A Strategic Overview and Vision of Simulation-Based Education in Healthcare in England: Enhancing Patient Safety and Learner Development

Introduction

The National Health Service (NHS) in the United Kingdom (UK) is one of the largest employers in the world, directly employing more than 1.5 million employees with diverse roles ranging from medical and nursing staff to allied health professionals and healthcare scientists. The NHS recently celebrated its 70th anniversary, being founded on 5 July 1948 on the premise that good healthcare should be available to all, regardless of wealth, and services should be provided for free at the point of delivery for all UK residents (NHS, 2016). The NHS serves a population of approximately 64.6 million with treatments ranging from emergency medicine and lifesaving operations to routine procedures, screening and public health interventions. The service is paid for out of general taxation which amounts to approximately £116.4 billion (approximately $148 billion dollars) annually.

The UK Department of Health and Social Care distributes the funding for the NHS to national and local commissioners such as NHS England, who then procure specific services from local bodies known as NHS Trusts, the voluntary sector and private providers who are responsible for the delivery of healthcare services as illustrated in Figure 1. These providers are regulated by the Care Quality Commission and NHS Improvement (Kings Fund, 2017). An NHS Trust is an organization serving either a specific function, or a targeted geographical area. Examples include:

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  Hospital acute Trusts, providing secondary care services

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  Mental health acute Trusts

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  Ambulance service Trusts

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  Community health Trusts, providing some primary care services.

Figure 1.

Simplified NHS structural diagram illustrating the relationship between the UK government bodies and the NHS healthcare provider services, with Health Education England being an executive, non-departmental body of the UK Department of Health and Social Care. Adapted from Kings Fund (2017)

To ensure the best possible care for patients, it is a requirement that the NHS workforce is sufficiently skilled and has the right abilities, attitudes and behaviors. In England, this task falls to Health Education England (HEE) which is an executive, non-departmental body of the UK Department of Health and Social Care, set up in 2012. It holds responsibility for the education and training of the entire healthcare workforce from undergraduate to postgraduate level and continuing professional development (CPD). The initial education of healthcare students is primarily provided through the funding of higher education placements within a healthcare setting. This involves healthcare students studying for extended periods of learning within a university, plus practical placements in a clinical environment, usually within an NHS Trust, working with patients and being mentored and supported by other healthcare professionals.

Once qualified, healthcare professionals join the NHS and enter the workplace, where there is a requirement of HEE and their NHS Trust to provide CPD and lifelong learning opportunities to ensure maintenance of professional registration and continuing delivery of outstanding care to patients. CPD is typically provided through a combination of traditional classroom training, online and digital learning and simulated practice or simulation-based education (SBE). Occupation-specific Royal Colleges support the professional registration of clinical professionals and represent their profession as well as providing additional education.

The funding for postgraduate medical and healthcare education is provided through a ‘tariff’ from the Department of Health and Social Care, delegated to HEE to manage. Funding is distributed to local education providers throughout England by HEE, through a Learning Development Agreement. Management of this funding is the responsibility of 13 local HEE office multi-professional Postgraduate Deans who hold responsibility for the commissioning of required services in their regions.