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The large-scale changes are partly due to the removal of Local Education and Training Boards and the merger of Health Education England with NHS England. They suggest that integrated care systems should take on a greater role. But the structures for training and education at a local and regional level lack transparency.

The Health and Care Act removed Local Education and Training Boards from statute. These boards were originally established to carry out Health Education EnglandÃÛÌÒÖ±²¥™s functions at local and regional level. They were directly involved in the commissioning of education and training based on local requirements. The purpose of this was to reduce duplication in the system.

How we collected evidence

We reviewed the education and training commitments within integrated care systems' (ICS) strategic documents, across all 42 ICS in England in autumn 2023. We'll review these strategic documents again in autumn each year.

What we learned 

There is a policy framework in place to suggest that ICS take a greater role in planning education and training capacity to meet local service requirements, there’s limited public evidence that this is taking place.

Health Education England and NHS England have now established non-statutory Regional People Boards. But there’s limited information about these boards in the public domain. The Integrated Care System design framework sets out that ICS should work with their local health and education provider organisations to plan, develop and, where required, grow the ‘one workforce; to meet future needs. The framework lists planning local educational capacity and opportunities and attracting local people into health and care employment.

NHS England set out further details on expectations for ICS in delivering education and training for health care staff in the NHS Long-Term Workforce Plan published in 2023.  The plan emphasised the need for system-wide integrated workforce planning and redesign. Education supply is central to this. The plan says that ICS, service providers and NHS England will work together to lead and commission sustainable education supply, including the supply of educators.  

The Long-Term Workforce promised that to support ICS, from 2024 NHS England will move to a position whereby national education and training plans will be developed at least 3 years in advance. This would support a more strategic approach to delivering the pipeline of staff across the NHS. At the system level, ICBs will be expected to deliver strategically placed investment in education to meet service needs. ICBs will be expected to consider placement capacity in their service planning within yearly operational plans.

An NHS England guidance4 document states that from 2022, ICBs were expected to coordinate and allocate resource to deliver their people function working with members of the ICS. This includes the key functions of educating, training, developing people and managing talent, by planning education capacity based on local workforce and service needs and overseeing the pipeline of clinical learner supply.

ThereÃÛÌÒÖ±²¥™s a lack of transparency about the roles and responsibilities of ICS in delivering their education and training objectives.

ThereÃÛÌÒÖ±²¥™s a lack of clarity about the ICS role in planning for training and education. While there is a requirement on ICS to work with local organisations to develop the ÃÛÌÒÖ±²¥˜one workforceÃÛÌÒÖ±²¥™6 approach, thereÃÛÌÒÖ±²¥™s no clear role delineation between the ICS and the other parts of the system.

ICS should be supported by national workforce planning based on projected workforce needs, as well as national initiatives to improve the supply of health and care staff. This might include funding for tuition fees and living costs for students. Currently, it is fundamentally unclear how local plans and priorities connect into national strategic direction and funding.

Integrated Care System leaders should:

• Publish details of their Regional People BoardsÃÛÌÒÖ±²¥™ structure, purpose and activities
• Report on all education and training commissioning activities.
• Provide measurable and attainable objectives for this work

Service providers should:

• Use the RCN Workforce Standards to support a safe and effective nursing workforce.

The relevant standards are: 

• Ensure that all nursing students must be supernumerary when in training.
• Comprehensive workforce planning should be undertaken and include a workforce learning needs analysis, commissioning and provision of training and education. Facilities for regular professional reflection and clinical supervision should also be in place to support ongoing learning and best practice development.
• Practice development encompasses clinical supervision, assessment, supervision and teaching, Continuing Professional Development (CPD), revalidation and lifelong learning. Practice development must align to the needs of people who use services.
• Make sure that nurse leaders are involved in workforce planning, setting staffing levels and skill mix, and developing staff within their workforce.