When thinking about the value and impact of ACP education we need to consider how much it costs to train an ACP against the potential benefits it would offer and how this can be funded, otherwise the question will continue to be asked… is it worth it? There is work still to be done to understand and be assured of the worth of ACP training and education (as covered in some other of my blog posts!). However, there is also a significant amount of money currently being spent on ACP training and education, and some difficulty in understanding and securing such funding.
The various funding routes for ACP training and education are complex and may often create a barrier for people who may be entirely appropriate for development as an ACP. My experience is that often individuals have taken quite a while to reach the point where they enquire about the options of ACP training. Many have expressed this is because they believed the support would not be available for them. They often are not aware of what the different routes for funding are and may have been ‘put off’ on at least one occasion on route, particularly by their line managers who similarly are unaware of funding routes, and of course do not want to lose a valuable member of staff from the rota during and after the training.
Funding routes for ACP include a much larger range today than may have been present when post-graduate training and education for health professionals began. This is primarily due to changes in national funding schemes where it has shifted from commonly a single source of funding being available, to a larger number of specifically targeted sources of income being provided in this sector.
Ring fencing of funds specifically for ACP training and education through the multi-variate routes has been a growing feature, particularly since the publication of the national Multi-Professional ACP Framework. However, it is evident that the extent to which ACP is funded, and whether it includes just course fees or salary support and backfill and other expenses is inconsistent nationally. (Council of Deans of Health report on ACP education).
The ACP Apprenticeships, which are the ‘new kids on the block’ when it comes to ACP training, have been seen as a potential answer to this complexity. This is especially because the largest funder in recent times (Health Education England) has indicated that their operating principle is one of switching off funding when an apprenticeship route becomes available. Apprenticeships may appear to be a promising proposition to reduce complexity and introduce some consistency. However, as we have seen already with other apprenticeships in health & social care, they are fraught with difficulties, large administrative burden, and have not achieved the number of people recruited onto apprenticeship schemes that had been hoped. This has left funds in the apprenticeship levy left languishing unspent despite the demand remaining to be high. In addition to this, the ACP apprenticeship is at post-graduate level, which is commonly new territory in this field and makes many even more nervous about relying on this to solve the funding supply issue for ACP.
We also need to recognise that some individuals and professional groups are more or less likely to self-fund their CPD training and education. For some professional groups (particularly AHPs) access to funding streams as described above have reportedly been harder to obtain and they have therefore been more likely to self-fund or look for scholarships or charitable organisations to provide funding. It is feared that if cuts in funding of CPD, as has occurred in the recent past were to continue, whilst some would look to self-fund, many would not be willing or able to do so.
Whilst the future looks somewhat rosy in this respect due to commitments made in last year’s Spending Round to provide personal budgets for CPD, it’s not at all clear how the problems of the past where funding is available but not spent effectively have now been solved. Frequently HEIs are not told until late in the academic year what the commissions for such courses are, and often with a time limit of a few months to implement before the funds are no longer available. Issues of identifying the right staff and getting everything in place to release and support them in time to undertake the training persist and are particularly problematic where staff are in small or specialised teams (more commonly AHPs and more senior or experienced staff). This makes funding support for ACP largely unplanned and patchy. This of course then increases the risks on investment in ACP training and education.
As noted in my previous blog, the extent to which ACP programmes, particularly where they have specialist clinical practice components within them, are available does also depend on HEIs being willing to take the risk to invest in developing and delivering the programmes. They would need to be convinced that
- They have the staff (with relevant skills and expertise) to work on these programmes, and that there is a secure pipeline of staff to continue to run these programmes. From the recent work the Council of Deans of Health has done on surveying the landscape of academic staffing, this is a risk and potentially one that is increasing (e.g. due to age of academic staff, and ability to attract and recruit staff from the NHS).
- There is a sufficiently large market that can be attracted to make the resources spent on delivering it worthwhile. HEE recently undertook a census to better understand the current supply and demand of ACPs but have not yet shared the outcome from this project. The ‘ACP market’ is therefore still not well understood.
- The potential income derived from this activity is at least equivalent to income they could derive from other sources. The standard tuition fee of £9250 per annum for an undergraduate student acts as a benchmark for this. Whilst there may be some arguments able to made of ‘other benefits’ that can be gained by running ACP programmes these are commonly measured against the benefits and potentially fewer costs of increasing the number of students on a ‘standard’ undergraduate programme.
All of this creates an unbalanced system where the national framework that defines and sets standards for ACP is ‘multi-professional’, but in reality, only certain professional groups, geographical areas, health care providers or specialist fields of practice can gain funding and thereby recognition, practice and employment as an ACP. This is an issue that needs to be solved if we to be true to the aspirations of the NHS Long Term Plan and the Multi-Professional Framework for ACP.