Health Education England
NCEL LETB Gateway 2 Submission
NCEL LETB Operating Model
Gateway 2 Submission
29 June 2012
Doc Reference: NCEL1227
Version: 1.8
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Health Education England
NCEL LETB Gateway 2 Submission
Gateway 2 - Operating Model
Contents
1.
Purpose ........................................................................................................................................... 4
1.1
1.1.1
The LETBs Role ................................................................................................................ 4
1.1.2
Developing the London LETBs ......................................................................................... 4
1.1.3
The North Central East London LETB .............................................................................. 4
1.2
Opportunity............................................................................................................................. 6
1.2.1
Overview ......................................................................................................................... 6
1.2.2
The London Opportunities .............................................................................................. 6
1.2.3
NCEL LETB – Local Opportunities .................................................................................... 7
1.3
Vision/Rationale ...................................................................................................................... 9
1.3.1
A Shared Vision for London............................................................................................. 9
1.3.2
NCEL LETB - Operational Vision....................................................................................... 9
1.3.3
NCEL LETB - Mission ........................................................................................................ 9
1.3.4
NCEL LETB - Desired Delivery Outcomes....................................................................... 10
1.3.5
NCEL LETB - Immediate Priorities ................................................................................. 10
1.4
Design Principles and Planning Assumptions........................................................................ 11
1.4.1
DH / HEE - Primary Design Principles ............................................................................ 11
1.4.2
London LETB’s - Collaborative Design Principles .......................................................... 11
1.4.3
NCEL LETB - Localised Design Principles ....................................................................... 12
1.4.4
Implementation Approach ............................................................................................ 13
1.5
2.
Introduction ............................................................................................................................ 4
Values and Culture ................................................................................................................ 14
1.5.1
Shared Values and Culture – DH / HEE / London LETBs ................................................ 14
1.5.2
NCEL LETB - Values and Culture - Delivery Methodology ............................................. 14
1.5.3
NCEL LETB – Values and Culture - Delivery Principles and Behaviours......................... 14
Our Governance and Relationships .............................................................................................. 16
2.1
Governance ........................................................................................................................... 16
2.1.1
NCEL LETB – Engagement, Representation and Accountability.................................... 16
2.1.2
NCEL LETB Governance – Roles and Responsibilities.................................................... 17
2.1.3
LETB Shared Services..................................................................................................... 21
2.2
Stakeholder Relationships .................................................................................................... 23
2.2.1
The Evolving National Healthcare Infrastructure.......................................................... 23
2.2.1
Building Stakeholder Relationship - Overview .............................................................. 25
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Health Education England
3.
2.2.2
Geographical Scope....................................................................................................... 25
2.2.3
Stakeholders Groupings ................................................................................................ 26
2.2.4
Engagement and Communications Framework ............................................................ 27
2.2.5
Rational for the Framework .......................................................................................... 27
2.2.6
Targeted Engagement ................................................................................................... 28
2.2.7
Engagement and Communication Strategy .................................................................. 29
2.2.8
Stakeholder Engagement and Communications ........................................................... 30
Our Organisation ........................................................................................................................... 32
3.1
Functions, Structure and Ways of Working .......................................................................... 32
3.1.1
Organisational Architecture Design Overview .............................................................. 32
3.1.2
Lead Provider and Local Education Provider Model – Overview and Rational............. 33
3.2
Functions ............................................................................................................................... 35
3.2.1
Overview ....................................................................................................................... 35
3.2.2
LETB Functions .............................................................................................................. 35
3.2.3
The Lead Provider - Functions....................................................................................... 35
3.3
Structures .............................................................................................................................. 36
3.3.1
LETB Structure ............................................................................................................... 36
3.3.2
Shared Service Structure ............................................................................................... 37
3.4
Ways of Working ................................................................................................................... 38
3.4.1
Workflows ..................................................................................................................... 38
3.4.2
Annual Business Planning Cycle .................................................................................... 38
3.5
4.
NCEL LETB Gateway 2 Submission
Running Costs and Affordability ........................................................................................... 39
3.5.1
Financial Envelope ........................................................................................................ 39
3.5.2
NCEL LETB Running Costs .............................................................................................. 39
3.5.3
Organisational Costs ..................................................................................................... 40
3.5.4
Projected Cost Savings .................................................................................................. 40
Transition and Continuing Operation ........................................................................................... 42
4.1
Transition Approach.............................................................................................................. 42
4.1.1
Rational for Transition .................................................................................................. 42
4.1.2
Phases of Transition ...................................................................................................... 42
4.2
Risk and Issues ...................................................................................................................... 47
4.2.1
Risks and Issues ............................................................................................................. 47
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Health Education England
NCEL LETB Gateway 2 Submission
1. Purpose
1.1
Introduction
The government announced its intention to transfer responsibility for commissioning education and
training to local partnerships, or Local Education and Training Boards (LETBs) in Liberating the NHS
Workforce. Formal guidance on implementation of these changes was published on 10th January
(Liberating the NHS: Developing the Healthcare Workforce - From Design to Delivery). LETBs will
take on much NHS Education and Training commissioning, including control of the Multi Professional
Education and Training levy (MPET) budget allocation, when the Strategic Health Authorities (SHAs)
cease to exist on 1st April 2013.
1.1.1
The LETBs Role
The role of the LETBs will be to:



1.1.2
Work in partnership with the local health community to identify and agree local priorities for
education and training to ensure the supply of compassionate, knowledgeable and highly
skilled people providing health and public health services well connect to social care
provision;
Plan and commission excellence in education and training on behalf of the local health
community in the interests of sustainable, high quality service provision and health
improvement;
Be a forum for developing excellence across the whole health and public health workforce.
Developing the London LETBs
NHS London has been working towards the creation of three LETBs for London based broadly upon
the geographic areas covered by the Academic Health Sciences Centres and Heath Innovation and
Education Clusters – NC and NE London; South London and North West London (Please refer to
supporting Document Reference NCEL1213).
The design teams supporting the three emerging LETBs have been working collaboratively supported by the expertise of NHSLondon - to develop target operating models for their individual
LETBs and also to create a joined up vision and approach to the delivery of LETB services across
London.
These new LETB arrangements will deliver benefit to patients, employers, the workforce, students
and trainees through excellence in education and training, tailored to local need while recognising
national priorities.
The three London LETBs will become fully operational in April 2013 when NHS London is disbanded
1.1.3
The North Central East London LETB
The North Central and East London Local Education Training Board (hereafter known as NCEL LETB)
is the largest of the three LETBs being set up to provide control and management of workforce
planning, education commissioning and provision across London.
A representative NCEL LETB Transition Board chaired by David Fish CEO of UCLPartners (UCLP) has
been put in place to oversee the organisational design of the NCEL LETB from April to October 2012
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NCEL LETB Gateway 2 Submission
prior to authorisation by Health Education England (HEE) and establishment of an end-state board,
with independent chair in October 2012.
The operational and organisational design process has to date been managed by the NCEL LETB
Design and Delivery Project Team that has drawn extensively on inputs resulting from
comprehensive stakeholder engagement, collaboration with the other two London LETBs and
NHSLondon subject matter expertise.
This documents sets out the proposed high level operating model that is to be adopted by the NCEL
LETB in order to provide excellence in service to all its key stakeholders.
The NCEL LETB has engaged with local stakeholders to gain support for the proposed leadership,
vision, governance, operating model and high level intentions as set out in this document and the
direction of travel as outlined in this document was been endorsed by the NCEL LETB Transition
Board at the meeting held on the 13 June 2012
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Health Education England
1.2
Opportunity
1.2.1
Overview
NCEL LETB Gateway 2 Submission
The immediate challenge facing the NCEL LETB - and the other London LETB’s - is the safe transition
to operational delivery of services of an excellent quality which meet the local, London and National
agendas within the reducing and non-negotiable financial envelope for the provision of such services
in the future. In delivering these services the NCEL LETB will need to address and deliver against the
following opportunities.
1.2.2
The London Opportunities
The future education and training commissioning system must ensure sustainable supply of the right
healthcare professionals and provide solutions to service problems – both local, pan-London and
recognise its impact nationally – while enabling enhanced innovation that will create professional
flexibility and organisational behaviour that the future NHS needs.
1.
Intra and Inter London workforce movements – The NCEL LETB must recognise the reality
that London is a net exporter of our health and social care workforce – to other parts of the
country, to private healthcare providers and internationally. The complex dynamics of intraLondon movements of staff and the relationship between education and training provision
need to be understood and managed in order to co-ordinate commissioning across LETBs in
London. NCEL LETB must be able to respond to national workforce development imperatives
such as the significant expansion of the Health Visiting workforce to 2015/16.
2.
Changing care settings – In future patients will expect excellent integrated care structured
around their needs rather than traditional professional boundaries. The focus of care must
shift to settings in the Community that are easier for patients to access and potentially
better value for money for the health service. In addition, and equally importantly, there
must be a substantial emphasis on cross-agency partnership to promote health and
wellbeing. These changes, which are now needed urgently, will need a transformed
workforce in appropriate numbers equipped with the knowledge, skills and behaviours to
deliver them. Education and training play a central role enabling safe and effective
workforce change supporting developments planned to improve patient experience and
population wellbeing. NCEL LETB will be a locally-focussed platform for partnership between
service and education providers to commission and provide effective and safe education and
training to support this service transformation.
3.
Utilising our collective abilities –The NCEL LETB believes that effective and carefully planned
multiprofessional education and training are a key means to bring together the disparate
parts of our healthcare system – e.g. primary care, secondary care, mental health, public
health, social care. Health outcomes improve when patients are cared for by integrated
teams aligned to pathways of care. While health service educational programmes must
continue to support the development of excellence in individual professional groups, more
can be done to commission education and training across professional boundaries. In
particular, the NCEL LETB will seek to sponsor education and training that fosters increased
generalism, integration and team-working. As a comprehensive network partnership of
health care and social care employers, six Universities, two Medical Schools and a successful
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Health Education England
NCEL LETB Gateway 2 Submission
Academic Health Sciences Centre, NCEL LETB is uniquely equipped to manage this new skills,
behaviour and competency approach to workforce change.
4.
Offering staff careers that are fulfilling and incentivising longevity – If the NCEL LETB is to
ensure its stakeholders keep the best staff, they must be supported through the changes in
skills, competence and behaviours that they will need to deploy in a fulfilling career.
Education, training and development have a crucial role in incentivising staff to remain
within the service and to provide excellent care to patients and people. It is an ambition of
the NCEL LETB to make NCEL a brand for excellence in education, Training and continuing
professional development across all professional groups.
5.
Improving health outcomes – London’s NHS needs services that are patient-centred;
population-focused; holistically designed; and orientated to prevention of long term
conditions. This can only be achieved by a healthcare workforce equipped to balance and
prioritise population and individual needs. Professionals will need increasing knowledge and
expertise to intervene with the best and most appropriate care, cognisant of the breadth of
solutions and available resources. Our experience with the NE NC London and Essex
(NECLES) Health Innovation and Education Cluster (HIEC) has demonstrated that properly
trained and motivated clinical leaders can be catalyse effective change for the good across
large populations. The NCEL LETB will work to equip more of the workforce to be agents for
health and well-being working in partnership with people, patients and providers.
6.
Improving clinical excellence – The NCEL LETB headline priorities include:
reducing the variations in care,
reducing errors,
increasing the right response to health needs with the right skills at the right time to reduce
duplication of effort,
clear communications with patients, between professionals and between components of the
system.




In Medicine and Dentistry the NCEL LETB acknowledges the imperative to implement the
recommendations of the Temple Report so that care delivered by Consultants is the default and
service delivery becomes an effective learning methodology for trainees.
7.
Promoting healthy lifestyles – There is a growing role for health professionals to be able to
intervene in health outcomes not just through direct care, but also using their skills to
influence patients and the public’s lifestyle. Supporting the development of professionals
able to care for the population at large as well as individuals will greatly support longer term,
population wide improvements in health.
1.2.3
NCEL LETB – Local Opportunities
The area to be served by the NCEL LETB shares some of the wider national and pan London
workforce issues, but also has unique characteristics and associated problems. The workforce
implications for the service of the current NHS North Central London, NHS East London and the City
and NHS Outer North East London strategic commissioning plans are significant:
1.
Primary Care strategies - The implementation of the North Central London and North East
London Primary Care strategies and integrated care programmes in North Central and North
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NCEL LETB Gateway 2 Submission
East London will have a direct impact on primary, secondary and community care in terms of
ways of working, education and training. It is expected that the provision of care will shift
from acute to community and primary care settings and that therefore the how and where
of educating and training the workforce will change significantly. The NCEL LETB will need to
understand the implications for training provision, pre-registration and continuing
professional development across all clinical professions and the wider workforce. How the
NCEL LETB provides for training and education will change to reflect the provision of care
across pathways of care and networks of providers rather than by organisational boundary.
2.
Organisational changes – Providers face significant organisation change. For example, the
Barnet, Enfield, Haringey Clinical strategy, the Health 4 North East London programme along
with significant organisational change associated with Barts Health and BHRUT, which all will
affect the provision of training and education across employers. The NCEL LETB will need to
collaborate and support its members responding to the education commissioning
implications of these organisational changes and ensuring the benefits possible from the
investment into infrastructure and restructuring are maximised.
3.
Local demography – The geographical area that the NCEL LETB covers encompasses London
boroughs with considerable wealth and other areas where all the local wards in a borough
are within the top 10 per cent of the most deprived in the country. The NCEL LETB will need
to develop new partnership working relationships with providers and HEIs to maximise local
recruitment to professional, academic and other development programmes to reduce
existing inequalities of access and opportunity.
4.
Productivity – Service providers are faced with significant productivity challenges which will
have an impact on ways of working, shape and size of provider workforce and education and
training.
5.
Workforce planning development – The development of workforce planning to inform both
long and short term education commissioning investment is in its infancy. The NCEL LETB will
need to continue the development in particular assuring integrated workforce, finance and
service planning.
6.
Health Visitors – It is expected that the NCEL LETB will need to respond to national
workforce development initiatives such as the significant expansion of the Health Visiting
workforce to 2015.
While NCEL does have excellent examples of educational practice, there are places where the quality
of education and training remains sub-optimal. The NCEL LETB recognises the opportunity to drive
up quality and performance through partnership, supportive development and where necessary in
making tough commissioning decisions.
The North Central and North East London area that the NCEL LETB will serve has excellent potential
to address these challenges.
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Health Education England
1.3
Vision/Rationale
1.3.1
A Shared Vision for London
NCEL LETB Gateway 2 Submission
The three London LETBs have agreed on the common design principles for the delivery and
management of Workforce, Education and Training for London. The approach of local and shared
functional services and the governance arrangements outlined in this document will ensure that the
three LETBs have a shared vision - and can speak with one voice - for London.
1.3.2
NCEL LETB - Operational Vision
The following operational ideals underpin the NCEL LETB and its vision of service delivery:




1.3.3
Working in partnership to deliver a service that meets local workforce reconfiguration,
education and training needs and ensures highest quality service to patients
Providing a lean, effective, responsive and transparent mechanism for decision making
Providing a lean, effective, responsive and transparent mechanism for commissioning and
funding education and training activities that drives delivery of excellence
Providing assurance that commissioning decisions and priority-setting reflect the needs of
patients, students and trainees and the health system as whole
NCEL LETB - Mission
The mission of the NCEL LETB is to optimise health outcomes and experience in the NE/NC locality
through delivery of excellence in multi-professional education, training and workforce development
that is aligned to current and future healthcare service needs.
The NCEL LETB will focus on ensuring that education commissioning and workforce development is
based on excellence of content and output through intelligent and challenging partnership working
across all healthcare service providers and education providers in the NE/NC locality: a Partnership
for Excellence. The NCEL LETB will build upon the values and partnership ethos of UCLPartners
(UCLP) and will maintain an uncompromising focus on excellence, quality and patient safety.
The NECL LETB will work closely with healthcare service providers to strengthen integrated
workforce planning and workforce development, including promoting leadership excellence. The
LETB will help enable service improvements and the re-design of services along care pathways,
particularly supporting the movement of services closer to homes and the development of
integrated care to meet the changing needs of the population. The evolving Academic Health
Sciences Network (AHSN) will provide the infrastructure for provider side partnership.
The NCEL LETB will operate to ensure that education and training are rooted in what really matters
to patients and what service providers need while striving to exceed quality standards in clinical
excellence. The LETB will be steered and informed through clear and open interactions with a full
representation of local service providers and Universities while responding to HEE and the
requirements of the national Education Outcomes Framework.
The NCEL LETB will work in partnership with local stakeholders, including patients, students and
trainees, local authorities, the independent and third sector providers and other LETBs. The LETB
will take a national leadership role in enabling the design and delivery of distinctive education and
training that maximises service, educational and placement resources in the most efficient and cost
effective way for patient benefit.
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Health Education England
1.3.4
NCEL LETB Gateway 2 Submission
NCEL LETB - Desired Delivery Outcomes
The NCEL LETB will deliver the following outcomes:

Provide a sustainable workforce responsive to the changing needs of the population and
equipped to provide excellent care for patient’s both now and in the future.

Be accountable and representative of the needs of local employers and other key
stakeholders through fair, transparent and evidence based decision making.

Ensure the local healthcare workforce consistently demonstrate the capabilities and values
needed to meet local health community needs and health improvement goals.

Commission relevant education and training in partnership with Universities with a focus on
quality outcomes and clinical excellence to ensure delivery of high quality, multi-professional
education and training in NE and NC London.

Ensure that education and training meets regulatory professional and assurance standards
that also aligns with the Education Outcomes Framework.

Establish appropriate roles and responsibilities between the NCEL LETB and the providers of
education and training services, including NHS placement providers.

Increase value for money from allocated Multi Professional Education and Training levy
(MPET) funding.

Have financial control of operational costs, including determining the scope and scale of
internal LETB operations and outsourced services.

Be responsive to future healthcare needs by supporting integration of health, public health
and social care and the movement of health services into community settings.

Establish appropriate roles and responsibilities between the LETB (‘the commissioner’) and
the providers of education and training services, including NHS placement providers.

Meet and where possible exceed expectations of Health Education England (HEE).

Model behaviours and values consistent the NHS Constitution
1.3.5
NCEL LETB - Immediate Priorities
While the capacity and capability to affect real change in education and training during ‘shadow’
operations will be limited and safety in transition remains a high priority, the NCEL LETB is eager to
prioritise the following improvements, amongst other outcomes:
 Enhancing the quality of postgraduate medical and dental education through increased
collaboration between placement providers and Universities
 Local Education Provider development to enhance undergraduate pre-qualification training
in nursing, midwifery and allied health professions
 Multiprofessional post registration training to supply excellence in clinical professionals to
provide integrated care across patient pathways
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Health Education England
NCEL LETB Gateway 2 Submission
1.4
Design Principles and Planning Assumptions
1.4.1
DH / HEE - Primary Design Principles
The primary design principles are those set out in Liberating the NHS: Developing the Healthcare
Workforce from Design to Delivery and the advice given by the Future Forum:
1. Greater accountability for all providers to plan and develop their workforce, whilst being
professionally informed and underpinned by strong academic links
2. Aspiring to excellence in training and a better experience for patients, students and trainees
3. Supporting NHS values and behaviours to provide person-centred care
4. Supporting the development of the whole workforce, within a multi-professional and UKwide context
5. Widening participation
6. Supporting innovation, research and quality improvement
7. Providing greater transparency, fairness and efficiency to the investment made in education
and training
8. Reflecting the proposed, explicit duty of the Secretary of State to secure an effective system
for education and training
9. Sustainability and value for money
10. Facilitate best use of local education and training resources
1.4.2
London LETB’s - Collaborative Design Principles
NHS London has been and will be responsible for healthcare workforce planning, education
commissioning and quality management until LETBs take full operational responsibility in April 2013.
This system has undergone significant development over recent years, developing capacity and
capability that has informed the design of the three London LETBs. To this end the three London
LETBs supported by NHSLondon have identified the following high-level collaborative design
principles:

Three LETBs for London, led by employers in partnership with key stakeholders
o Allocations made from HEE to individual LETBs
o Local accountable bodies for education, training & workforce planning
o Constituted to exercise authority invested in them,
o Employer-led with input from key stakeholders

Complete the roll-out of the MDECS process
o Fewer direct commissions for individual placements – all medical and dental
commissioning through Lead Providers
o Lead Providers take up QA responsibilities in relation to individual placements/rotations
o Potential development of LP model to
i. multi-specialty,
ii. integrated primary & secondary care,
iii. multi-professional education
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NCEL LETB Gateway 2 Submission

Setting a direction of travel
o Local where possible, centralised where necessary
o Move to planning and commissioning education and training on a multi-professional
basis which is across a care pathway and patient focused

Focus on efficiency
o Establish a shared service working to the LETBs to deliver functions that are most
effectively done together across London
o Requirement to meet challenging reductions in running costs
o Commissioning support from other agencies as well, e.g. CfWI to provide certain
workforce analysis

Safe transition
o The LETBs are committed to safe transition
o The model proposed allows for certain current NHSL/PGD functions to be integrated in
a single shared support service
o Some functions will transfer to individual LETBs and LPs at the outset, others can follow
and those elements that are best delivered once for all three LETBs have a sustainable
basis for the future.
These high-level operating model design principles are further underpinned by a number of more
specific shared design principles – please refer to Appendix 1 LETB Shared Design Principles for
further details.
1.4.3
NCEL LETB - Localised Design Principles
The NCEL LETB has identified opportunities to maximise the benefits of partnership working to
further elaborate existing improvements for the benefit of patients, trainees, employers and the
wider health service, particularly for individual localities. In order to achieve this, the NCEL LETB’s
design has and will continue to based on the following principles centred upon Partnership for
Excellence:
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
Contribute to an excellent patient, student and trainee experience
Sustain delivery during transition
Be provider/employer driven to meet current and future workforce needs
Have a fair, transparent and accountable governance structure that averts and manages
potential conflicts of interest
Promote innovation, multi-professional training and research excellence with University
partners based on care pathways.
Drive maximum return on investment within a defined financial envelope
Champion multi-professional development working with experts in the field
Ensure the highest possible quality and safety standards and promote clinical excellence
Promote challenging partnership working and collaboration
Facilitate input across all healthcare professionals and workforce groups
Encourages partner organisations to oo-ordinate non-MPET funded education and training
(e.g. Bands 1-4 and social care workforce) to leverage mutual benefit and benefit for the
system as whole.
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Health Education England
1.4.4
NCEL LETB Gateway 2 Submission
Implementation Approach
Using the design principles and planning assumptions as set out above, the current operational
system will be re-designed and reconfigured by the three London LETBs and NHS London - working
collaboratively and with full consultation with stakeholders - to best meet individual LETB, London
wide, National and International service needs.
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Health Education England
1.5
NCEL LETB Gateway 2 Submission
Values and Culture
1.5.1 Shared Values and Culture – DH / HEE / London LETBs
The NCEL LETB endorses the following statement on shared values and culture
‘London has a leading role both nationally and internationally in training and education of healthcare
professionals. We take this responsibility seriously and will work together as three LETBs to ensure
that this position of national and international leadership is enhanced. We have agreed to work
together to represent London when appropriate and to that end will meet regularly to discuss issues
that affect London as a whole. Throughout the year we will seek to align our planning processes so
that we are proactive in our awareness of each other’s plans. We will be collaborative and
transparent in our dealings as individual LETBs and also when we work together. We have agreed
that there are a number of areas where it will be sensible and more efficient if we were to do them
just once for London. This could include commissioning smaller specialities.
We are all committed to driving up patient care and improving people’s experience of working in the
healthcare system. We must attract the best people to come and work in our health system. We see
high quality education and training as a key that will lead to excellent high quality research which in
turn we want to see leading to improvements in quality and innovation in our patient delivery
systems. Through this cycle we will enable improvements in the health and wealth of London’
1.5.2
NCEL LETB - Values and Culture - Delivery Methodology
The NCEL LETB will fulfil its vision by ensuring the following are integral to its delivery methodology:
•
•
•
•
•
•
•
•
•
•
1.5.3
Care pathway specific
Patient facing
Continuity between undergraduate and postgraduate
Pedagogic research
Identifying and creating innovative solutions to long term problems
Collaboration with other LETBs, particularly the two in London, to share good practice,
make the best use of resources and avoid unnecessary duplication
Innovation resources
Involvement of the private and voluntary sectors
Ensure education of the whole workforce, including bands 1-4
Maximise opportunities for working with the AHSN to avoid duplication of effort and
expense
NCEL LETB – Values and Culture - Delivery Principles and Behaviours
The NCEL LETB will fulfil its vision by ensuring the following principles and behaviours are embedded
within its operations and our manifested in people’s behaviours and the ways things get done:

Effective leadership with a shared vision and agreed outcomes
 Collective responsibility, working together in a transparent, inclusive and accountable
way
 Well articulated ways of working within the NCEL LETB
 Explicit links to planning for workforce transformation, e.g. better services better value
 Collaboration with other LETBs within and without the bonds of London.
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Health Education England


NCEL LETB Gateway 2 Submission
Takes difficult decisions
Takes cross-sector decisions that support commissioning consortia and system-wide
leadership

Learning organisation
 Learn from the past and experiences of others
 Resolve disputes
 Develop the capability to undertake workforce modelling
 Aim for the best
 Model high values and attitudes (to probity, fairness, widening participation,
compassion, equality and diversity)

Demonstrate professional and clinical legitimacy for joint decisions
 Commission and decommission through robust processes
 Support a pan-London voice on education and training

Make the best use of resources to ensure a trained workforce to meet patients’ needs
 Demonstrate effective governance
 Accountability for resources
 Promote best value with due regard for impact on partner organisations

Robust workforce planning at employer level
 Assess workforce design, skills and behaviours not just workforce numbers
 High level multi-professional dialogue to define key workforce issues
 Education and workforce development to support strategic service changes and
innovation not just business as usual
 Working with the Better service, better value workforce transformation and change
planning boards
 Accurate and consistent intelligence that can be used to inform planning and modelling
across the sectors. Develop a consistent approach to understanding requirements so
that we can plan in an integrated way for the medium and long term. This will include
understanding the local labour market and ensuring that the workforce analysis is
sufficiently robust to translate into an education change programme.
 Essential to include all the workforce in the workforce planning process, including the
independent/third/private sector and the GP practice workforce
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Health Education England
2.
Our Governance and Relationships
2.1
Governance
NCEL LETB Gateway 2 Submission
This section covers the governance arrangements for the NCEL LETB including details of the
formation of the Board, the relationships between the LETB and the Academic Health & Sciences
Networks (AHSN) and the governance arrangements for shared (once for London) services.
2.1.1
NCEL LETB – Engagement, Representation and Accountability
The constitution of the LETBs is designed to give employers a strong voice in the development of
Education and Training tuned to local workforce need across acute, mental health and community
health services, primary care and local government. LETBs will need to link with a comprehensive
partnership of service and training providers, including Universities, Local Authorities and non-NHS
healthcare providers, forming a partnership for excellence, innovative and value for money.
To this end the NCEL LETB operating framework has been designed to maximise engagement whilst
streamlining representation so as to enable delivery, effective governance and direct lines of
accountability.
The streamlining of representation from stakeholder to member, from member to constituency,
from constituency to Advisory Council representation, and from Advisory Council representation to
LETB Board representation provides an operating framework whereby the Board can provide an
appropriate degree of representation in line with HEE requirements and attain the required skills
mix, whilst remaining small enough to enable effective governance and decision making.
The proposed operating framework not only serves to maximise engagement and representation in
the planning and decision making process but also serves to provide a structure whereby there is
only one layer of separation between the Board and the operational delivery for which it is
accountable - as shown in Figure 1 below.
Figure 1: Target Operating Model – Organisational Structure Overview
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2.1.2
NCEL LETB Gateway 2 Submission
NCEL LETB Governance – Roles and Responsibilities
HEE - the NCEL LETB is represented by the Independent Chair who is a member of the HEE National
Governing Body – working to agree Local, National and International priorities. The NCEL LETB will
submit reports via its Independent Chair into HEE - reports will cover financial and performance
management and quality assurance and by exception any escalated risks and issues.
NCEL LETB Board – the Independent Chair and the mandated executive and non-executive
members will collectively form the Board responsible for discharging LETB duties. The proposed mix
of membership – as shown in Figure 2 below - will serve to maintain an appropriate balance of skills
and experience within the LETB.
2/3 Provider
1/3 Other
Remuneration
Voting
Non Exec
1
No
Independent Chair
Nationally appointed
Day
Allowance
Exec
1
No
Managing Director
Via recruitment process
Employee
Exec
1
No
Via recruitment process
Employee
Exec
1
No
Via recruitment process
Employee
Mandated
Seats
Mandated
Structure
Figure 2: Target Operating Model – NCEL LETB Board Membership
‘Constituency’
Skills / Role
Comments
Director of Finance (and
Commercial Lead)
Director of Education & Quality
(and Performance Lead)
Non Exec
1
Yes
Systems Representative
Non Exec
1
Yes
Provider 1
Non Exec
1
Yes
Provider 2
Non Exec
1
Yes
Provider 3
Non Exec
1
Yes
HEI Provider
Non Exec
1
Yes
Student / Trainee
Non Exec
1
Yes
Patient Representation
Appointment
Member to be the Chair of Advisory Council who will initially be the Chair of the ASHN
Appointment nominated by the NED of the AHSN
Board (or another NED from the AHSN Board
as the organisations mature)
Members will be representing the Provider
perspective - bringing a mix of skills and
knowledge of Primary and Secondary Care
Provision
Day
Allowance
Nominations from constituencies appointed via simple
majority of the Advisory Council Members
Day
Allowance
Nominations from constituencies appointed via simple
majority of the Advisory Council Members
Nominations from constituencies appointed via simple
majority of the Advisory Council Members
Nominations from constituencies appointed via simple
majority of the Advisory Council Members
Nominations from constituencies appointed via simple
majority of the Advisory Council Members
Day
Allowance
Day
Allowance
Day
Allowance
Day
Allowance
Nominations from constituencies appointed via simple
majority of the Advisory Council Members
Day
Allowance
Total: 11 (including Chair)
The Board will act as the governance body that is directly accountable for the activities of the LETB
Delivery Unit. The Board will be responsible for:



Co-designing and overseeing a strategy to implement HEE requirements - setting the
strategic direction of multi-professional, education, learning and development within NCEL
by agreeing an annually updated Strategic Plan (five year).
Providing oversight of multi-professional integration and activity with and within providers;
Providing assurance over the operational delivery of the LETB ‘business’ - undertaking a
NCEL wide quality assurance function with regards to workforce reconfiguration delivery and
education and training provision (including performance, competition, value for money,
quality and local failure regime management).
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Health Education England




NCEL LETB Gateway 2 Submission
Ensuring stakeholder engagement and being responsible for open and transparent
consideration of views presented through the Advisory Council.
Overseeing an executive with responsibility for the LETB ‘business’, including the governance
of any shared services.
Co-operating with other London and national LETBs to present a ‘London Voice’ and equally
with other LETBs on national issues.
Managing significant risks and issues, and reporting on progress against agreed quality and
performance measures on a regular basis (and by exception on patient safety and quality
risk and issues) to HEE.
The Board will receive regular dashboard/scorecard reports that will encompass the KPIs and
Benchmarks as outlined in this document and also cover key risk and issues. This Dashboard report
and escalated risk and issues will be presented to the Board and HEE in line with agreed corporate
governance reporting requirements. Risk and Issues escalated to the Board will be reviewed and the
Independent chair will ensure that appropriate responses are made.
The proposed draft terms of reference of the Board as outlined above and any supporting reporting
framework will be fully aligned with HEE governance structures and requirements as and when they
are known.
Non-Executive Membership of the Board will be endorsed by a simple majority of the Advisory
Council - should the Advisory Council be unable to agree their representation for a specific seat on
the Board the final appointment decision would fall to the Independent Chair of the Board.
LETB Board meetings would initially be monthly – moving to bi-monthly or quarterly as agreed by
the Independent Chair
Development Process – the Independent Chair and Executive Board members will be recruited /
appointed in line with HEE timelines with the expectation the executive would in post July / August
with the Chair following in September / October. Other non-executive members would then be
nominated by and or agreed with the Chair with these nominations being endorsed by an majority
vote of the LETB Transition Board / Advisory Council – with an expectation that all members of the
Board would be recruited by the end of November. The initial term of the non-executive members
will be for 24 months after which their re-election staged over a 12 month period as constituencies
mature and develop appropriate processes to agree representation. Appointments will be overseen
by and Appointments Committee / Panel.
Advisory Council – (shared with the AHSN). The Council will act as a Clinical and expert leadership
forum that is collectively responsible for



Enabling stakeholder engagement between the LETB and their respective
constituencies ensuring that there are appropriate methods and mechanisms to
support their representation.
Actively engaging with all existing and any prospective providers (education and
training and service providers).
Collating views and feedback from representatives on all matters relating to
healthcare education and training and workforce issues
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





NCEL LETB Gateway 2 Submission
Openly and clearly presenting views of members to the LETB Board for due
consideration.
Reviewing, endorsing and making recommendations to the Board regarding the
annual and five year planning process.
Reviewing key decisions taken by the Board
Reviewing, endorsing and making recommendations regarding Board membership
and reappointments
Reviewing reports on the financial and operational performance of the LETB.
Supporting the development of Advisory Groups
o reviewing, endorsing and making recommendations regarding the make-up
of the Advisory Groups
o reviewing, endorsing and making recommendations regarding the chair of
the Advisory Groups
o reviewing, endorsing and making recommendations regarding Board
sponsorship of Advisory Groups
The proposed draft terms of reference of the Advisory Council as outlined above and any supporting
reporting framework will be finalised and agreed formally with the AHSN and appropriately aligned
with HEE governance structures.
The Chair of the Advisory Council will be a NED of the AHSN Board – initially this will be the Chair of
the AHSN Board with the potential to be another NED of the AHSN Board as the system matures.
Members of the Council will be nominated as representatives from within their constituencies.
Advisory Council meetings would initially be bi-monthly – moving to quarterly as agreed between
the Chair of the Advisory Council and the Independent Chair of the LETB Board.
Development Process - The current members of the NCEL LETB Transition Board will migrate to form
the initial membership of the Advisory Council. The initial term of members will be staggered for reelection over 24 months as constituencies mature and develop appropriate processes to agree
representation. In the event that a Constituency was unable to agree representation then the Chair
of the Council would hold the deciding vote. Please refer to Appendix 2 NCEL LETB Transition Board
Membership – for proposed representation.
LETB Delivery Unit – consisting of the Executive Directors and a number of Portfolio Managers and
Administrative support. In short the role of the unit is to manage and coordinate all activity required
to facilitate, support and empower the LETB Board, Advisory Council and Advisory Groups to (1)
make commissioning recommendations and (2) oversee commissioning activity quickly and
efficiently; and (3) ensure such recommendations are implemented (e.g. by the Joint Support
Services).
The LETB Delivery Unit will be tasked with implementing the plan within tolerances as set by the
Board and will report to the Board on progress, key decisions/actions taken, the finances of the LETB
and the education and training commissions and funding flows within NCEL, and the quality of
delivery by providers - reporting any material request for change/deviations to the Board or
conversely to implement the same as directed by the Board.
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NCEL LETB Gateway 2 Submission
The Unit will be led by the Managing Director who will coordinate activities across all areas of
workforce reconfiguration and associated education and training commissions supported by a
Director of Quality Assurance and a Director of Finance (collectively forming the LETB Executive) as
well as a number of Portfolio Managers all of whom will have clear roles and responsibilities to
deliver the following as a collaborating team:

First-rate support to the LETB Board, its Advisory Council, Advisory Groups, Constituencies
and Membership
 Integrated and Endorsed Workforce Reconfiguration Plans,
 Integrated and Endorsed Education and Training Commissioning
 Excellent support to Advisory Groups to enable
o The identification of planning priorities
o Integrated workforce responses to service reconfigurations
o Excellence in Workforce Reconfiguration and Education and Training Needs Assessment
o Portfolio Management of Commissioned Activities
o Efficient use of the LETB Joint Support Services
Development Process – the Executive will be recruited in line with HEE timelines with the
expectation that the executive would in post July / August. The Portfolio Managers will be recruited
to post following the NHSLondon timeline and processes with the expectation that these would be in
place prior to full authorisation currently targeted for January/February 2013. Appointments to the
LETB Delivery Unit will be overseen by an Appointments panel – consisting of LETB (Transition) Board
Members supported by HR expertise from NHSL London with input from HEE where mandated
Advisory Groups - the LETB Delivery Unit will work with the Advisory Council to facilitate the
setting up a number of Advisory Groups in order to deliver the mandate of the LETB Board. It is
expected that such Advisory Groups would fall under two main categories
Long-Term - professional groups that would take on a sub-committee role to the Board with
regards to specific areas of LETB Business / expertise – with an understanding that these
could move to become more automatous bodies within the LETBs constituency
Shorter-Term - task and finish groups established by the LETB to address specific issues with
a cross-professional emphasis and time limited existence.
The LETB Board will be able to assign members as sponsor/s to specific advisory groups (depending
on how contentious the issue being addressed). Each Advisory Group will have a Chair nominated by
the Advisory Council - either from the within the Council itself (or from the Council’s pool of
alternate representatives) or if desired an external expert - with the Chair being endorsed by the
Board and reporting informally to the Board member sponsor/s. Advisory Group members would
not be substantive appointments but practicing clinicians and experts. The development and work
of the Advisory Group will be supported by a Portfolio Manager assigned by the LETB Delivery Unit.
This approach ensures that Advisory Groups have the right leadership, integrity, gravitas and the
ability to galvanise stakeholder buy-in and agreement on the proposed direction of travel as it is
developed prior to ratification (or otherwise at Board level) – i.e. it ensures there are no surprises
from within the LETB family.
Advisory Group meetings would be expected to be held at a frequency contingent with its mandate.
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NCEL LETB Gateway 2 Submission
Membership – In addition to the Constituencies that nominate to the Advisory Council, the LETB
and AHSN (as a separate entity to the founding membership arrangements for UCLP) will invite
individuals to become Members. Members will be supported by a virtual forum whereby they can
detail and express their interest in specific LETB/AHSN business areas. This would enable the
LETB/AHSN/Constituencies to send out targeted information pertinent to member’s interests and
conversely receive and act on feedback from members.
The membership would meet for an annual open meeting - chaired by the Independent Chair – that
will act as the forum whereby members can

hold the board to account with regards to
I.
attendance and performance
II.
the quality of the services provided
III.
delivery against plan

explore and scrutinise the five year and annual plan
LETB Joint Support Services – works to support LETB Delivery Unit to discharge the LETB
responsibilities (more information provided below).
2.1.3
LETB Shared Services
The LETB Shared Service Governance Group (SSGG) will govern LETB Joint Support Services (shared
services).
Purpose - The SSGG’s terms of reference will be to:




Assure the design of the shared service operating model and it’s fit with the required cost
envelope
Oversee the safe and effective implementation of the shared service operating model
Agree key handover dates between NHSL/Deanery and LETBs
Ensure shared services is delivering ‘business as usual’ support to LETBs, enabling them to
function effectively
Remit - The SSGG’s remit and responsibilities will develop over the phases of transition, details of
this may be found in section 4.1. The intention is that the LETBs will start to take more decisions and
take more of a leading role balanced within the constraints of the duties of the SHA while it still
exists.
Membership - The SSGG will comprise representatives from each of the three London LETBs. The
Managing Directors, Finance Directors and Directors of Quality & Education from each of the London
LETBs will form the membership of the group. In attendance members of the current operation to
advise on issues as needed.
The SSGG will be chaired by the Independent Chairman of one of the three London LETBs. The
Independent Chairman from the host-LETB will not be permitted to chair the SSGG.
Meeting Cycle - The SSGG will commence meeting monthly during the Phase 2, and every 2 months
thereafter.
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NCEL LETB Gateway 2 Submission
Working Sub-Groups - In phase 1 (summer 2012) a Whole System Transition Group will oversee the
design of the shared service operating model with input and advice from a Medical Workforce
Group. Aspects of the shared service provided by NHS London will also be included in this redesign.
A combined model of shared services will be designed by September 2012 end of Phase 1. Going
forwards to implementation the Shared Services Governance Group may want to continue with
working groups as appropriate.
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2.2
NCEL LETB Gateway 2 Submission
Stakeholder Relationships
2.2.1 The Evolving National Healthcare Infrastructure
The Health and Social Care Bill will disestablish SHAs and ‘Developing the Healthcare Workforce’ and
‘From Design to Delivery’ establishes devolution of decision-making power from regional to local
levels and employer ownership of the system via LETBs. HEE will be have national oversight and will
be accountable to the Secretary of State for ensuring that the health workforce has the right skills,
behaviours and training, in the right numbers, to support the delivery of excellent healthcare and
health improvement.
Figure 3: Target Operating Model – the Evolving Healthcare Infrastructure
These NHS reforms are introducing a number of new sub-national structures to co-ordinate the work
of, and relationships between, different bodies in defined geographical areas - refer to Figure 3
above. These include LETBs as well as Clinical Senates and AHSNs amongst others – which in turn sit
alongside current structures (some of which are also under review) – these structures include but
are not limited to









Clinical Senates
Networks
Specialised commissioning hubs
Academic Health Science Networks (AHSNs)(and AHSCs)
Comprehensive Clinical Research Networks (CCRNs)
Collaboratives for Leadership in Applied Health Research & Care (CLARHCs)
Health Innovation and Education Clusters (HIECs)
Quality Observatories (QOs) and Public Health Observatories
Local Authorities
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NCEL LETB Gateway 2 Submission
A key issue which has arisen in the design of the new system is that the numbers and geographical
boundaries of both the new and existing structures vary significantly. In some cases this lack of
consistency will not matter, but in others it could lead to problems in maintaining effective working
relationships and partnerships.
The NCEL LETB believes there are significant benefits from closer alignment between structures as it
will be easier to develop and maintain effective partnerships between structures and member
organisations if arrangements are consistent. The NCEL LETB believes this will contribute to greater
efficiency (including support arrangements); to closer links between the research, innovation
education and clinical communities; and ultimately to improved outcomes.
Achieving close alignment between the NCEL LETB, the AHSN, Health and Well-being Boards and
Clinical Senates and other parts of this emerging architecture provides a real opportunity to bring
together clinicians with NHS providers (inclusive of third sector and independent)and
commissioners, academia and industry to drive the adoption and spread of innovative care and
treatment that improves patient outcomes and population health. The NCEL LETB will take a leading
role alongside the AHSN in bringing these component structures and organisations together across
our geographical area and beyond.
The NCEL LETB is aware of and supportive of the healthcare infrastructure alignment review being
undertaken by the NHS Commissioning Board that is based on the following principles:






Where possible boundaries of sub-national structures should be based on communities
which have coherence in terms of work patterns. The foundation of this should be links to
local authorities and CCGs, and patient flows.
There should be alignment of structural boundaries wherever relationships between
structures are important.
Where one-to-one alignment is not possible there should be a principle of ‘nesting’ of
boundaries within overall common footprints (i.e. co-terminous, but not necessarily at a
one-to-one level).
The nesting approach should recognise, and build up from CCG and local authority
boundaries, and should normally align within the four NHSCB regional boundaries.
Convergence of Senates, AHSNs and LETBs around a core pattern of geographical footprints
should be considered carefully so that strong local linkages can be established, building on
existing patterns and relationships.
The core pattern of geographical footprints should provide the most affordable and costeffective working arrangement within the range of numbers being considered for each
structure.
Given the complexities associated with this transition the NCEL LETB is aware that relationships with
this evolving architecture will have to be managed flexibly and proactively so that the current one
time opportunities - to achieve benefits through closer alignment where possible and desirable to
achieve an architecture which will support improved partnerships and improved outcomes for NCEL
- are achieved. Existing partnership development expertise within UCLPartners will inform this
activity.
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2.2.1
NCEL LETB Gateway 2 Submission
Building Stakeholder Relationship - Overview
The NCEL LETB will ensure that education and training is rooted in what really matters to patients
and what service providers and commissioners need - while striving to exceed quality standards in
clinical and educational excellence. In order to achieve this - the NCEL LETB will develop and
maintain close working relationships with a comprehensive range of stakeholders as represented in
Figure 4 below.
Figure 4: Target Operating Model – Developing the Five Year Plan
As outlined above the NCEL LETB will be steered and informed through clear and open interactions
with a full representation of local service providers and Universities while responding to HEE and the
requirements of the national Education Outcomes Framework.
A number of these stakeholders will be internal to the proposed operational constituencies and
processes as outlined in the previous section – other important interested parties will be on the
periphery of a LETBs business and will have to be engaged with on a targeted basis.
The following sections aim to provide an overview of how the NCEL LETB intends to develop and
maintain working operational relationships with its stakeholders in order to effectively discharge its
duties.
2.2.2
Geographical Scope
Stakeholder identification is the critical first step to developing successful targeted communications
to, and the involvement and engagement of, interested parties in the development of relationships
that support the continuous improvement LETB internal operations and the services it supports.
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NCEL LETB Gateway 2 Submission
NHS London has undertaken a mapping exercise in order to ensure that the geographical boundaries
of the London LETB’s are appropriately aligned and that engagement relationship with key
stakeholders within these areas and across these boundaries are articulated and understood (Please
refer to Supporting Document reference number: NCEL1213 for further information) – the LETB
geographies will be agreed by HEE prior to full authorisation.
Stakeholder engagement is at the heart of NCEL LETB’s operating model. Full engagement with
members is critical to ensuring the successful delivery of an operational service that meets local
workforce reconfiguration, education and training needs in order to deliver the highest quality of
service to patients.
2.2.3
Stakeholders Groupings
The high level stakeholders with which the NCEL LETB will engage include but are not necessarily
limited to:









Providers of NHS services
Local authorities
Education providers
Professional regulation/registration bodies
Clinical Commissioning Groups
NHS Commissioning Board
Health Education England
Academic Health Science Networks
Clinical Senates
The NCEL LETBs will work to develop transparent and substantial arrangements for the engagement
of key stakeholders locally, including:






Patients, service users and the public
Education providers
Primary care
Local government (public health and social care)
Staff representatives e.g. through the Social Partnership Forum
Other representatives as locally determined
The NCEL LETBs will engage with key partner organisational groupings including:









Clinical Networks
Academic Health Science Networks (AHSNs)
Commissioning Groups
NHS Commissioning Board sectors
Local Government
Commissioning Support Units
Health and Wellbeing Boards
Local Healthwatch
Regional Social Partnership Forums
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2.2.4
NCEL LETB Gateway 2 Submission
Engagement and Communications Framework
The LETB will work with its stakeholders to develop an appropriate engagement and
communications framework (building on existing groups and for a where ever possible) that best
facilitates their involvement – elements of the framework might include (but not necessarily be
limited to):












2.2.5
Membership - creating a broad membership based LETB with a virtual presence shared with
the AHSN.
Website - developing a website providing information about LETB services and how to
become involved in LETB activities and, register interest or become a member.
Register of Interests – developing a web-based register of interests to enable direct email
alerts to members pertinent to their specific areas of interest with potential to invite
members to take part in and inform LETB/AHSN activities and projects.
Social media – setting up a site on Twitter/Facebook to communicate service updates and
general health news to members.
Virtual Student Union/Trainee Forum - creation of a virtual student union / trainee forum to
enable direct access to LETB business.
Patients Forum – creation of a patients forum to enable direct access and feedback to LETB
business – this can be based upon existing patient action groups
PR/You Tube Campaigns - focussed on high-lighting the education and career opportunities
within the LETB geography.
Targeted Outreach - attendance at events in conjunction with local community/patient
groups and bodies – to gain participation of hard to reach groups.
Direct Mail/Email Campaigns – to the membership and local residences, encouraging
participation in specific activities / forums / groups / research / health initiatives etc.
Board Membership – to develop skills based membership via executive and non-executive
representation.
Advisory Council Membership – to create an advisory body (Council) that represents LETB
constituencies.
Provider Partnership Groups – to set up and facilitate groups that enable subject matter
experts from the LETB membership and constituencies to become directly involved in work
of the LETB.
Rational for the Framework
The development of a comprehensive engagement and communications framework will serve to
provide the vehicle by which the LETB can develop:
Student and Trainee Insight and Endorsement – by continuously reviewing education and training
programmes, satisfaction and feedback to ensure that new developments are focused on
participants needs. For example a dedicated student/trainee insight forum / framework– supported
by a range of collaborative research techniques to understand user and their priorities for change
and improvement – would enable the LETB to prioritise programme improvements to ensure they
meet participant needs.
Patient Insight and Endorsement – by continuously reviewing patient pathways and patient
satisfaction and feedback to ensure that new developments are focused on patient needs. For
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NCEL LETB Gateway 2 Submission
example a dedicated patient insight forum / framework – supported by a range of collaborative
research techniques to understand usage and why people are not satisfied with current service
provision – would enable the LETB to prioritise a programme of improvements to ensure that
workforce reconfiguration, training and education is targeted to address patient concerns in order to
better meet their needs and expectations. This links into activities in hand by clinical networks – e.g.
London Cancer
Professional Insight and Endorsement – by working closely with professional groups to develop and
maintain excellent collaborative relationships with professionals and facilitating these professional
groups to challenge, advocate and provide the service information required to improve workforce
design, educational and training opportunities and programmes. The NCEL LETB will to develop
systems to inform decision-making by feedback from patients, students, trainees and members.
2.2.6
Targeted Engagement
The NCEL LETB is aware that it must target resources and activities to identify and engage
stakeholders at the margins – i.e. those that have historically been hard to reach, those currently on
the periphery of existing engagement arrangements, or those without a satisfactory engagement
portal. The LETB will work to develop and maintain interactive and integrated working relationship
with such stakeholders.
Proposed Approach to targeted engagement
The (urrent LETB Transition Board) Stakeholder Working Group will regularly review the stakeholder
mapping outputs and current engagement activities in order to identify groups that may require
targeted engagement activities – and to monitor the success of any such activities. This activity will
be shared with the AHSN. The LETB has to date identified the following groups that require targeted
engagement activities:




Third Sector
Local Authorities
Students
Patients
Stakeholder Relationships Development resources will be engaged to work with the Design Lead,
Project Manager, and LETB Transition Board members and stakeholders to identify and develop key
relationship contacts with such groups and to define and implement / facilitate an engagement
strategy of networking events, and workshops to ensure their involvement in LETB business.
The following have been identified as key tasks that will need to be undertaken to support this
approach





Identifying stakeholder groupings requiring targeted engagement activities
Identifying initial contacts within these stakeholder groups
Identifying Engagement Leaders for these groups
Working with the Engagement Leaders and these Groups - help to define and implement a
strategy for their engagement
Supporting the Engagement Leaders to build sustainable working relationships and
engagement vehicles (forums, groups, committees) to facilitate successfully engagement
with the LETB
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2.2.7
NCEL LETB Gateway 2 Submission
Engagement and Communication Strategy
The NCEL LETB will undertake specific engagement and communication activities during design,
transition and operational delivery as outlined below:
Design Stage
During the design stage the LETB will undertake the following activities







Use opportunities when LETB Transition Board representatives and LETB staff (when in post)
are engaging with stakeholders to promote the LETB approach and ethos, and seek feedback
Hold local open sessions in partnership with stakeholders to canvass views on the LETB
operating model and how best to ensure their engagement in its design, development and
delivery
Actively test the LETB design and any proposed developments with these stakeholders
Develop a web presence to publicise and direct people to the LETB information – which
could also serve to provide a feedback forum
Develop a newsletter to communicate progress to stakeholders
Identify ‘Engagement Leaders’ to represent and facilitate the engagement of specific
stakeholder groups/constituencies
Develop a communications strategy to utilise IT to best advantage – i.e. emails, You Tube
videos etc. in order to maintain communications with stakeholders
Transition Stage
During the Transition stage the LETB will undertake the following activities







Maintain regular communication on developments with Stakeholders via website and
newsletter
Undertake outreach to stakeholder constituencies and support ‘Engagement Leaders’ to
develop an inclusive engagement framework for the LETB
Target engagement activities with periphery and historically hard to reach groups that need
proactive engagement; developing avenues for regular information exchange as well as
opportunities for their on-going involvement.
Engage and appoint appropriate executive and non-executive LETB Board members to
deliver a skills based board in line with HEE guidance and stakeholder expectations
Develop an interim Advisory Council that demonstrates fair representation of constituencies
in line with HEE guidance and stakeholder expectations
Ensure involvement of appropriate stakeholders in the shadow activities of the NCEL LETB
such as the commissioning planning cycle and the development of investment plans and
workforce strategies
Continue to develop a stakeholder relationship framework that demonstrates fair
representation of patient, professional, managerial, organisational and sectorial
stakeholders across the LETB area
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NCEL LETB Gateway 2 Submission
Operational Stage
During operational delivery the LETB will undertake the following activities
 Mobilise engagement with stakeholders to
o gain nominations for LETB and Advisory Council membership
o
o
hold the LETB to account regarding
•
value for money
•
the quality of service being provided
•
individual board member performance
to establish appropriate engagement portals and mechanisms (Advisory Groups)
that will enable stakeholders to come together to
• investigate ways to improve education and training opportunities
• define workforce and education and training strategic plans
• define service quality, implementation targets and associated key
performance indicators (KPIs) and reporting requirements
• hold Service Providers to account regarding service quality, delivery of
targets and performance against KPI's
• drive value and reduce the cost of the service provision.



2.2.8
Raise awareness throughout the constituency of the benefits of LETB and how it can be
utilised to promote positive change.
Ensure consistent and appropriate communications are maintained with all stakeholders.
Build local cross-boundary, national and international relationships to the benefit of NCEL.
Stakeholder Engagement and Communications
Stakeholder Engagement Activities
To date the following key targeted engagement activities have been undertaken:



NCEL LETB Transition Board - set up with a wide representation with members acting as
Engagement Leaders
NCEL LETB Working Groups - set up to support design and development in following areas
o Governance
o
Target Operating Model (TOM)
o
Stakeholder Engagement
NCEL Design Lead (Chris Fowler) - appointed and working with ‘Engagement Leaders’
focusing on LETB design and development and the engagement of their constituencies. To
date targeted engagement discussion have been initiated with:
o
Primary Care / GP’s - focus: creating a forum for engagement
o
Nursing and Midwifery - focus: developing future operational delivery models
o
Independent Sector - focus: developing an improved route to engagement
o
Patient representation - focus: developing a patient forum / network
o
Trainee representation - focus: gaining representation and developing a network
o
Student - focus: gaining representation and developing a virtual forum
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Health Education England
NCEL LETB Gateway 2 Submission
Engagement Events
o
The following events have been held
 1st NCEL LETB Stakeholder Event – held 10 April 2012
 GP Engagement Event – held 13 March 2012
 NCEL LETB Transition Board meeting – held monthly
 Governance, TOM and Stakeholder Engagement Working Groups meetings
 NHS London LETB Stakeholder Event – 14 June 2012
 HEE Engagement Event – 15 June 2012
o
The following events are planned
 2nd NCEL LETB Stakeholder Event – 18 July 2012 and follow on events with a
Commissioning Cycle Focus
 NCEL LETB Transition Board meeting - monthly
 Governance, TOM and Stakeholder Engagement Working Groups meetings
Stakeholder Communication Activities
To date the following key communications channels have been put in place

NCEL LETB Website - set up providing access to key papers and updates

NCEL LETB Bulletin - issued monthly to circulation list and uploaded onto website

NCEL LETB Project Update - issued weekly to project team

NCEL LETB Stakeholder Events and Meetings - as noted above
Communications have been supported by

Question and Answers - developed and shared via the website

Stakeholder Circulation List - developed and maintained by the project team
The following communications channels are planned to be developed

You Tube Video - the creation and sharing of a you tube video

Social Media Outputs - the development of a Twitter/Facebook feeds

Specific Stakeholder Forums - to be put in place

Web Based Membership - database of interest supported by targeted email communications
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Health Education England
3.
Our Organisation
3.1
Functions, Structure and Ways of Working
3.1.1
Organisational Architecture Design Overview
NCEL LETB Gateway 2 Submission
The future education and training environment across London will comprise the following functional
entities:

LETBs – will act as commissioners in the new system and will be responsible for the following
activities
o Workforce planning and reconfiguration
o Planning commissioning strategies
o Contracting with Lead Providers and setting statement of requirements (SoRs)
o Managing the quality and relationships with the regulators
o Working with providers to improve the quality of education and training
o Developing Providers
I.
II.
LETB Operational Delivery (Localised) – that will drive local workforce strategy and
develop local workforce reconfiguration and education and training plans with due
consideration of the London and broader national and international environment
LETB Joint Service(s) Office - that will support the London LETBs and the Lead
Providers by executing functions where there is merit in doing so once for all London
LETBs (Shared Services)

Lead Providers - who will be responsible for the delivery of education and training, as
commissioned by the LETB – and undertake the following activities
o Quality managing the education delivered by Local Education Providers (LEPs)
through leadership and management of LEPs and trainees and students to achieve
the NCEL LETB vision for education and training
o Recruitment (shared service element)
o Managing trainee rotations/student placements(shared service element)
o Reviews of trainee/student progress(shared service element)
o Construction and oversight of training programmes

Local Education Providers (LEPs) - will deliver education and training and will be responsible
for local quality control (Lead Providers can also be LEPs)
The document “LETB Development Briefing Document: Function-based Outline of Activity; January
2012” described function taxonomy as provided by London’s education and training system. The
analysis below is based on that taxonomy and a summary document is included – please refer to the
Supporting Document reference NCEL1287 LETB Capabilities Statement.
A full analysis of all of the activities carried out by NHS London and the Deanery (including PSSO) has
taken place. The three LETBs have reached consensus on which activities should be local, which
should fall to the lead providers (further subdivided by those which will be shared) and which
services should be shared.
Transition of these services will be managed in a staged process as outlined in section 4.
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Health Education England
NCEL LETB Gateway 2 Submission
The Figure 5 below shows the breakdown of these functions into their respective areas. Costings for
these areas can be found in section 4.
Figure 5: Target Operating Model – Functional Infrastructure
3.1.2
Lead Provider and Local Education Provider Model – Overview and Rational
Overview
Within London the Lead Provider (LP) model was developed to transform and to promote significant
improvements in PGMDE in order to enable it to keep pace with changes in healthcare delivery. The
LP model enables a clear distinction between the roles of education commissioners and providers.
This change in approach to the commissioning of education and training is built upon a series of
national policy developments, from Sir John Tooke’s independent inquiry into Modernising Medical
Careers through to the Department of Health’s report on Educational Commissioning for Quality.
The model offers - through appropriate collaboration between LETBs (as commissioners in the new
architecture) and LPs – the opportunity for educational investment in training to be better aligned to
service need, thereby improving patient care.
Adoption of the model offers a way to implement a commissioning system designed to ensure a high
quality and appropriate healthcare workforce for now and for the future.
Excellence and innovation in education would be encouraged through contestability and clear
statements of requirements (SoR) from the LETBs that will be developed in partnership with
interested constituencies and that will be published so that everyone – including trainees, students
and patients can be actively engaged in supporting the move to make training programmes in NCEL
the best nationally and internationally.
The success of LP/LETB system can and will be measured using agreed and streamlined targeted
metrics against the SORs.
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Health Education England
NCEL LETB Gateway 2 Submission
Rational for Adoption
The driving forces behind the adoption of the LP by PGMDE are, at the high-level, the same as those
being experienced by the wider heathcare system – i.e. to ensure that



the workforce is better prepared for tomorrow’s health care needs
education and training are improved significantly
unique health care resources are more wisely used to support education and training whereever possible
In order to achieve these changes the leadership and management of the provision of PGME training
was devolved to organisations (LPs) – that



were better positioned to make timely changes to education and training so as to deliver the
quality improvements required to meet the changing needs of the ever-evolving healthcare
system
served to bring together Local Education Providers (LEPs) to make local decisions about the
provision of training and manage the service training relationship
could involve LEPs in a process of co-creation and peer oversight of education and training
with increased buy-in and mutual support for innovation and improvement
The LP model has been designed to
 focus all providers on the end point of better training for better care
 maintain a clinically lead approach
 enable better engagement and ownership of training programmes and trainees
 bring service and education planning together
 innovate to improve training
 target improvement to trainee experience in service delivery so as to attain excellent
performance across all departments in LEPs
Within the model, efficiency of delivery is enhanced by the fact that LP’s are supported in their role
by a shared service of “Provider Support” that provides common back-office functions - inclusive of
London’s role in National recruitment – and the LPs manage and govern these function in
partnership.
To LP model is relatively new but tangible benefits are already beginning to be released that include



More frequent and localised training events
o better for trainees as more accessible
o better value for money
Improved liaison and direct communication with trainees
Review and leverage of existing resources that historically just flowed into the system
o e.g. study leave funding
Approach Summary
The NCEL LETB will adopt the LP model for managing all contracts (not just medical and dental). The
LETB will manage the relationships, determine statements of requirements and perform contract
performance management activities with LPs only. LPs will be responsible for the contract
management activities with LEPs, rather than the LETB. The LETB will only get involved in
exceptional circumstances with LEPS.
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Health Education England
3.2
Functions
3.2.1
Overview
NCEL LETB Gateway 2 Submission
A comprehensive review of the current delivery infrastructure has been undertaken - full details of
these functions can be found in Supporting Document reference number NCEL 1287 (LETB Capacity
Statements). The following section uses this taxonomy to outline where these functions will be
performed within the new architecture.
3.2.2
LETB Functions
Within the new architecture the NCEL LETB will be responsible for:
LETB Operational Delivery - Localised Functions
Functions are currently performed by NHS London.





Workforce strategy
Workforce planning
Education planning
Education quality
Education Commissioning Decisions (including LCMDE - Deanery)
LETB Joint Services Office - Support Functions
The NCEL LETB will be responsible for ensuring that the following functions done once for all LETBs
(shared) provide an appropriate quality and level of support to the business activities of the NCEL
LETB
Functions currently performed by NHS London:



Procurement and Contract Management
Finance
Informatics
Functions currently performed by PSSO / Deanery




3.2.3
Programme Intake and Recruitment
Library
Lead Provider Support Services Functions
HR and Finance are expected to be provided as a shared service by HEE via a subcontract
with NHSBSA
The Lead Provider - Functions
The NCEL LETB will be responsible for ensuring the quality of the following functions that will be
commissioned from and provided by LPs: (inclusive of DILP)




Programme Design
Programme Delivery
Placement Management
Assessment
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Health Education England
3.3
NCEL LETB Gateway 2 Submission
Structures
Each LETB has developed its own organisational structure to meet local needs and to interact with
the Shared Services. Details of the other two London LETB structures can be located within their
individual Gateway 2 submission documents – the current proposed NCEL LETB structure is outlined
below.
3.3.1
LETB Structure
The NCEL LETB organisation is shown in Figure 6 below. All roles are graded using the NHS Agenda
for Change scheme (these will be reviewed in line with DH Guidance).
Figure 6: Target Operating Model – Organisational Structure
LETB Chair - The LETB chair must be an independent chair. This will be a part time role (the current
assumption is 4-5 days per week). The job description for the LETB chair can be found in Supporting
Document reference NCEL1240 (Annex B). Appointments for the role of chair are expected to
complete by the end of July 2012.
Managing Director - The job description for the Managing Director can be found in Supporting
Documents reference NCEL1240 (Annex C). Appointments for the role of Managing Director are
expected to complete by August 2012. This is a Band 9 role.
Director of Finance - The job description for this role has been prescribed by HEE can be found in
Supporting Document reference NCEL1240 (Annex D). Appointments for the role of Director of
Finance are expected to complete by August 2012. This is a VSM role.
Director of Education & Quality
The NCEL Director of Education & Quality is a clinical grade role. The job description for this role has
been written locally and can be found in Appendix 3 – NCEL LETB Non Mandated Job Descriptions.
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Health Education England
NCEL LETB Gateway 2 Submission
Appointments for the role of Director of Education & Quality are expected to complete by August
2012. (cross check)
Portfolio Managers X3
The NCEL Portfolio Managers will pull together teams of people from various stakeholder groups and
the specialist resource pool to create business case for change for new LETB activities as well as
managing business as usual activity. The job description for this role is attached in Appendix 3.
Portfolio Manager appointments will be made from August 2012 onwards. This is a band 9 role.
Engagement Manager - costs to be shared with AHSN – to support governance, constituencies and
membership and maintaining and enhancing the engagement framework and supporting processes
and communications. The job description for this role is attached in Appendix 3.
Administrative Support x3
There will be three Administrative Support resources for the NCEL LETB. One Administrator will
support the executive and non-executive directors and act as Secretariat to the LETB Board and Two
further Administrators will act as project support the work of the Portfolio Managers. The job
description for these roles is attached in Appendix 3 respectively. These are all band 6 roles.
Specialist Resource Pool
The NCEL LETB will have a pool of specialist resources which they can mobilise to work on specialist
projects as and when required. The size of the resource pool will be dependent upon the cost
envelope available for the NCEL LETB.
3.3.2
Shared Service Structure
The organisational structure of the LETB Shared Service Organisation (LETB SSO) will be determined
as part of the detailed design process to be carried out during Phase 1 (Please refer to Figure 5 , and
Section 4.1).
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Health Education England
3.4
Ways of Working
3.4.1
Workflows
NCEL LETB Gateway 2 Submission
The NCEL LETB high-level organisation work-flow is shown in Figure 7 below.
Figure 7: Target Operating Model – High-Level Workflow
From this high-level workflow a number of scenarios have been developed by the NCEL LETB and
these have been explored and tested with interested stakeholders. Feedback from this engagement
has enabled the NCEL LETB to stream-line this process and an example business as usual scenario is
included at Appendix 4 – NCEL LETB Workflow Example, which provide an overview of the workflow
through this new architecture.
3.4.2
Annual Business Planning Cycle
The Planning Cycle
A business cycle has been constructed by NHSLondon to provide an overview of the critical business
undertaken within the scope of education and workforce commissioning system within any given
year. The NCEL LETB will begin to integrate its operations with this cycle and prioritise its shadow
operations and functions to this plan and participate in the retrospectively-focused and in year key
activities and Lead the future facing activities as a priority on receiving shadow operating status. To
this end the NCEL LETB has a half day event scheduled for the 18 July that will start to focus
engagement with stakeholders with regards to this planning cycle and will begin to work with
stakeholders to put in place the Advisory Groups needed to develop and support this commissioning
cycle going forward.
Please refer to the Supporting Document NCEL1288 – LETB Proposed Commissioning Cycle – which
illustrates two different perspectives of the business cycle required for workforce and education
commissioning system. The first cycle provides a high level overview of the medical and non-medical
education planning and commissioning cycle. The second cycle details key operational milestones
associated with the wider education and workforce commissioning system.
Scope of the business cycle
The following work-streams have been highlighted within the business cycle:
 Strategic workforce planning
 Non-medical education planning and commissioning
 Medical education planning and commissioning
 Medical recruitment and rotation
 Contract management: Learning Development Agreement and Lead Provider
 Continuing Professional and Personal Development (CPPD)
 Simulation and Technology-enhanced Learning Initiative (STeLI)
 MPET statutory functions
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Health Education England
NCEL LETB Gateway 2 Submission
The business cycle includes information from three separate financial/ academic years, with the
associated business activities run in parallel. This requires the following to be simultaneously
maintained throughout any given year:



Backward view - to ensure activity is taking place to agree activity outturn and final
reporting/ evaluation, etc,
In year focus -to ensure activity taking place to deliver contract management and
performance, mid-year reviews, uptake reports, statutory reporting to DH, etc,
Forward planning - activity to plan for future academic/ financial years such as strategic
workforce planning, stakeholder review sessions to plan future requirements, allocations
and budgets set, etc.
Supporting narrative providing further detail against each business cycle activity is also provided in
the Supporting Document reference NCEL1288 which corresponds directly to the business cycle.
3.5
Running Costs and Affordability
3.5.1 Financial Envelope
Current guidance from DH suggests LETBs will be required to operate with between 1.3 and 1.6
percent of the overall MPET allocation (with 1.3 percent being the most likely). For London this
equates to between £15-19m, and for the NCEL LETB between £6-7m (based on a differential
allocation methodology). It is approximately 40 percent less that NHS London currently manages the
MPET budget with (£26m 2012/13).
3.5.2
NCEL LETB Running Costs
The running costs for the NCEL LETB organisation are shown in Figure 8 below. An uplift of 25% has
been applied to salary costs to account for other costs such as pension and accommodation costs
Figure 8: Target Operating Model – Running Costs
In addition to the above, NCEL LETB will have a pool of specialist resources available to call off to be
able to provide support on projects as and when required. The size of the specialist resource pool is
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Health Education England
NCEL LETB Gateway 2 Submission
dependent upon the funding available for the NCEL LETB, which is expected to be between £1.2£1.8M.
It should be noted that the organisation above is the minimum requirement to be able to operate.
3.5.3
Organisational Costs
Please refer to Appendix 5 - London LETB As-Is Financial Breakdown 2012/13, which provides an
overview of the available budget by key functions
3.5.4
Projected Cost Savings
Efficiency Drivers
The whole approach to the design and development of the NCEL LETBs emerging target operating
model has effectively served to embed efficiency drivers in all areas of service delivery for which
LETBs will be responsible – these efficiency drivers and their potential efficiency benefits
are outlined below

•

Collaborative / Lean Operating Model (Localised Functions) – as has been demonstrated in
this submission the NCEL LETB has been designed to be extremely lean with a working ethos
based on collaboration and partnerships working approach that will utilise the emerging
AHSN to mobilise expertise from within the system via its Advisory Council and a number of
Advisory Groups. This new symbiotic working relationship - of collaborative working for the
benefit of the whole system – has the potential to reduce costs by leading to
o more effective and efficient access to and utilisation of existing expert resource by
LETBs
o LETBs being closer to the “customers” (providers/employers) enabling a refocusing
on activity that they value, removing the costs of activities that they do not value
o Removal of some costs inherent in running a hard commissioner-provider split
Lead Provider Approach – rolling out the LP approach has the potential to reduce cost by
o Introducing a different contractual relationship with a smaller number of providers –
leading to a reduced undertaking of expensive procurement / contracting activities as
well as a simplified quality management relationship based on the statement of
requirements and targeted indicators that focus on ensuring and enhancing quality and
excellence in the system.
o LPs managing local providers more efficiently due to being closer to them
o An appropriate move to different mix of skills focused on achieving and maintaining
quality in a collaborative environment based on building mature and effective
relationships with providers – improving the quality and value for money of the whole
system.
Shared Service Reconfiguration – has the potential to reduce costs by
o bringing together LETB support services under a one governance and management
structure to enable efficiencies of scale to be identified and current areas of over
resourcing / under resourcing to be identified and addressed.
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Health Education England
NCEL LETB Gateway 2 Submission
Efficiency Opportunities
The LETBs are working with NHSL and London Deanery to identify areas for potential cost reduction
to support the above efficiency drivers to release savings in the short to medium term - and a
number of early efficiency opportunities have already been identified for consideration these
include:





Co-located Estate - vacating current premises to a better value location and co-locating staff
could release in the region of £1m p.a. of estate savings
Professional Advisor / Interims Contractual Review – a comprehensive review of such
contracts could potentially release signification savings (£tbc)
Special Projects – termination of special projects would be expected to release in the region
of £2.5m of savings
Information Technology – investment in appropriate information technology to support the
business of the LETBs could potentially release circa £3million per annum by 2017
Efficiency Activities - A number of efficiency activities are currently being implemented by
NHSLondon and the London Deanery in order to reduce running costs to 01 April 2013 as
part of their existing annual CIPs – for example The London Deanery has initially identified a
range of savings which may total £600k in 2013/14. These will increase as functions are
redesigned.
Summary
Further work will be undertaken during the transition stage to



Develop the detail around the cost benefits of the above efficiency drivers
Design and deliver the shared services and contracting model to support implementation
Identify, quantify and agree which efficiency opportunities and existing efficiency activities
LETBs would wish to prioritise and take forward from now to 2014.
These high-level efficiency drivers, emerging efficiency opportunities and the on-going programme
of efficiency activities as outlined above provide a high-level of confidence that the required costs
saving can be released by this emerging education and training system for healthcare in London by
2014/15.
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Health Education England
4.
Transition and Continuing Operation
4.1
Transition Approach
4.1.1
Rational for Transition
NCEL LETB Gateway 2 Submission
The NCEL LETB is aware of the scope, scale and complexity of the changes that are required to effect
a system change that can deliver the required efficiency saving. As such it supports the proposed
interim transition of these services as a way to afford the London LETBs the time required to review
and re-configure service delivery while at the same time ensuring their safety in transition.
The NCEL LETB will thus seek and promote close collaboration with each of the two other LETBs in
London to ensure safe transition of functions from NHS London as well as to maximise opportunities
for efficiencies and outcomes across London. This collaboration would also serve to enhance
relationships with LETBs across England and provide a cohesive London voice to HEE during this
transition period.
The NCEL LETB will work to ensure a safe transition of operations from NHS London by:





4.1.2
Developing a robust NCEL LETB Transition and Authorisation plan
Close collaboration with NHS London and the other two LETBs in London
Robust design principles
A staggered operational transition
Maximising the utilisation of and input from current expertise and resources both in NHS
London and across the stakeholder groups
Phases of Transition
Overview of Approach
The three LETBs in London have decided to work together through the transition period to develop
the final operating model for the whole education system by April 2014. The intention is that the
LETBs will start to take more decisions and take more of a leading role balanced within the
constraints of the duties of the SHA while it still exists.
The LETBs have identified four phases of transition and have mapped the proposed governance
arrangements for each. These are:




Phase 1: July 2012 to October 2012
Phase 2: November 2012 to March 2013
Phase 3: April 2013 to March 2014
Phase 4: April 2014 onwards
Working with colleagues at NHSL the LETBs have identified three main areas of transition with clear
lines of accountability and responsibility throughout the transition phases. In particular the overall
responsibility for the safe transition will remain with NHS London until it ceases operation on the 31
March 2013. It will oversee the work through the LETC (Local Education and Training Committee),
this will also be called the LETB Transition Group which reflects the growing sense that the LETBs are
taking more decisions.
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Health Education England
NCEL LETB Gateway 2 Submission
The Working Groups
The working groups that will initially report to the LETC are as follows:
1) Business as usual (2012/13 annual plan) group (LET Management Group) – ensuring safe and
effective operational functioning with clear accountability for decision making on this year’s
current plan. LETBs will be expected to take more decisions as they become established in
shadow form.
Membership: LETB DLs/MDs, NHSL and Deanery
2) Whole System Transition Management Group – responsible for development of the new
operating model for the whole NHS education and training system in London and the safe
transition from the current system. To oversee the three areas of:
 Shared Service development and cost efficiency
 Local LETB development
 People and talent management so people in the current system are managed and
communicated with effectively and closure of the SHA is completed
Membership: LETB DLs/ MDs to lead, advice and input from NHSL and Deanery - Chaired by a
LETB lead
3) LETB Shared Services Governance – responsible for oversight of the shared service elements
and ensuring effective interface with the local LETBs over the transition phases. Established by
Phase 2.
Membership: LETB MDs with managers from the delivery system - Chaired by a LETB
Accountability
Figure 9 below outlines the accountability for each of the three main groups through phases 1 and 2.
Figure 9 – Target Operating Model - Transition Management and Governance in Phase 1 and 2
NHS London Board
London Education & Training
Committee (LETC)
Whole System Transition
Management Group
Shared Services
Operating Model
Local LETB
Operating Model
Medical Workforce
Group
LETC Management Group
Business as usual
Finance Group
HR/People Group
Handover Closure
Operating Model
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Health Education England
NCEL LETB Gateway 2 Submission
In Phase 2 - as per Figure 10 below - there will be a gradual transition from the LETC to the LETBs
Figure 10 – Target Operating Model - Phase 2 Transition Governance Arrangements in Phase 2
LEGACY
NEW
NHS London Board
LETC
(LETB Transition Group)
Business as usual
Health Education England (HEE)
South London
LETB
Whole System
Transition Management
Group
North Central &
East London
LETB
North West
London LETB
Shared Services Governance Group
Shared Services
Operating Model
HR/People
Receiving
Responsibilities
Details of each group are listed in the Table 1 below:
Table 1 – Working Group Responsibilities
Business As Usual Working Group (LETC Management Group)
Business As Usual 2012/13 annual operating plan and on-going responsibility will be discharged through the
existing NHS London governance arrangements. This will ensure that the day to day functioning of the system
continues during transition. Initially the LETC will continue to be the main governance and oversight group
with a BAU working group. It is expected that the LETC will continue through to early 2013 and will meet to
fulfil the oversight of business as usual making key decisions as required with a gradual handover of
responsibilities to the shadow LETBs until they are authorised and commence full operation by April 2013.
This group will have active LETB engagement and leadership and it is expected that the LETBs will start to take
a much more active role in decision making during this period .
The Whole System Transition Group
Oversight and assurance that the whole NHS education and training system in London will safely transition into
the new operating models for the three LETBs will be held by the LETC and the development of this Whole
System Transition Group. The group will meet fortnightly to keep track of transition progress and make key
decisions as required led by the LETBs. This group will continue to meet to fulfil the oversight of the whole
system transition until the HEE LETB authorisation process is completed. There will be a number of working
groups established:





Shared Services Operating Model
Local LETB Operating Model
Medical Workforce Group
Finance, Estates, Facilities and Infrastructure working group
People and HR working group
Closure of NHSL and handover

LETB Shared Services Governance Group
The LETB Shared Services Governance group will take on responsibility from the LETC as the LETBs become
established and authorised for the shared service oversight.
Transition Note - The Whole System Transition Group will ensure that the shared services operating model will
be redesigned over the summer 2012. Gradually throughout Phase 2 this group will handover responsibilities
to the LETBs through the Shared Service Governance Group.
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Health Education England
NCEL LETB Gateway 2 Submission
Transition Roadmap
The following road map, Figure 11, outlines the key activities to be carried out during each phase of the transition process.
Figure 11 – Target Operating Model - Phase 2 Transition Governance Arrangements in Phase 2
Jun
Phase 2
Sep
Aug
Jul
2013-2014
2013 (Q1)
2012
Phase 1
Phase 0
Oct
Nov
Dec
Jan
Feb
Mar
Phase 4
Apr ’13 – Mar ’14
Apr ’14 – Mar ‘15
Business As Usual
Transition Period
Define local
LETB roles
LETB chairs
appointed
Recruit LETB
MDs
People
Move
2014-2015
Phase 3
Recruit local LETB
executive team (incl.
people transition)
TUPE of Staff complete
where required
Communicate with staff
and Stakeholders
Selection and Recruitment of Local LETB
and shared services staff
‘Voice for London’
Self assessment of LETBs
Against authorisation criteria
LETB Future
Design
Design activity for shared
services to meet the
efficiency
(spec, design & sign-off)
Gateway 2
submission
Transitional
Management
LETB Business
As Usual
Lead Provider Development
Gateway 3
submission
Select LETB to
manage shared
services
Agree
detailed
design
Authorisation
Preparation
(Gateway 3)
Develop LETB
IT &
accomm rqmts
Implement
Shared Service
Implement cost efficiency design
LETB authorisation process
LETBs
established
Local LETBs operational (shadow form)
Shared Services Interim Management Arrangements
Transition functions from
shared service to LETBs/ LPs
LETB Shared Service
Governance Group Mtgs
Transition
Governance
LETC – Business as usual 2012/13 cycle
LETC – Business as usual 2012/13 cycle
LETC – Whole System Transition
LETC – Whole System Transition
X3 LETBs (HEE)
Local LETBs
Business as usual/ Whole System Transition
authorised
LETB Shared Service Governance Group
Page: 45
Health Education England
NCEL LETB Gateway 2 Submission
Transition Plan
Details of the Transition Plan to be managed through the Whole System Transition Management
Group are detailed in Table 2 below
TABLE 2 – Transition Plan
Key
Decisions
Organisation,
People &
Structures
Management
Governance
Key Activities
Page 46
Phase 1 - July to Sept’12
Phase 2- Oct to Mar’13
Phase 3 – Arp to Mar ‘14
 Select interim shared services
transition lead
 Agree scope of shared services
cost efficiency project
 Agree interim working
arrangements with the
Deanery & NHS London
 Select the shared services LETB
host
 Sign off cost efficiency &
design proposals
 As-is
 Deanery to remain in current
form
 NHS London to remain in
current form
 As-is
 As above
 Shared services to still be
governed through NHS London
structures and through to the
single LETC
 Agree staff communications
strategy
 Communicate transition plan
to staff and stakeholders
 Agree shared services location
and infrastructure
 Sign off Annual Business Plan
(2013-14)
 Sign off end state plan (2014
onwards)
 Interim structures & working
arrangements (TBD)
 TUPE transfer of staff
(where appropriate); all staff
employed by HEE
 Staff move as required to
new location completed
 Organisation formally
hosted by one LETB
 Final state governance
arrangements in place for
2014 onwards
 Shared services governance
group
 Produce detailed transition
plan
 Appoint interim shared
services transition leader
 Define scope of shared services
& interfaces with local LETBs
 Complete LETB shared service
host selection
 Produce detailed operating
design of shared services for
transition (including job
descriptions)
 Define interim structures and
working arrangements for
phase 2
 Assure continuity of service
(BAU)
 Commence development of
Annual Business Plan (2013-14)
 Interim arrangements
 Shared service governance
group formed in shadow form
 Shared services governance
group to be accountable to
the three LETBs in shadow
and once authorised
 Convene first shared services
governance group and agree
LETB chair
 Implement design (to deliver
shared services as agreed in
phase 1)
 Assure continuity of service
(BAU)
 Plan TUPE process (as
appropriate)
 Prepare staff communications
and key messaging
 Commence staff selection &
recruitment process
 Determine staff location for
new organisation
 Support LETB authorisation
 Develop infrastructure
arrangements for new
organisation (e.g. IT and
locations)
 Develop shared services
business plan (including SLAs,
KPIs , reporting & budget)
 Commence development of
end state plan (2014 onwards)
 Year one/BAU activities
operational
 Performance management
procedures operational for
shared service (including
resolution procedures for
performance management
issues which cannot be
resolved locally by each
LETB) through Shared
Services Governance Group
 Develop end state plan
(2014 onwards)
Health Education England
4.2
NCEL LETB Gateway 2 Submission
Risk and Issues
4.2.1 Risks and Issues
The following table provides an overview of the high-level risks and
The following tables list the operational/clinical, reputational and financial risks, as well as
associated mitigating actions, issues associated with the design and transition to full operational
delivery of the proposed Target Operating Model as described in this document. A NCEL LETB risk
and issue log providing a more detailed analysis is attached at Appendix 6 – NCEL LETB Risk and
Issues Log.
Operational
Key Risk/Issue
Talent
 The LETB model cannot be designed
quickly enough to allow coordination
with the wide system transition
 Key current staff are lost to the system
leading to a loss of corporate memory
and instability in continuing operations
Mitigation




Consensus
 Agreement cannot be reached between
the three London LETBs on which
services should be shared and how



Planning & Quality
 Insufficiently
robust
workforce
planning
 Non-achievement or shortfalls of the
education outcomes framework



Conflicts of interest
 Perception that conflicts of interest will
not be appropriately managed by the
new structure
Page 47

Co-ordinated with wider system HR
timetable to support staff retention as
appropriate
Swift identification of high-level positions
and job descriptions, with support from
HEE where required for nominations
Ensure roles are designed to be attractive
to the desired profile of a candidate
Ensure the HR process is well planned,
implemented and communicated to staff
in the wider system so as to secure staff
retention where appropriate
Build on good relationships between
three Design Leads, and engagement
with HEE as established, to manage
agreed process
Agree process for resolution on any
outstanding issue
Regular design sessions held between
LETBs, supported by operating model
team
Need robust shadow and transition
period prior to April 2013
Need support and transparency of
current operating process in
development
Maintain engagement and provision of
information from local service providers
LETBs operating model to be explicit
about roles and responsibilities of the
board and the different parts of the
system
Health Education England
NCEL LETB Gateway 2 Submission


Explicit governance statements to
address conflicts of interest
Create and maintain transparency in the
decision-making process overseen by HEE
appointed Chair
Reputational
Key Risk/Issue
London reputation
 Risk of losing London’s inter/national
reputation in education & training
Mitigation


Buy in
 Failure to effectively engage and
communicate with key stakeholders.
 Securing buy-in is challenging –
recognise the need to reach out to
diverse networks – e.g. CCGs, public
health and social care, private sector


Managed through joint-governance
between the three London LETBs;
enables them to collaborate and provide
/ maintain one voice for London where
this adds value
LETBs Lead Provider delivery and
commissioning approach will ensure and
enhance quality of delivery and local
reputations and thus reinforce London
wide reputations
Continue stakeholder mapping and
strategy
Build on strong relationships, existing
networks and forums



Continue engagement to date with key
stakeholder groups
Announce/post direction publically and
transparently
Develop and utilise full suite of
communication channels and outreach
tools to engage and inform stakeholders
Financial
Key Risk/Issues
Cost envelope
 The cost envelope does not allow for
sufficient delivery of responsibilities
Mitigation



Page 48
Local LETB has been designed to be very
lean - and to utilise expertise from
within the system via Advisory Groups
Manage transition period with other
London LETBs to ensure best value for
money solutions are delivered, and what
should be done to maximise efficiencies
and reduce costs (e.g. Shared Service).
The LETB will mitigate against the
proposed model being outside the
costing envelop by the LETB finance
working group developing several
operating models with the central NHSL
Health Education England
NCEL LETB Gateway 2 Submission

Allocation
 This is further complicated by a potential
introduction of tariffs and allocations
methodology which might reduce the
amount of funds available

Transition
 There is insufficient resource to manage
the transition/ transformation to
separate LETB operations resulting in a
decline in quality
 Difficulty of achieving and delivering cost
reduction and organisational
reconfiguration simultaneously.




Page 49
finance group
NHSL / Deanery providing financial
information and costs per functional
areas
Request DH/ HEE providing more clarity
on methodology and outcome
Finance Group surveillance and
advocacy of allocation methodology;
LETBs to lobby HEE on this area
Prioritisation of LETB responsibilities
(e.g. statutory vs. Ideal); may require
current functions to have reduced
capacity (or transferred responsibility) is
not material to planned future
operations
Release funds for 2013/14 through
ending of Special Projects and CIPs
Transitional resources/support available