The ‘World Health Report 2006 – Working together forHealth’ was a timely reminder of the importance of a welltrained, competent workforce – present in sufficient numbers – in the delivery of effective health care services.The report provides a clear assessment of the crisis facedby the global health care workforce. In particular, itfocuses attention on the acute problems faced by non-industrialised countries of the south: problems which arecharacterised by severe shortages, inappropriate skillmixes and gaps in service provision.1

For industrialised countries the problems, while differ-ent and not as acute, are no less challenging. The diseaseprofile of the world is changing as the prevalence of long-term conditions increases globally. Worldwide there are246 million people with diabetes and this is expected torise to 380 million by 2025.2 Across the UK the number ofpeople diagnosed with diabetes is estimated at 2.2 million.3 This is set to rise to 3 million by 2010.4 At thesame time the age profile of the UK population is chang-ing and as a result, by 2010, the overall size of the work-force in the UK is set to decline by 700 000 as the numberof school leavers reduces and a growing number of people reach retirement.5 This will have a significantimpact not only on the future demand for services, butalso on the capacity of the health care workforce itself.

Partly in response to these challenges, health policyacross the UK has refocused with an increasing emphasis on:• Improved public health with an emphasis on preven-tion and supporting people in making healthier choices(as a way of reducing demand).• Providing care closer to home.• Supporting people with long-term conditions to self-manage.

Responding to these challenges will require a skilled andflexible workforce capable of meeting the changinghealth care needs of the population. Achieving this willnot be easy as it will necessarily require not only a trans-formation in skills, but also a change in the culture of thehealth and social care workforce.

An important tool in helping to deliver these changes isNational Workforce Competences (NWCs). NWCs arestatements of competence describing good practice, whichare written to measure performance outcomes. Theydescribe what needs to happen in the workforce – not whatpeople are like. NWCs are developed by Skills for Health,the Sector Skills Council for the UK health sector. Skills forHealth’s remit is to help the whole sector develop solutionsthat deliver a skilled and flexible workforce in order toimprove health and health care. All the competences aredeveloped through partnership working with organisationsand services across the NHS, independent and voluntarysectors to ensure that they reflect best practice and thatpatient safety is safeguarded. They have a wide range ofuses and applications, which include but are not limited to:• Workforce planning and design.• Role design/redesign.• Service design/redesign.

• The development of job descriptions and role profiles.• Supporting new ways of working.• The development, design and evaluation of trainingcourses.

A key feature of competences is that they are deliberatelywritten not to be role specific. This provides flexibility asit enables them to be packaged into the roles that arerequired to meet the needs of a local population.

Following recent completion of the project, a suite ofcompetences is now available for diabetes. Constructedalong a high-level patient pathway, they encompass:• Diagnosis.• Management of type 1 and type 2 diabetes.• Children and young people.• Transitional care.• Pregnancy.• Screening and management of complications.• Management of the ‘at risk’ foot.• Psychological and emotional support.

These are complemented by competences recently devel-oped to support the delivery of patient education.

There are a number of examples of the innovative useof competences to improve the delivery of diabetes care.In a number of areas, competences have been used as abasis for the development of training for non-specialiststaff. In Inverness, for example, they have been used todevelop an e-learning course supplemented by practicalworkshops. Similar work has been undertaken in othercentres across the UK.

Ensuring the delivery of high-quality diabetes care thatmeets the standards set out in the Diabetes National ServiceFramework6 will be dependent on all staff being equippedwith the skills and competences appropriate to their role.NWCs have an important role in helping to achieve thisand the challenge for services is how their use is main-streamed to maximise the benefits for people with diabetes.

Further information on NWCs and the diabetes work-force competences is available on the Skills for Health web-site at: http://www.skillsforhealth.org.uk. Further informa-tion on diabetes is available on the National DiabetesSupport Team website at: http://www.diabetes.nhs.uk.

Karen Walker, Programme Manager, Skills for Health

References1. World Health Organization. The World Health Report 2006 –

Working together for health. Geneva: WHO, 2006.2. http://www.idf.org/home/index.cfm?unode=3B96906B-

C026-2FD3- 87B73F80BC226823. http://www.diabetes.org.uk/Professionals/Information_

resources/Reports/Diabetes_Prevalence_2006/4. World Health Organization. Facing the Facts: The Impact of

Chronic Disease in the United Kingdom. Geneva: WHO, 2005. 5. Skills for Health. Sector Skills Agreement for Health (England).

Bristol: Skills for Health, 2006.6. Department of Health. Diabetes National Service Framework.

Standards. London: DoH, 2001.

LEADER

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