Bringing new IT skills to the NHS

Source:  "eHealthInsider - Education" ( www.ehealthinsider.org/ )
Date: 16 May 2007

The NHS is implementing new computer systems at an unprecedented rate. Some support is available from system suppliers but the NHS must ensure that the systems are fully supported on an on-going basis.

More NHS staff than ever before are required to have technical skills which they can apply to computer systems used for the provision of healthcare. These health informatics staff are becoming as vital to the NHS as their clinical and administrative colleagues. By providing up to date, accurate clinical information about the condition and treatment of a patient, better care can be provided and outcomes improved.

Because of the scale of the National Programme for IT in Healthcare (NPfIT), the LSPs and health systems vendors have had to bring in large numbers of new IT staff, with little or no previous experience of the NHS or of health systems. For these staff to become effective in this market sector, they require a significant amount of training in the workings of the NHS and healthcare technologies as well as specific health systems. For a typical NHS trust, the problem is both that they have insufficient IT staff to support the new systems as well as lack of experience with large system implementation projects. Previous implementations of systems such as electronic patient records have been run as stand-alone projects and the supplier has provided the technical expertise to see the project through to completion. The difference with NPfIT is that NHS trusts are receiving multiple systems which must be integrated and the systems suppliers are working to very tight budgets and timescales. This has meant recruiting new technical and management staff, many from the private sector.

Critical skills

Some of the critical skill areas for support staff in the NHS and suppliers are:

     • NHS business processes and the patient journey

     • Healthcare specific technologies such as HL7 and DICOM

     • Specific health systems such as Cerner Millennium, iSoft, GE PACS and HSS RIS

     • Project management within the NHS

     • Technical support for users

Arguably the most important of these is to understand the business of healthcare provision in the NHS and to relate to clinicians when they talk about the patient journey. Without understanding the process of diagnosis and treatment in the NHS, how can health informatics staff provide appropriate computer systems and correctly prioritise support?

The National Audit Office report released in June 2006, strongly recommended improvements to NHS staff training "to strengthen capability, including project management and IT skills available” and added that "The shortage of such skills is an immediate risk to the timely implementation of the programme, and strengthening capacity in these areas will be a long-term asset for the NHS."

What is the best way to make sure that staff are up to the job?

Staff require training in a range of health systems and health informatics courses covering the skills required to perform their roles effectively. Ideal Training has developed a wide range of health systems and health informatics courses that address these issues. The courses are aimed both at NHS staff and staff within health systems suppliers and LSPs that have responsibility for implementing, supporting and running new health systems. This training provides the knowledge and skills required to enable information to be collected, managed, used and shared to support the delivery of healthcare.

Understanding the NHS ethos

An essential element is in ensuring that staff new to the NHS understand the ethos, infrastructure and workings of the NHS. The course “Healthcare Provision in the NHS” which includes a background in health and social care as well as the structure and culture of the NHS, provides a solid foundation. Run over two days, the course is suitable for systems supplier IT staff moving on to NHS projects as well as support staff who have recently joined the NHS.

Additionally, technical support staff within the NHS and the LSPs need to provide a range of support services on the specific health systems applicable to their organisation. This may cover a number of areas such as: care records, primary care systems, PACS and RIS. Implementation staff need to be able to design, configure and build a system for installation within a hospital and support staff need to manage and maintain the systems behind the scenes to ensure smooth operation of the systems by the hundreds of clinical and administrative users who depend on it.

Training can be provided on individual health systems such as Cerner Millennium, RiO, GE PACS or HSS RIS as well as on the integration of these systems that make up the complete LSP solution.

There are also a number of technical areas such as networking and data management which require staff to have specific knowledge and skills to provide support within the NHS. One example is the use of the N3 network to provide high speed connections between NHS organisations. A three day course called “Network Support for NHS Staff” covers all aspects of networking including N3. Another specific area is the use of the NHS Data Model which is fundamental to producing statutory returns to the Department for Health. This is covered in detail in a two-day course. Some level of HL7 training is usually required by technical staff who build, implement and support health systems

Practical, hands-on, relevant

For the health systems training to be effective, it should be practical and hands-on and made as relevant to the NHS as possible, with exercises, examples and case studies designed specifically for the healthcare sector. For example project and service management are familiar territory outside the NHS but rather than send staff on a standard PRINCE2 course focusing on examples taken from financial services or telecoms, staff will benefit much more from a course specifically designed for the NHS such as “PRINCE2 Foundation and Practitioner for the NHS”.

Whatever role staff are playing in the massive expansion of IT in the NHS the training they receive will be critical to the success of projects such as NPfIT. The health of the nation is closely linked to the skills of the technical staff behind the systems.

For more information about the training paths available for health systems support staff please visit www.idealtraining-uk.com .

Flexing training facilities to meet peaks of demand

With the various IT initiatives being introduced through NHS Connecting for Health, there is one common factor underpinning successful implementation; the ability to successfully train NHS staff in an effective, timely, cost efficient manner.

Whilst there have been some successes with the use of e-learning in the NHS, it is likely a great deal of training delivered for systems such as electronic care records , will be through instructor led training (ILT).

All local service providers are committed to programmes of ‘Train the Trainer', as part of their contractual agreements . Many trusts have already identified - and started - to develop the internal staff for training delivery.

Challenges

However, one of the challenges facing trusts is the lack of suitable training venues. It is acknowledged there are limited appropriate training facilities in many NHS trusts to enable staff to use new IT systems.

With the responsibility for training staff in new technologies and applications resting with trusts, mobile training units can form an important resource to provide additional facilities that can be called upon when needed.

Dr Phil Candy, NHS CFH director of education, training and development said: “Using these units will help to minimise disruption to frontline staff and is a cost-effective solution to meet training needs.”.

Among the problems often faced when developing training plans to support implementation is the ability to complete the training close to the ‘go live' date. To ensure that learning is reinforced and put into practice. Usually, this means the training plan must be compressed to no more than eight to10 weeks prior to the live date. This puts enormous strain on existing trust IT training suites where resources are already highly utilised.

Case: Greater Manchester South East Sector

Elaine Richardson is Greater Manchester South East Sector project manager for implementation of the community patient administration system which is within the North-west West Midlands cluster.  She tackled the challenge of finding suitable training space for the 1200 nurses, healthcare professionals and administration staff requiring training.

The sector was committed to commissioning new IT training facilities, however they would not all be completed in time for the start of the training programme. They turned to mobile classrooms .  Three PC Pods were utilised on-site at the Glossop rural community rehab unit and Tameside offices for training NHS personnel on the new computer system required for introducing and implementing, the new NHS Care Record Service.

The PC Pod is a 10-seat mobile training unit containing all the learning tools and resources that would be found in a purpose-built IT training suite. Featuring the newest IT facilities, each PC Pod can be connected to an organisation's existing network. Internet access can be provided too.

Six NHS staff trainers delivered skill development modules encompassing six sessions to support the administration and patient care learning elements.  Obtaining the skills to ensure successful management of the NHS Care Record, and achieving the right balance for the best standards of patient care, were key issues.

Elaine Richardson comments: “We had to consider several factors in undertaking the IT training to meet our needs. Training facilities had to be linked to the NHS N3 network”. “So, we were restricted as to where we could do the training.  Off-site was not possible, so using our existing network we sited the PC Pods in the car parks next to the buildings”.

“The trainers were very impressed – and at home with - the PC Pods.  Each is well equipped with the essential IT systems and facilities, while delegates enjoyed the pleasant learning environment”.  “The vehicle design provides comfort and a sense of space – all conducive to providing an ideal learning environment.  Being on-site, staff time away from their day-to-day tasks and disruption to daily routines was minimised.”  She continues: “Our training programme continues to support our commitment to achieving the highest standards and best practice in the use of technology”.

“Ultimately, the prime objective and focus for training people in new IT skills should be for obtaining the highest standards possible in patient care.”

Case: Ipswich Hospital NHS Trust

Ipswich Hospital NHS Trust was the first to book PC Coaching mobile training units (MTUs) after NHS Connecting for Health (NHS CFH) appointed the firm as the sole provider of MTUs and trainers for the National Programme for IT across England last autumn.

The 800-bed hospital, one of the largest and busiest in the East of England, used two stand-alone PC Pods on-site to facilitate the iSOFT training needs of over 1,300 staff, including administrative and clerical staff, nurses and surgeons on its patient administration system.

The two-year framework agreement, managed by NHS CFH's Education, Training and Development Programme, addresses the training facility shortage across the NHS for end user training delivery, in an initiative designed to strengthen support for the NPfIT.

Neil Turnbull, head of programme delivery at Ipswich Hospital NHS Trust commented: “We've used PC Coaching MTUs for very successful IT skills development roll-outs before, but while we needed to increase training capacity, under the new framework agreement we also achieved significant cost savings of nearly 20 per cent.  “The PC Pods meant the training proved most successful. We were able to manage the whole training process with minimal disruption to staff working schedules. Our staff obtained the necessary additional IT skills in a state-of-the-art, well laid-out learning environment. They learned in comfort too - a key benefit staff highlighted in positive delegate feedback.”

PC Coaching's NHS project director Phil Gray said: “The agreement with NHS Connecting for Health makes it easier - and much faster - for NHS trusts to access our mobile training facilities and trainers.  “It ensures the training solution has been quality assured, as well as achieving significant cost savings from procuring nationally, rather than locally.”