to the KSF;
- Mapping tools;
- An invitation to attend a workshop to complete the mapping exercise.
This was reinforced by contact with staff. A workshop was held in January of this year and a senior administrator gave a brief introduction to the e-KSF and how she could help staff using this tool.
The need for this initiative was reinforced and staff began to map their respective modules supported by peers who had advanced knowledge in this area.
Inevitably, some staff were unable to attend the workshop and individual follow-up and support has been required. Fortunately, academic staff who have close contact with clinical colleagues helped to champion the mapping process.
Developing the tools
A small team of administrative and academic staff developed a simple tool for the mapping exercise. This was a grid containing all the KSF dimensions and their respective levels against which module leaders could place a tick where a link is apparent.
A spreadsheet was developed for each level so all modules and their relationship to specific dimensions of the KSF could be examined. This would enable us to examine the whole portfolio of modules and spot any gaps in relation to the KSF. Consequently, this would help the planning of future modules and programmes.
Separate spreadsheets were also developed for each programme. These were designed to show how all module options for each programme could map against KSF dimensions and levels. This would help students to choose the modules most appropriate to their needs. An example from a module run at Salford on legal aspects of healthcare is given in Table 3.
Simultaneously, the school has implemented PDPs for all students - this initiative has been developed in partnership with trust colleagues to ensure this is complementary to PDPs used with the KSF.
The benefits of undertaking this mapping exercise are far-ranging and impact upon NHS staff, managers and commissioners and educational staff in the school of nursing. They include:
- Ability to match training needs and PDPs to our modules and programmes;
- Ability to match career and pay progression to our modules and programmes;
- Planning how education helps to achieve their own goals;
- Increased likelihood of gaining support from managers to access study related to NHS needs;
- Bridging the theory-practice gap;
- Seeing how trust goals can be achieved through supporting staff in lifelong learning.
There were other benefits:
- It became easier for trust-based educators to justify how they utilise education resources/budgets in relation to the KSF;
- Partnership working was strengthened;
- Staff satisfaction increased where modules and programmes could be seen to relate to student and NHS requirements;
- Students may be attracted from the wider workforce of the NHS;
- There would be informed planning for future developments.
NHS staff face many changes and the KSF focuses on what staff can do rather than on what they think. Mapping CPD activities against the KSF helps to identify ways to meet challenges. Recent developments have embraced this and there has been more investment in work-based learning and clinical skills opportunities.
Our mapping exercise may need adjusting in light of feedback from clinical colleagues and prospective students. We debated whether to simply link modular learning outcomes with dimensions of the KSF or whether to include levels of the dimensions that could be achieved by the students. The usefulness of including levels needs to be discussed and the mapping tools may also need to be refined. We need to use marketing materials, communication networks and our website to communicate this information to NHS colleagues. We also need to continue to help students link their learning with the workplace and improving patient outcomes and believe that using PDPs will help to reinforce this message.
Finally, we have recognised that future programme development must take account of the KSF at an early stage. This will involve developing learning outcomes, and teaching learning and assessment strategies in partnership with NHS colleagues to ensure that their educational needs are met.
- This article has been double-blind peer-reviewed.
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