The impact of commissioning processes on the delivery of continuing professional education for cancer and palliative care
Introduction
The system of commissioning nursing and other non-medical education and training was introduced into the National Health Service (NHS) in the mid 1990s in response to Working Paper 10 (1989) which transferred funding from the National Boards to the Department of Health (DoH). Some re-organisation has since taken place and the original title has changed, but the core functions of the workforce development confederations (WDCs) are the same. They collate workforce development plans, identify service needs, ensure that adequate numbers of nurses are recruited and trained and that the content of educational programmes matches service needs.
From the outset there were fears that the commissioning process would hamper service planning. It was suggested that poor quality numerical data would impede ability to forecast requirements (Burke, 1995) and that this aspect of the work would take place at the expense of addressing the needs of existing practitioners for continuing professional education (CPE) (Francis, 1996). In a later paper, Francis and Humphreys (1998) also expressed concern that commissioning would fail to take into account the skills-based nature and content of educational programmes, especially post-qualification. This issue was considered in greater depth by Hudson (1996) who was particularly concerned about the need of the existing workforce to keep abreast of technical advances in care, especially in specialist areas of practice. Taking cancer and palliative care as his exemplar, Hudson (1996) pointed out that the CPE needs of this specialist group would not be met effectively under the new system because numbers would be so small that courses would not prove economically viable at local level. He predicted that unless the CPE needs of small, highly specialist groups of practitioners continued to be met regionally or nationally, they would become increasingly scarce, more fragmented and less satisfactory. As this paper will argue, at least some of these fears have now been realised.
Much has been written about the quality of post-registration courses (see for example Barriball et al., 1992; Pedder, 1998; Furze and Pearcey, 1999) and the need to invest in CPE for health professionals has been reflected in numerous Government policy documents (DoH, 1998; DoH, 1999; DoH, 2000a; National Audit Office 2001). However, little has been written about the effects of the commissioning process itself on the quality and relevance of post-registration nursing education,especially in relation to specialist areas of practice. Moreover, it is difficult to interpret and apply the literature relating to CPE to educational practice because of the lack of agreement concerning the definition of CPE and its aims.
Section snippets
Literature review
One of the most widely accepted definitions of CPE for health professionals is that it should enable them to improve health care outcomes (Green, 1984). However, in the UK this issue seems to have become confused. Early proponents of CPE, whose writing predates the introduction of the educational commissioning process, suggested that its purpose was to ensure that the requirements for professional updating stipulated by the national boards were being met (Bysshe, 1991). Other authors have
The study
The study reported here took place as part of a larger initiative to explore the training needs of the workforce in a Cancer Network in the London area (Kelly et al., 2003). Its purpose was to identify the skills held by the nursing workforce throughout the local Cancer Network, to map the existing educational provision and to identify any factors which appeared to be operating as enablers or barriers to training. The project was a joint initiative between the WDC and the Cancer Network.
Aim
The aim of the arm of the study reported in this paper was to explore the process of educational commissioning and its perceived effectiveness in meeting the service needs of people with cancer throughout one London Cancer Network. The study sought information about how the commissioning process was perceived by key stakeholders within the WDC, the two universities which provided the education for practitioners in relation to cancer and palliative care throughout the Network and educational
Study design
A qualitative, exploratory approach to data collection was considered the most appropriate in view of the dearth of literature concerning the educational commissioning process in general and particular to cancer care (Silverman, 1997) and because qualitative methods are particularly appropriate when a large amount of information is required from a small number of key individuals (Rose, 1994).
Information was sought concerning the nature and relevance of education provision for cancer and
Ethical considerations
Permission to undertake the study was given by the ethics committee serving the local trusts. All participants were assured that the data would be treated in strict confidence and their identity as well as the identity of their institutions would not be disclosed in the final report or publication. All participants received verbal and written information about the project. Written consent was obtained before data collection commenced.
The views of workforce development confederation representatives
Both representatives from the WDC summarised their role as:
Making sure that the required workforce is in place, with educational commissioning responsive to local requirements in line with national policy changes.
A key feature of this role was considered to be maintaining effective working relationships with staff in the trusts and universities. This was regarded as an important function of the senior nurse advisors in the WDCs. However, educational commissioning was not their only function and
Discussion
The views of stakeholders obtained during this in-depth, qualitative study were generally well corroborated. A major problem with commissioning post-registration nursing courses was failure to identify educational needs accurately as a result of insufficient attention being given to TNA at trust level. Commissioning was also dominated by the need to demonstrate value for money at the expense of innovation, a point already made by Francis and Humphreys (1998). In addition, stakeholders
Conclusion
Soon after the introduction of commissioning into nursing education, anxieties were expressed concerning its effects on the provision of CPE,especially for specialist practitioners. This in-depth, qualitative study sought information about how the commissioning process was perceived by key stakeholders in the WDC and the two universities which provided the education for practitioners in relation to cancer and palliative care throughout a local Cancer Network. Shortcomings included failure to
Acknowledgements
We thank the Workforce Development Confederation which provided the financial support for this study.
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