Executive summary

NHS England Workforce Training and Education Yorkshire and the Humber (NHS England WT&E YH) would like to thank the education and senior leadership team representatives for attending this Senior Leader Engagement (SLE) meeting. The main findings are:

• Health Education England (HEE) has now fully transitioned into NHS England WT&E YH and the changes to the intervention process going forward will focus on 2 yearly SLE meetings. Where required, risk-based meetings will be arranged in line with the quality framework.
• The trust has identified Acute Medicine as one of their top challenges, along with supervision arrangements across the board and will require close monitoring by NHS England.
• A new Urgent and Emergency Care (UEC) Centre is opening in November 2024 at the Scarborough Site.
• The new Director of Midwifery has had a positive impact on the provision of support for midwifery students in improving culture and engagement across learners.
• An Allied Health Care Professional (AHP) Head of Education is now in post who has engaged well with learners across the organisation to improve experiences of their placements.
• A Learning, Education and Development Group has been established to develop strategies around multidisciplinary teaching.
• A new Guardian of Safe Working Hours (GoSWH) has been appointed.
• The trust has undertaken extensive work in support of the multiprofessional agenda in providing a more inclusive environment and continuing evaluation of processes to implement improvement.
• There are no open requirements for the trust and has received a summary report from NHSE to aid in their analysis of the 2024 General Medical Council National Training Survey (GMC NTS) survey. NHS England will expect that any actions are documented in the trust self-assessment return in the Autumn. The trust has received 6 reported instances around bullying and undermining or patient safety comments within Acute and Emergency Medicine.
• The next Senior Leader Engagement Meeting is due to take place in 2026.

Review overview

Background to the review

Senior Leader Engagement (SLE) meetings aim to strengthen working relationships with senior leaders, to develop an understanding around the commitment to the education and training quality agenda.

Evidence

• 2023-2024 Tariff Report
• 2023 April York Monitoring the Learning Environment (MLE) Report
• 2023 National Education and Training Survey (NETs) Highlights
• 2023 National Training Survey (NTS) Scores and Ranks
• 2024 Quality Report
• 2023 Health Education England (HEE) Deans’ Equality, Diversity and Inclusion (EDI) Annual Report
• 2024 Guardian of Safe Working Hours (GoSWH) Board Report
• Practice Assessment Record and Evaluation (PARE) Top 5 Bottom 5

Who we met with

Education team:

• Director of Medical Education
• Medical Education Manager
• Chief Nurse
• Deputy Chief AHP – Lead for AHP Professional Standards
• Head of Medical Education
• Associate Director, Medical Governance
• Freedom to Speak Up Guardian
• Director of Finance
• Medical Director

Review panel

• Education Quality Review Lead: Professor Andrew Lockey, Quality Associate Dean (NHS England chair)
• Specialty Expert: Claire Arditto, Regional Head of Allied Health Professionals
• Speciality Expert: Cheryl Guest, Integrated Care Board Link (H&NY)
• NHSE Education Quality Representative: Jon Hossain, Deputy Postgraduate Dean
• NHSE Education Quality Representative: Vicky Jones, Quality Support Manager
• Supporting role: Michele Hannon, Quality Administrator

Review findings

The review panel thanked the trust for accommodating the senior leader engagement meeting (SLE) and were informed that the review panel were seeking to understand any initiatives made within the organisation and challenges impacting on training where new sustainable methods of improvement could be identified.

Equality, diversity and inclusion

The trust identified several networks, including equality, diversity and inclusion (EDI), who are focusing on ensuring that a broad range of staff are invited to input into organisational improvements. The following was noted:

• Staff groups including Black and Minority Ethnic (BAME), and neurodiversity networks work together to ensure that essential feedback is provided through the Chairs to the executive team.
• A suite of EDI training is available through the Human Resources (HR) team for staff, with several additional networks being considered.
• The trust reported they are making improvements to their workforce planning at every level with areas of good practice from within the organisation being reviewed for wider implementation across the staff groups.

Governance and reporting

• The GoSWH appointment has been confirmed and reporting will continue to take place. The linked Associate Dean will make contact in their role as regional lead for the guardians going forward. Reports received were around late finishes, with 80% of submissions coming from Foundation Year 1 and further work will need to be done to encourage more senior doctors to engage with the process.
• The Freedom to Speak Up Guardian (FTSUG) indicated that there were no main areas of education and training to highlight. The numbers of reports submitted by PDiT were low, with those reports received being around the behaviours and experiences of bullying impacting on their overall experience rather than specifically education. Engagement with the induction process was a suggested option in working with the PDiT and to provide assurances on anonymity throughout the process.
• The trust would benefit from providing guidance on the key differences between the FTSUG and GoSWH to outline the roles to learners so that concerns are appropriately directed to ensure appropriate action can be taken.

Medical specialties

Acute internal medicine

• The ongoing environment within the NHS has resulted in several challenges, including industrial action, for the trust impacting on service and delivery. However, a wide range of local teaching within the wider trust setting, is being provided to ensure Postgraduate Doctors in Training (PDiT) gain the optimal opportunities to support their learning environment.
• It was acknowledged that several ongoing issues have been identified within Acute Medicine, especially around adequate supervision. The trust has made two new appointments, and this will be further supported by a new Clinical Lead from Renal Medicine who will commence on secondment from September. Two locums are now also in post, with a colleague due to return from maternity leave and this should provide a broader level of support. NHS England will continue to monitor the impact of these changes on the PDiT going forward.
• Industrial action has impacted the trust. PDiT continued to attend teaching and maintained contact with consultants on the ward, with limited cancellations reported in relation to study leave.
• The trust has undertaken significant work within the medical and surgical specialties at the Scarborough Site, enacting proportionate levels of monitoring of concerns along with feedback from PDiT. Improvements have been noted with expectations this will be reflected in future General Medical Council (GMC) results.
• Supervision has been a challenge within the trust with the majority of PDiT now having a named supervisor identified from August. However, ensuring continuity of allocation for those commencing outside of standard rotations has proved more difficult.
• Despite the challenging environment, supervisors have continued to build on their relationships with the PDiT and work is underway to engage with the workforce further to establish better processes in identifying areas for attention before being raised through the national training surveys.
• It was noted that there is an impact on the ability to negotiate locums and substantive posts within the organisation, which may influence other rotas such as General Internal Medicine. However, the trust was commended on their progress within the diversity of supervision becoming available reducing reliance on a small group of individuals.

Multi-professional training

Allied healthcare professionals (AHP)

The trust appointed a Head of AHP Education and Training which is having a significant positive impact for learners. As part of the role the following was noted:

• Significant workstreams provided on improving skills, developing scores and specialty competencies with a more robust way of support for learners.
• The trust met with the Health Education Institution (HEI) to discuss pre-registration practice-based education to support the move towards a set capacity model where more learning can be provided where necessary. This entails changes to the current ways of working which are underway.
• Development of a robust governance process is in place for AHP placement quality review and where areas fall short of the required standard NETs (75%) scores for quality in student feedback there is a formal process for review – The level of this has been increased this year to 80% to support on-going improvement. The NETs questions would be utilised to review for all AHP groups, and this is reported at the AHP Board for assurance.
• Learners now have access to a AHP Newsletter to strengthen communication links as well as newsletters between medical nursing and allied health to share learning opportunities.
• AHPs and students on placement are being supported to undertake clinical supervision training and 550 individuals have now been trained in health coaching. Learners are also being supported to access development and leadership forums which is providing excellent training opportunities around EDI, being good leaders and neurodiversity.
• Concerns had been raised around cancellation of placements which after undertaking a significant amount of work around provision of processes and support is having an impact on staff morale.
• There has also been a wider push to take on board data received through PARE and NETs to ensure a wider appreciation of the learner voice. Feedback from this process will also be used towards induction to enhance the levels of support available. The trust is aiming to develop roles and responsibilities towards ‘good guidance for clinical educators’ to ensure continuity across nursing and AHPs.

Nursing and midwifery

The chief nurse has been undertaking a review of initiatives which are working well in supporting students within the learning environment and where the trust can implement further improvements. These were noted as:

• Review of governance structures around surveys. The use of PARE would be a good source of data to assist in the review of information around the quality domains and identify themes in guiding where further work could be implemented.
• Utilisation of a Department Manager, alongside band 7 support, continue to support staff in their understanding of student roles.
• Practice Learning Facilitators (PLFs) are considered an important role to guide nursing and advocate learners in providing guidance for new registrants.
• Listening events with learners to expand on the current offering of education and support provided.
• The use of in-situ educators to work alongside live simulations on the job to enhance the overall learning experience. Improved senior team visibility is ensuring learners can engage in the exchange of feedback.
• The trust acknowledged there is currently no clear development and management pathway. This is anticipated to be implemented soon with the aim of giving learners clear guidance on what good supervision should be received.
• A Director of Midwifery has been appointed to help support students and whilst there was a large offering of education and support available for student midwives, nurses and AHPs it was acknowledged that there were still improvements to be made.
• The Scarborough site is close to full recruitment within maternity and are looking at ways where reasonable adjustments in terms of travel time could be used.
• Maternity across the trust is included as part of the Integrated Care Board (ICB) Culture Change Programme in supporting a review by the Nursing and Midwifery Council (NMC) following concerns around bullying and undermining within the organisation. Engagement with learners has been paramount in taking on board recommendations for change and ongoing work around a clear improvement plan.

Safe Learning Environment Charter (SLEC)

The SLEC was launched following a piece of investigative work conducted in response to the Ockenden Report. The application of the charter has now been extended beyond midwifery to include all professions. A presentation was given to the trust team to enhance their understanding of the charter, which has a golden thread of EDI running throughout its principles and the priorities which should be considered in ensuring continued improvement for its workforce. NHS England were happy to provide support and guidance where required and agreed to share the slides post meeting.

The trust was asked to outline how they were sighted in relation to the charter. The trust can use a self-assessment maturity matrix accessed through the website and were asked to provide their feedback on current versus future areas which would benefit from improvements.

The trust confirmed that mapping has commenced against previous interventions which have taken place to address learning, development and culture concerns within the organisation. NHS England will ensure that this area is covered at future SLE meetings.

Tarriff

Discussions were undertaken around the allocation within the organisation to ensure that learners are being adequately supported and the trust has confirmed that a review is underway.

NHS England confirmed that the trust has signed off the current agreement, with finance schedules updated and payments should now have been made. The process for any outstanding payments in relation to tuition was outlined, with a tendering process required to initiate any further interim agreements required. Guidance on whether funding will be expanded, and which professions may be included is pending. It was acknowledged that the funding is currently nurse centric and further work could be considered within maternity.

It was suggested that further work around capacity and importance of education will be central to understanding the best utilisation of the funding. Training grants are available, and work could be done within the system to identify areas this could be used.

It was noted that within the last 12 months a Learning, Education and Development Group has been established looking at multi-disciplinary teaching to develop better strategies. The trust has employed 3 Leadership Fellows, who will be coordinating a celebration event of all education at the trust across all the disciplines. 

Areas that are working well

Report approval

Report completed by: Vicky Jones, Quality Support Manager
Review lead: Andrew Lockey, Associate Dean
Date approved by review lead: 16 October 2024

NHS England authorised signature: Jon Hossain, Deputy Postgraduate Dean
Date authorised: 29 October 2024

Final report submitted to organisation: 4 November 2024

Publication reference: PRN01548