Health, Wellbeing and Local Government

Committee Inquiry: Health and Social Care Workforce Planning

Evidence from David Smith, Food Policy Adviser, the Welsh Food AllianceWe welcome this opportunity of presenting evidence from a citizen and service user perspective. The Welsh Food Alliance is an independent self-financed organization. It brings together expertise, and citizens, in all aspects of food policy. We aim to provide a new perspective based upon informed public participation. Work force planning is central to delivering improved quality public services and the achievement of social justice. It is also an issue which has been some what neglected by the third sector, and in our view statutory bodies need to be much more pro-active in engaging with service users at the earliest stages of the planning process. Recently, the Royal Society of Health commissioned an article on the theme of 'Caterers - Health workers in disguise’ (1). To help test this theme, this evidence focuses upon two aspects of the 'Quality of Food’ strategy, which is currently out for public consultation. The National Assembly for Wales 'Quality of Food’ motion included (A) Making Food Studies part of the National Curriculum, teaching pupils about nutrition as well as how to cook healthy food, and (B) Improving the nutritional standards of school meals and meals provided in hospitals (17th October 2006). In respect of (A) do we currently have sufficient trained food specialists to deliver the new curriculum commitments from September 2008 to the required standard set out in the relevant National Curriculum Order? What will be the estimated shortfall of food teachers, especially at Key Stage 2? What action has been taken to provide refresher food teacher training? What attention is being given by Design and Technology Advisers to address these issues? Turning to (B) it is unclear whether the latter includes investment in training NHS catering staff, or if it is intended, at some point, to include public and private sector nursing and residential homes, or community based services. In our opinion they should, since workforce planning, development, education and training will be essential for the health and wellbeing of all vulnerable population groups. We consider public health aspects beyond health and social care. So some questions may not be directly applicable to (A) and (B). Information provided is usually drawn from varied Welsh Food Alliance submissions, in response to Welsh Assembly Government, DfES or Food Standards Agency consultations. Our evidence does not consider the efficacy of government consultation processes, as a means of raising workforce-planning issues, which span different tiers and functions of government, nor do we consider the consequences for health and social care workforce planning arising from the societal problem of obesity, although these will be considerable, as these are beyond the scope of this Inquiry, but require urgent attention.

Question One 

Is workforce planning undertaken by the right agencies and in such a way that takes into account other key factors such as finance, service planning and training capacity?  Should it be more or less centralised?

(A) National Curriculum

In March 2007, in evidence submitted to the Welsh Assembly Government National Curriculum consultation Design and Technology Questionnaire. The following points were raised:

5. The revised Order includes emphasis on Health and Safety issues at KS 3 and 4:

 Tend to Agree

Our Comments

This is an extremely important aspect of Design and Technology. However, consequences follow in relation to teacher training required in basic food preparation and nutrition at Key Stage (KS) 2 alongside a Primary Hygiene Certificate. We would wish to be assured that CPD training is not provided in a piecemeal manner, but is properly accredited as part of a continuing process of staff development. All will have financial implications to ensure effective implementation

.

10. It is proposed that the revised National Curriculum subject Orders will come into effect as detailed below:

Our Comments:

Key Stage 2: effective workforce planning and development will be essential to ensure, planned training and support. This must be in place for effective implementation. This is especially the case with food, where there are implications for non-specialists and the need to ensure appropriate food hygiene certification. How, who and where will such training be undertaken? How will this be effectively regulated?  We see the need for sharing and collaboration across Wales - perhaps using school clusters - primary, secondary and mixed clusters to enhance teachers knowledge and skills base.  In Wales, it is noted that the approach is still fragmented. Key Stage 3: It is noted that some school departments do not cover these areas, at this level, due to accommodation problems, time tabling and staff shortages, which will have to receive attention and better now than later.

Other comments

Overall we see food education as an essential aspect of future Public Health strategy and we would emphasise the role of workforce planning and development to ensure the citizen centred public service delivery supports our wider ambition for a healthier population in a future Wales. We would welcome further consultation, especially in terms of workforce planning and development.”At all Key Stages, local authority Design and Technology Advisers, appropriately trained and experienced in food have a key role to play in advising Head Teachers.

(B) School meals and meals provided in hospitals.

The current UK framework groups qualifications under 'occupational' National Vocational Qualifications (NVQs) related to a specific job and are based on knowledge, skills and competence now required in the workplace. In contrast, vocationally-related qualifications (VRQs) provide a broad introduction to a particular vocational area, for example, the preparation and cooking of food. In social care, which is a Welsh Assembly Government (WAG) priority, social care workforce planning is centrally guided and supported at local, regional and national levels, with support and leadership of Care Council Wales, with partnership / collaborative approaches at all levels, based upon an NVQ approach to work based assessment and training. In school meals, catering training WAG has sought to devolve this to each local authority. In effect, each local authority had to undertake their own assessment of staff training needs, and based upon this, make an application for a grant offering training for school caterers. The stated aims and objectives of WAG school meals training initiative were:

• "To help equip caterers with the necessary skills and knowleges (sic) to support the delivery of the proposals in Appetite for Life
• To ensure that professional development and training plans caterers' levels of competence and identify the new skills required to deliver with confidence the changing service
• To apply minimum standards which would support existing training”.

(Sent by WAG to LEAs, December 2006) A number of local authorities have used WAG School Meals Training Grant aid as an opportunity to fund the delivery and assessment of 'food preparation and cooking’ at NVQ level 2. Whereas others opted to focus upon classroom based VRQs.  We believe that there are too many options instead of well planned, organized and funded training with good qualifications nationally recognized. In contrast to this, in various policy statements it is noted that officials have been following the English option of VRQ training for school meals workers in order to achieve the 'nutrient standards 'to be prescribed in future regulation. In our view this class room based approach to delivering nutrition training is certainly cheaper than NVQ work based training, but is this the most effective method of equipping staff with the craft skills to switch from reheating pre-fabricated foods, to fresh methods of food production? We need to be bolder than just asking for minimum standards for this essential service, which is offering a piecemeal approach to workforce planning, training and development. What is required is a qualified and recognized role for catering workers within the system and workforce planning. How much more efficient and effective for this to be approached with the same vigor and enthusiasm as social care workforce planning, with a catering workforce expertly trained and recognized for the important function they have within the system. In line with recent WFA recommendations and correspondence with Ministers, WAG have now requested Skills for Health to undertake further work to support a more coherent approach to workforce planning. To what extent this will support the development of effective workforce planning, covering all aspects of public sector catering has yet to be revealed. However, it should be noted that when asked, in the context of a recent review, Skills for Health consultants did not know the size of the health workforce covered by the People 1^st, the hospitality and catering sector skills council We conclude, from information currently available, that there appears to be limited, if any capacity, at the centre, to support workforce planning across the Welsh School Meals service, let alone other aspects of public sector catering. In our view the service improvements, as set out in 'Appetite for Life’, should be given adequate resource to develop workforce planning for schools and expand good practices into other human services provided for all vulnerable population groups. It should be noted that in 2005 WFA sent a letter to the appropriate WAG official with responsibility for VQRs and NVQs. No acknowledgement or reply was received. This letter can be found at Appendix A. In terms of meals provided in hospitals, workforce planning includes catering and non-catering members of the healthcare team. We are aware of a WAG Hospital Food report, which has yet to be agreed by the NHS Management Board and the Minister. We suggest the Inquiry may wish to ascertain the extent to which workforce-planning issues have been addressed.  

Question Two

Is the information available to workforce planners of sufficient quantity and quality to ensure effective planning?

(A) National Curriculum

We assume that workforce planning information is available to, and acted upon by local authorities. Further, that local authority Design and Technology Advisers across Wales will have intimate access to sufficient quantity and quality to ensure effective planning. Our understanding is that in various parts of Wales the food component within Design and Technology has not been given the attention required, especially in terms of the food specialists who will deliver this aspect of the curriculum.  It is of concern that some schools are failing to deliver food education adequately. In evidence to the review of National Curriculum Orders, in order to help shape the future workforce required, WFA proposed:

• Mandatory healthy eating module in all teacher training at an awareness raising level, so they are equipped to promote healthy eating as part of a healthy lifestyle using accurate, consistent up-to-date messages. Training should be extended to all those who work with children, such as classroom assistants.
• Mandatory requirement to refresh food specialist training will be important as part of CPD.
• CPD opportunities, which may need to be developed. Awareness of and access to courses etc should be improved within schools. [Is this a support function the LEA could play? or should it be a central function?]
• A strategy should be developed and put in place to address the falling numbers of teachers being trained in food-based subjects and grow a larger pool of food specialist teachers.
• Adoption of a scheme along similar lines to the Food Partnership scheme in England where food teachers in secondary schools train teachers from their primary feeder schools to teach basic food skills, thus increasing skills and confidence of teachers and resulting in transferal of children with minimum competence in food skills and an awareness of the importance of this issue. This works well in England. It is difficult to understand why this has not been put into practice in Wales.

(B) School meals and meals provided in hospitals

In relation to the former, this is undertaken at the local level, where the local authority, at a corporate level, will be responsible for ensuring that sufficient quality and quantity of appropriately trained staff are available. This however will be constrained by the variability in (i) resources, (ii) training priorities, (iii) local authority capacity and (iv) the need to provide adequate cover and continuity in service delivery. Food education and training is expensive (ILO, 1997). We therefore emphasize the importance of shared arrangements across all aspects of public sector catering. 

Question Three

Is workforce planning undertaken with sufficient regard to future patterns of demand for services?

(A) National Curriculum

It is assumed that this is undertaken at the local authority level. Based upon past experience, with evident bias against the food component within Design and Technology, it is unclear how well prepared local authority Design and Technology advisers and LEA’s across Wales have made adequate workforce preparations, for example, in terms of delivering KS 2, which will leave the situation very little improved.

(B) School meals and meals provided in hospitals

The extent to which school meals staff have been deskilled by previous pressures arising from Compulsory Competitive Tendering, or the reduced skills and training required by new entrants reheating fabricated food is unknown. What is known is that training has moved to 'in house’ work based delivery of food preparation and cooking at NVQ Level 1. Whereas, in my personal experience, twenty years ago, a large proportion of part time students attending Further Education College provision were from public sector catering. The WAG School meals grant aid for training, referred to above, indicates some regard for the future pattern of service demand. Reference is made in 'Appetite for Life’ of the need to extend and develop skills in kitchen staff to help overcome the use of pre-fabricated foods high in fat, salt and sugar. Whereas, we need to revert to former methods of craft training if we are to get the improvements that are necessary.

Question Four

Are all stakeholders included in the process e.g. from the statutory, voluntary and private sectors?

(A) National Curriculum (B) School meals and meals provided in hospitals

Again we stress the need for joint arrangements and planning across all public sector human services, which require food education.

Question Five

To what extent do the current arrangements support or hinder effective joint working between health and social care and across the statutory, voluntary and private sectors?

(A) National Curriculum

In our view, current arrangements do not support effective joint working between education, health and social care sectors. In our view this lack of joined up government hinders the achievement of Welsh Public Health objectives. The effective delivery of food education within the national curriculum is an essential component in delivering effective human services in Wales and provides a firm foundation for all employers to build upon, including health and social care and beyond. It will also be important in achieving 'full public engagement’ as advocated by the Welsh Wanless report (2002). Teacher training is presumably driven by the requirements of the school, subject to resources, cover and capacity issues. In a sense the workforce may be seen as sufficiently flexible to meet the requirements of the school, with adjustments taking place where specialist food teaching staff are unavailable. The implications for example at KS 2 are unknown, bearing in mind that schools now have to deliver food as a compulsory subject from 2008. This means that arrangements to implement commitment (A) should already be in place to ensure schools have the capacity to deliver on this important aspect of government public health policy, which we have advocated over the past ten years. We observe the use of untrained people to deliver food 'training’ through community food initiatives and other activities. In our view it would be best if the school system could focus its resources on strengthening mainstream provision, rather than being drawn into extra mural activity, such as after school cookery classes and cookery bus type activity, which cannot possibly meet the overall population needs of pupils and schools across Wales.

(B) School meals and meals provided in hospitals

Local authorities, as other public sector catering organizations, will decide on their own requirements. Local authorities are large organisations. Training could well be fragmented across different functions, such as leisure, staff and civic catering, tourism outlets, schools meals and provision for older people. We are not aware of co-operation and partnership working between local authorities, or for that matter other publicly funded or commissioned catering services. This contrasts with the co-operation and partnership working expected across all sectors delivering social care.

Question Six

What are the arrangements for work force planning in areas with cross border patterns of service use (e.g. health services in North Wales)?

(A) National Curriculum     N/A

(B) School meals and meals provided in hospitals...

N/A

Question Seven

To what extent do the current workforce planning arrangements affect the use of agency staff and what is the impact of this on budgets?

(A) National Curriculum

Unknown

(B) School meals and meals provided in hospitals

Some use of agency staff, but one local authority found this not especially helpful

Question Eight

Are the current arrangement addressing the need for Welsh speaking and Black and Minority Ethnic staff?

(A) National Curriculum and (B) School meals and meals provided in hospitals

Yes in so far as local authorities, and NHS Trusts have relevant diversity and human rights policies in place and that these are acted upon.

Question Nine

To what extent is workforce planning anticipating changing patterns of service commissioning and provision and the changing or blurring of professional roles?

(A) National Curriculum

This service is not commissioned. In terms of boundary issues, it is unknown what impact the use of teachers assistants are having upon the employment of more expensive and trained specialist food teachers, especially at KS 2. Teachers assistants are important in assisting with the overall organisation of the delivery of food education, as well as freeing up the teacher to focus upon improved learning and practical outcomes.

(B) School meals and meals provided in hospitals, residential and nursing homes and more generally community nutrition services.

The school meals service is not commissioned. To some extent 'meals on wheels’ are commissioned. Workforce planning is required to address WAG’s ambition to promote local food production for local food consumption, and the up skilling required to enable fresh food production, which is in tension with pressures arising from current food price inflation and increased wage costs related to the need for equal pay for work of equal value. In this context, we see both the opportunity and need for the school meals service to provide community based meal provision either in the home or some other community setting to improve social contact, as part of a citizen centred approach to public service delivery.

Question Ten

Does workforce planning take sufficient account of the need for trained and effective managers?

(A) National Curriculum  -  No

We need to make sure that Head Teachers fully understand what is required to deliver food education. Design and Technology Advisers have a key role to play, provided they have an understanding and sympathy for the subject matter.

(B) School meals and meals provided in hospitals

The danger is that Stage 1 training occurs, without systematically improving the quality and capacity of catering supervision and management within the school meals service. Currently, cost pressures on local authority budgets means that managers are being retired early, even with the prospect of redundancy.

Question Eleven

To what extent have the European Working Time Directive and the increasingly international labour market had an impact on, and been acknowledged in, workforce planning?

(A) National Curriculum   

N/A

(B) School meals and meals provided in hospitals

  N/A

Conclusion

The effectiveness of current and future arrangements for workforce planning in the health and social care sectors in Wales is only one part of the solution. With the need for 'full public engagement’ (Wanless, 2002) to bring the supply and demand for scarce health care resources into equilibrium, the role of the public education system in 'making Food Studies part of the National Curriculum, teaching pupils about nutrition as well as how to cook healthy food’ requires sufficient investment in planning, delivering and evaluating the effectiveness of quality food education.  This in turn will provide a firm foundation upon which workforce planners across all human services will be able to build upon for the future. Apart from informed citizens, other occupations and institutions beyond health and social care can make an important contribution in ensuring that the 'food trolley’ is given equal status to the 'medicines trolley’ - in all health and social care settings, whether they be institutional or community based. It is therefore suggested that wider workforce planning arrangements will need to be considered and acted upon if, for example, catering workers are also to become healthcare workers in disguise. Ultimately, the societal problems we face in addressing food and nutrition issues, and in particular addressing growing obesity and the serious cost implications for the NHS, extend well beyond workforce planning, and at root are about the way the food is produced in the first place. No doubt this will be the subject of another Committee Inquiry.

Recommendations

1. Joined up planning and other arrangements are required to ensure efficient and effective collaboration and partnership working across all publicly funded catering services. This would be consistent with 'Beyond the Boundaries’ (2006) recommendations. Where possible an integrated approach to workforce development is required across all the different aspects of public sector catering. This will assist with increasing overall awareness, understanding, knowledge and skills transfer for overall benefit of workers and service users. 2. Particular attention should be given to ensuring that revisions to UK wide National Occupational Standards, used by public sector caterers, across various sector skills councils, are fit for purpose and effectively support Welsh publicly funded and commissioned human services, including Health Challenge Wales. 3. Revised National Curriculum Orders should provide firm foundations for food education, underpinned by a practical application and understanding of nutrition across all human services, including health, social care and wellbeing. 4. A designated Welsh Assembly Government officer should have overall responsibility for ensuring these recommendations are acted upon. 2^nd November 2007 (1) Royal Society of Health Journal, 'Caterers - as Health workers in disguise’ David Smith, Summer edition 2006

Appendix A

WFA Correspondence with WAG 2005. This was related to NVQs/VRQs providing the necessary foundation for catering workforce planning. No acknowledgement or response to this correspondence was ever been received. Dear Mr Waller,

Making the connections improving public services’ National Vocational Qualifications - Food Preparation and Cooking Levels 1 - 4

In our letter of May 31st we stated that from a value for money perspective, an NVQ approach would 'make a real connection' with improved service delivery and could be a robust way of demonstrating competence in a realistic work environment. With an NVQ approach adopted by the Welsh Assembly Government in relation to social care, it is difficulty to understand why England are proposing a classroom based vocationally related accreditation for school catering. Generically the NVQ approach to mandating delivery of nutritional standards is clearly relevant to funding all college and employer based catering education, including hospitals, leisure centres, schools, prisons, further and higher education, home care settings, residential and nursing homes in Wales. Could you please let us know if the issues outlined in our previous letter have been considered on a cross sector skills council basis in Wales and if so with what result? Yours sincerely, Jean Sullivan
Chairperson Robert Waller
Principal Officer
Training, Skills and Careers
Welsh Assembly Government
Cathays park
Cardiff CF10 3NQ 31st May 2005 Dear Mr Waller,

Food Preparation and Cooking - NVQs across all relevant Sector Skills Councils and local government

The Welsh Food Alliance has championed improved health over the past seven years. In doing so we have been very conscious that a skilled workforce is a critical factor if we are to bring about the scale of change envisaged in the fully engage scenario indicated by the Comprehensive Review of Health and Social Care in Wales (2003). On August 27th 2004 we organised a Food Education Inquiry at the Wales Centre for Health. The Inquiry considered the People 1st draft NVQ occupational framework and standards for Food Preparation and Cooking. The outcome, involving over two dozen people from local authority, the NHS, NPHS, trade and public health organisations, was two fold. Firstly, we agreed that the proposed NVQ framework and standards for Food Preparation and Cooking should be appropriate to meet the needs of business in complying with the impending EU food hygiene regulations across all sector skill bodies in Wales. Secondly, the Inquiry proposed a mandatory nutrition unit, at levels 1 - 4, so that we mainstream this unit across all Sector Skills Councils and avoid a fragmented approach across the sector. Following the consultation period, which ended in October 2004, a further informal consultation limited to industry and training providers took place in December 04.   People 1st concluded, contrary to FSA, DfES and our advice, that nutrition should be an optional unit, since industry and training providers agreed they neither had the assessment capacity, nor the need for such a requirement. It is in fact closely in line with what one would have expected. In most cases companies working in the catering sector do not see any added value from their staff having nutrition training. They will therefore see it as a low priority in terms of the subject make-up of the VQ/NVQ. Likewise colleges don't see it as high priority because it adds to course costs in a way that is not demanded by the 'market' of industry requirements. This is disappointing given the extent of public subsidy of vocational education, and the real contribution this could make to public health and the long term need of all employers for a healthy workforce. The only sector of catering which may have a slightly different attitude is the 'institutional sector' where there is an increasing pressure for nutrient specification and those designing menus have to take that into account. They may therefore see nutrition training as a higher priority. As you may be aware in England, DfES are working with the Food Standards Agency, local Learning and Skills Councils and People 1st in developing new vocational qualifications for school caterers and creating many more training opportunities. We also understand that England will introduce funding, support and guidance for school catering staff, to ensure catering staff are well trained in relation to the delivery of agreed nutrient standards. From a value for money perspective, an NVQ approach would 'make a real connection' with improved service delivery and could be a robust way of demonstrating competence in a realistic work environment. With an NVQ approach adopted by the Welsh Assembly Government in relation to social care, it is difficulty to understand why England are proposing a classroom based vocationally related accreditation. The NVQ approach to delivering nutritional standards is clearly relevant to funding all college and employer based catering education, including hospitals, leisure centres, schools, prisons, further and higher education, home care settings, residential and nursing homes. We would be pleased if issues outlined in this letter could be considered on a cross sector skills council basis in Wales and in relation to your departments contribution to 'Making the connections - improving public services' (2004). In allocating finite public resources we trust that the Welsh Assembly Government will give particular attention to supporting NVQ Food Preparation and Cooking programmes where nutrition forms a mandatory element of the underpinning knowledge for NVQs rather than a mandatory unit. In this way we can be assured that nutrition becomes an integral part of managing a catering business and employee assessment at NVQ levels 2, 3 and 4. This it is noted will enable us to revert to the position experienced in catering education from1960 - 1990. Of course employers are entitled to determine the content of NVQ programmes and we appreciate that government may not wish to be prescriptive. On the other hand the Assembly Government is entitled to positively encourage employers (and employees) who contribute to Health Challenge Wales, and play their part in contributing, in a very practical way, to changing public needs, and improving skills and the long term health of the nation. Yours sincerely Jean Sullivan
Chairperson

Appendix B Labour market issues

Turning the Tables: Transforming School Food - Recommendations for the Development and Implementation of Revised School Lunch Standards - December 2005.

Extract from Welsh Food Alliance response to the consultation from the Department for Education and Skills concerned with UK labour market issues. Labour market issues will inevitably constrain and determine a phased programme for change. The process of change in any catering organisation must start at the higher level, by establishing appropriate standards and by putting in place management and training systems, which enable improved service delivery. Delivering food preparation and cookery training, including food safety and nutrition, and NVQ assessment programmes that will underpin the transition from processed to freshly prepared food which will be essential. Collaboration between small business units will ensure efficiency and effectiveness. The Government propose a new VRQ, accredited by the QCA, to help school cooks understanding of what makes a healthy meal, and importantly, how to market them to encourage young people to eat them. But this only covers one aspect of workforce development. In focusing upon Stage 1 training it should not be assumed that other aspects of organisational change would automatically present themselves. The danger is that Stage 1 training occurs, without systematically improving the quality and capacity of catering supervision and management within the school meals service. We also note that if a Scottish style system is introduced in England, then it should be possible for aspects of Stage 3 training (see paragraph 3.7) to be accommodated and supported very cost effectively by the central system. (See our comments at Question 3: Learning from elsewhere).