A review of employee training challenges in the NHS

Written by Laura N.


1. Introduction

The problem of employee training effectiveness is relevant for all organisations operating in the healthcare industry (Balbale et al., 2015). The educational process in this context is often hindered by such barriers and challenges as poor time availability (Osaro and Chima, 2014) and the limited effectiveness of educational programmes (Maisonneuve et al., 2014). In recent years, the National Health System (NHS) organisation has been frequently criticised in the UK for long wait times, low service quality and insufficient competence of its personnel members (Kaidi and Atun, 2017), which undermines the implementation of the 6Cs concept promoted by the studied organisation (NHS, 2017a). The aim of this essay is to review employee training challenges in the NHS.


2. The Significance of Employee Training in the Healthcare Context

Contemporary national healthcare systems experience the need for making their operations sustainable in order to compete with private institutions and to maintain the high quality of medical services (Goh and Marimuthu, 2016). One of the components, which is relevant to this aspect, is employee competence that is viewed as a combination of professional skills and communication skills (Weimann and Weimann, 2017). The second element is especially important because doctors and nurses have to communicate with both their colleagues and patients who frequently experience and express negative feelings. Therefore, they need to be able to effectively transfer relevant information and resolve arising conflicts. However, the training of healthcare professionals is often performed by academic workers rather than by practitioners (Graban, 2016). This substantially decreases the effectiveness of such educational activities because the tutors often have a limited understanding of the operational context and problems of their trainees. While this inefficiency could be addressed by assigning training functions to high-performing employees, this approach is substantially underutilised in contemporary healthcare institutions. This decreases the potential positive impact of the educational process on the quality of medical services.

At the same time, employee training in the healthcare industry is not limited to work-related skills but also includes safety training, incident reporting training and other compulsory programmes that are required by state regulations (Wickramasinghe, 2016). The need for continuous staff development is associated with the increasing standards of healthcare services quality within the patient-centric model of the treatment process (Balbale et al., 2015). Unfortunately, this approach also increases organisational stress levels as employees have to invest extra time and efforts and combine additional education with their primary job responsibilities. Additionally, the quality of many training programmes is not substantial for ensuring good results due to their limited practical relevance or the lack of part-time education routines. Education in the healthcare context is also associated with the problem of post-training appraisal (Kadiresan et al., 2015). This activity is required to verify if new knowledge and skills have been successfully acquired. However, a large number of contemporary healthcare organisations rely on sub-optimal metrics that do not register and reward educational achievements, which leads to the frustration of employees and decreased their intentions to continue education.

The 6Cs framework is a set of values for all healthcare and social care personnel members designed by the NHS organisation (NHS, 2017a). The framework includes such healthcare services quality dimensions as compassion, care, communication, competence, commitment and courage (see Appendix). They are all viewed as sources of added value that guarantee patient satisfaction and the compliance with the national medical industry standards. That said, the practical implementation of these principles requires substantial competence on part of regular employees. It may also be difficult to verify if these values are adhered to by healthcare practitioners during their education and employment (Passmore, 2017). While the NHS is actively promoting value-based recruitment practices, mere ethical compliance is not sufficient for meeting the standards set by the 6Cs framework. Hence, specific training practices must be implemented to support the promoted concepts. The final quality of rendered services is also undermined by the problem of extensive workloads and underpayment in the UK healthcare industry (Osaro and Chima, 2014). These factors substantially reduce employee morale and the intention to participate in training programmes as well as to spend time on additional education in a highly stressful environment.

State organisations including the NHS make training an obligatory practice for employees to ensure that they possess up-to-date knowledge and skills and to guarantee patient safety (Garcarz and Wilcock, 2016). NHS managers have the responsibility to control the execution of educational programmes and to evaluate the results of staff development. However, the quality of these monitoring and evaluation procedures greatly varies between different institutions and the compulsory nature of training courses may serve as an additional stress factor for already overworked employees.


3. Employee Training Challenges in the NHS

The survey of academic training quality in the UK performed by Blencowe et al. (2017) revealed that only 53.1% of the surveyed 143 respondents were satisfied with the organisation of the training process. Only a third of them received the guaranteed research time and were properly and regularly supervised. This is a highly concerning sign because these students may encounter competence-related problems in their future employment and may require additional on-the-job training and incur expenses. It should be noted that the problem of medical education efficiency is expected to become especially prominent in the next several years due to the post-Brexit limitations of cross-border employment and collaboration in many spheres including the healthcare industry (Fahy et al., 2017). This substantiates the necessity to improve the quality of internal labour resources and increase the effectiveness of medical specialists training in UK-based educational institutions. These measures must be implemented to maintain the current quality standards.

To resolve the problems of medical specialists training, the NHS introduced the Foundation Training Programme in 2009-2010 (Maisonneuve et al., 2014). However, postgraduate specialists participating in this initiative criticised it for not reflecting the actual needs of medical practitioners. Poor scheduling of educational sessions also conflicted with their work routines. Additional criticisms were referred to the lack of practical training in project management that is essential for administration and paperwork in the workplace. Education-related problems are also evidenced among nursing home specialists that demonstrated inconsistencies in terms of their epidemic control and prevention knowledge. According to the surveys, this information is often omitted from the employee orientation process and is provided only during infection outbreaks (Kaur et al., 2017). Therefore, the opportunities of epidemic prevention are significantly limited because the persons responsible for controlling this sphere are not aware of the specific practices that can prevent disease outbreaks.

Another problem of the NHS personnel is the lack of communication skills (Bruton et al., 2016). While medical analyses provide the clinical picture of patients’ health, specific symptoms such as pain effects and other indicators of perceived treatment effectiveness cannot be obtained without communicating with medical services recipients. Unfortunately, many doctors and nurses in the NHS system demonstrate the absence of such communication skills. This results in the loss of valuable data as the accuracy of information collection and transfer is critical for both clinical treatment effectiveness and patient satisfaction. These concerns were supported by the findings of Robert et al. (2014) who surveyed 148,657 UK healthcare industry practitioners. As much as 41% of them stated that they had not been taught patient communication skills within the scope of their educational programmes. Hence, this important element of medical personnel knowledge is not offered to a large share of the NHS professionals who have to acquire it themselves through on-the-job training.

The analysis of the NHS nurse’s competence by Haw et al. (2014) identified an additional training-related problem. It was discovered that the respondents did not report a large number of medical errors of the doctors they were working with. These behaviours were largely substantiated by the inability of the nurses to clearly determine if the mistakes made by themselves and their colleagues were violations of the medical practice standards. Many issues with NHS personnel training can also be explained by the lack of continuity due to the high rates of employee turnover (Sebastiano et al., 2016). As some skills are obtained through on-the-job instruction, short-term employment does not provide the knowledge necessary for rendering high-quality medical services. At the same time, the use of large amounts of part-time workers prevents cross-training or the internal transfer of knowledge and competences within the professional teams that are working together for a long time.


4. Conclusion

Employee training challenges are experienced by all organisations in the healthcare industry that practice the patient-centric approach to medical treatment (Balbale et al., 2015) and experience the need to improve employee performance and competences to meet high quality standards (Graban, 2016). That said, the values promoted by the new regulations are frequently not supported by appropriate training programmes (Passmore, 2017). The current NHS problems can be explained by substantial employee workloads (Osaro and Chima, 2014), ineffective teaching methods (Blencowe et al., 2017), poor adaptation of the educational programmes to working environments (Maisonneuve et al., 2014) and the lack of accurate post-programme appraisal (Kadiresan et al., 2015). Hence, it can be recommended that the NHS should address these problematic dimensions by making compulsory training programmes more practical and delegating the delivery of lectures to successful practitioners rather than academic specialists (Graban, 2016).



Balbale, S., Turcios, S. and LaVela, S. (2015) “Health care employee perceptions of patient-centered care”, Qualitative health research, 25 (3), pp. 417-425.

Blencowe, N., Glasbey, J., McElnay, P., Bhangu, A., Gokani, V. and Harries, R. (2017) “Integrated surgical academic training in the UK: a cross-sectional survey”, Postgraduate Medical Journal, 93 (1), pp. 581-586.

Bruton, J., Norton, C., Smyth, N., Ward, H. and Day, S. (2016) “Nurse handover: patient and staff experiences”, British Journal of Nursing, 25 (7), pp. 386-393.

Fahy, N., Hervey, T., Greer, S., Jarman, H., Stuckler, D., Galsworthy, M. and McKee, M. (2017) “How will Brexit affect health and health services in the UK? Evaluating three possible scenarios”, The Lancet, 1 (1), pp. 1-9.

Garcarz, W. and Wilcock, E. (2016) Statutory and mandatory training in health and social care–a toolkit for good practice, London: CRC Press.

Goh, C. and Marimuthu, M. (2016) “The Path towards Healthcare Sustainability: The Role of Organisational Commitment”, Procedia-Social and Behavioral Sciences, 224 (1), pp. 587-592.

Graban, M. (2016) Lean hospitals: improving quality, patient safety, and employee engagement, London: CRC Press.

Haw, C., Stubbs, J. and Dickens, G. (2014) “Barriers to the reporting of medication administration errors and near misses: an interview study of nurses at a psychiatric hospital”, Journal of psychiatric and mental health nursing, 21 (9), pp. 797-805.

Kadiresan, V., Selamat, M., Selladurai, S. and Mohamed, R. (2015) “Performance Appraisal and Training and Development of Human Resource Management Practices (HRM) on Organizational Commitment and Turnover Intention”, Asian Social Science, 11 (24), pp. 162-176.

Kaidi, A. and Atun, R. (2017) “Fixing the Recruiting and Retention Problems in Britain’s NHS”, [online] Available at: https://hbr.org/2017/08/fixing-the-recruiting-and-retention-problems-in-britains-nhs [Accessed on 14 October 2017].

Kaur, J., Stone, P., Travers, J., Cohen, C. and Herzig, C. (2017) “Influence of staff infection control training on infection-related quality measures in US nursing homes”, American Journal of Infection Control, 1 (1), pp. 1-6.

Maisonneuve, J., Lambert, T. and Goldacre, M. (2014) “Doctors’ views about training and future careers expressed one year after graduation by UK-trained doctors: questionnaire surveys undertaken in 2009 and 2010”, BMC medical education, 14 (1), pp. 270-279.

NHS (2017a) “The 6Cs”, [online] Available at: https://www.england.nhs.uk/leadingchange/about/the-6cs/ [Accessed on 14 October 2017].

NHS (2017b) “Introducing the 6Cs”, [online] Available at: https://www.england.nhs.uk/leadingchange/about/the-6cs/ [Accessed on 14 October 2017].

Osaro, E. and Chima, N. (2014) “Challenges of a negative work load and implications on morale, productivity and quality of service delivered in NHS laboratories in England”, Asian Pacific journal of tropical biomedicine, 4 (6), pp. 421-429.

Passmore, J. (2017) The Wiley Blackwell Handbook of the Psychology of Recruitment, Selection and Employee Retention, Hoboken: John Wiley & Sons.

Robert, G., Waite, R., Cornwell, J., Morrow, E. and Maben, J. (2014) “Understanding and improving patient experience: A national survey of training courses provided by higher education providers and healthcare organizations in England”, Nurse education today, 34 (1), pp. 112-120.

Sebastiano, A., Belvedere, V., Grando, A. and Giangreco, A. (2016) “The effect of capacity management strategies on employees' well-being: A quantitative investigation into the long-term healthcare industry”, European Management Journal, 1 (1), pp. 1-11.

Weimann, E. and Weimann, P. (2017) High Performance in Hospital Management: A Guideline for Developing and Developed Countries, Berlin: Springer Science & Business Media.

Wickramasinghe, N. (2016) Handbook of Research on Healthcare Administration and Management, Hershey: IGI Global.