Journal of Workplace Learning

Work-related continuing education and training: participation and effectiveness

Hywel Thomas Tian Qiu

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Hywel Thomas Tian Qiu, (2012),"Work-related continuing education and training: participation and
effectiveness", Journal of Workplace Learning, Vol. 24 Iss 3 pp. 157 - 176
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Work-related continuing
education and training:
participation and effectiveness
Hywel Thomas and Tian Qiu
School of Education, University of Birmingham, Birmingham, UK

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Abstract

Work-related
education and
training
157
Received 12 August 2011
Revised 29 September 2011
27 October 2011
Accepted 8 November 2011

Purpose Within the context of policies on developing the workforce of the government health
sector in England, this paper aims to investigate participation in work-related continuing education
and training (WRCET), its pedagogy and effectiveness. Individual and organizational characteristics
associated with effective WRCET are examined.
Design/methodology/approach The paper employs a cross-sectional study, using data from
annual large-scale National Staff Surveys of 2006 and 2009. Based on detailed occupational groups, the
authors classify respondents to high- and low-skilled staff and develop four dependent variables that
combine specific types of training with respondent assessments of the effectiveness of their training
for their professional development. Probit regressions models are estimated for both groups of
workers, controlling for individual and organizational characteristics.
Findings Participation in WRCET increased between 2006 and 2009 for both groups with
differential patterns of participation across four types of training. Applying an effectiveness criterion
eliminates relative change in participation rates between the groups and results in only about a quarter
of those who participated in WRCET rating it as effective. Appraisal and particularly membership of
positively rated work teams are strongly associated with training being rated as effective.
Originality/value This is the first use of this large-scale data set to appraise health sector policies
on WRCET. Distinguishing between participation alone and whether participation is perceived as
effective has benefits in appraising training policies and identifies appraisal and membership of
positively rated teams as factors associated with effective WRCET. Use of an effectiveness criterion
shows very large differences between participation alone and participation in effective WRCET.
Keywords Training, High- and low-skilled, Effectiveness, Teamwork, Appraisal, Health sector,
Team working, Performance appraisal
Paper type Research paper

Introduction
How effective is the work-related continuing education and training (WRCET) in which
workers participate? We address this question by examining recent policies on
developing the workforce of the National Health Service (NHS), the government funded
and provided health sector in England and the countrys largest employer. With some
of the most highly qualified and least qualified people in the country (NHS (Information
Centre Workforce and Facilities Team), 2010), attracting, retaining and developing this
workforce are an essential component of the NHS ability to meet the demand for its
services. In a national context of low growth in the workforce and where the way we
develop skills and their contribution to productivity remains a serious weakness with
particular gaps in basic and intermediate skills (DfES, 2003), there is a premium on the
NHS to develop its own workforce. It is a responsibility which is recognised through
policies on staff development both for healthcare professionals accustomed to receiving

Journal of Workplace Learning

Vol. 24 No. 3, 2012
pp. 157-176
q Emerald Group Publishing Limited
1366-5626
DOI 10.1108/13665621211209258

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158

WRCET and those who do not have professional qualifications, including addressing
gaps in adult literacy and numeracy (Department of Health, 2000, 2001a, b).
There are two sets of research questions. The first set examines participation,
pedagogy and effectiveness: has the policy commitment towards lower skilled workers
had an impact on access to training; what is the distribution of training between
different pedagogies; and, crucially, its effectiveness in terms of doing the job better
and staying up-to-date? The second set of questions analyse the extent by which
individual and organizational characteristics are associated with employee
assessments of effective WRCET. In examining these questions, we draw on data
from the annual National Staff Surveys of 2006 and 2009, a period when the impact of
greater emphasis on training the lower skilled should be evident.
We set our enquiry in the context of national and international evidence on
recipients of WRCET across the economy as a whole and then identify features of
WRCET specific to the health sector. The fourth section describes our data sources and
research design; section five specifies the model and reports the empirical results; and
section six is the discussion followed by a brief conclusion and implications for
research.
Recipients of WRCET
Across different sectors of the economy, UK and international studies show that the
main recipients of WRCET are the more highly educated and highly skilled (Jenkins
et al., 2002; Dolton et al., 2005; Arulampalam et al., 2004). Younger workers are also
more likely beneficiaries (Oosterbeek, 1998; OConnell and Jungblut, 2008), although
this effect may increasingly be influenced by more rapid skills obsolescence
(Arulampalam et al., 2004). Evidence on gender is less clear, although there is evidence
that women are more ready to pay for their training (Bassanini et al., 2005). Unlike
several other European countries, part-time workers in the UK are less likely to be
trained (Arulampalam et al., 2004).
Organizational factors also influence access to WRCET. Large firms are more likely
to provide training, although comparative European data shows the UK as a special
case with training provision unaffected by organizational size (Bassanini et al., 2005,
pp. 64-5). This may also relate to the nature of the training, i.e. it depends on whether
training is mostly general or specific (Georgellis and Lange, 2007; Bougheas and
Georgellis, 2004). Ownership is also a factor with workers in the public sector more
likely to be recipients (Arulampalam et al., 2004). Recent work has also focused on the
benefits of teamwork and team members attitudes towards teamwork (Gallie et al.,
2012; Kiffin-Petersen and Cordery, 2003). Studies find that the degree of autonomy and
flexibility of teams influence learning and effectiveness at work (Felstead et al., 2010;
Lantz, 2011; Procter and Burridge, 2008).
A recent appraisal of trends in UK adult training shows average levels of
job-related training have declined through much of the 2000s and have now returned to
1993 levels (Mason and Bishop, 2010). On the impact of government policies designed
both to improve economic competitiveness and enhance social cohesion, it shows
some narrowing of the gap in training rates between low-qualified and
highly-qualified employees as a result of some increase in training rates for the
low-qualified. A characteristic of many of these studies is that they report whether or
not training has occurred rather than the amount of training, different types of training

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or its effectiveness. Yet, the modes of training used by firms are an important aspect of
how workers learn and its perceived effectiveness.
In examining modes of training and their effectiveness, the distinction between
learning as acquisition and participation appears significant (Sfard, 1998), the former
emphasising content and the individual accumulation of knowledge and skills while
the latter stresses the participative, active and situated nature of learning (Hagar, 2004;
Lave and Wenger, 1991). Thus, a UK study combining worker self-report and
observation by researchers notes that learning as a by-product accounted for a very
high proportion of the reported learning of the people we interviewed (Eraut, 2007)
and German data (Kuwan et al. 2003, p. 302, cited in Muller and Jacob, 2008) on
workers perceptions of means of learning, ranked self-learning in the workplace and
experiences from former workplaces as the most important, followed by instructions
by and learning from colleagues and supervisors at the workplace while formal
further training provided in the firm or by outside suppliers only ranks at third place.
The rest is private self-learning. An empirical development of the concepts of
acquisition and participation shows the positive effect of activities associated with
participation, highlighting the contribution that the everyday experience of work can
have in enhancing work performance through activities such as doing the job, being
shown things, engaging in self-reflection and keeping ones eyes and ears open
(Felstead et al., 2005). This has resonance with findings on communication, shared
responsibility, flexibility, and coordination mechanisms in 107 Portuguese firms
(Rebelo and Gomes, 2011) and a systematic review of the impact of collaborative
continuing professional development on classroom teaching and learning which
identified effective interventions likely to include: use of specialist expertise;
opportunities for teachers to observe each other; peer support; and use of workshops
and seminars (Cordingley et al., 2005). Co-workers are also shown as influential in
encouraging participation by lower educated workers (Sanders et al., 2011). As these
different forms of pedagogic activity have prima facie differences in their resource
implications, for example whether or not located in the work setting, our design
attempts to link different forms of training with their likely resource implications.
WRCET in the NHS
Strategy
The wider evidence provides a comparative basis for our analysis of WRCET in the
NHS as there are developments specific to the sector. An Audit Commission report
(Audit Commission, 2001) identified uneven participation in training, including groups
who typically receive less WRCET, such as part-timers, groups working unsocial
hours and agency staff. Responding to these problems, NHS policy over the last decade
has sought to widen access to WRCET with particular emphasis on those without
professional qualifications and doing so through an infrastructure of supervisors,
mentors and an e-learning strategy (Department of Health, 2001a, passim, b, passim).
These policies are implemented through a nationally specified framework where,
first, jobs are reviewed using a knowledge and skills framework developed to classify
jobs and create a new integrated salary structure. From this base, staff appraisal is
intended to support progression to higher skilled jobs through access to WRCET
(Department of Health, 2004a, b). This progression is represented in the skills escalator,
a concept intended to facilitate and enable all levels of the workforce to renew existing

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skills and acquire new knowledge and skills. More recent reports continue to recognise
the potential of this strategy for developing existing members of the workforce and for
recruiting new staff where opportunities for a large scale skills escalator framework
are immense (NWP, 2005; Robertson, 2007). We note, however, a report drawing on
two qualitative studies of these initiatives which suggested their impact on skills
development for lower skilled staff was patchy (Cox et al., 2008). Nonetheless, the
approach clearly has potential benefits both for individuals and the NHS, and one
aspect of the success of the policy would be evidence of greater access to WRCET by
lower skilled workers, and for such WRCET to be assessed as effective. The policy can
also assist in meeting the training implications of changing work processes.
Work processes
Changes in work processes increasingly challenge role demarcation and stress the
importance of teamwork with changes occurring across health systems (Bach, 2000).
On demarcation, an example at the higher skill end is the introduction of anaesthesia
practitioners who undertake a wide range of duties traditionally undertaken by
anaesthetists, allowing one anaesthetist simultaneously to oversee the care of two
patients (Royal College of Anaesthetists, 2006). Another and more widespread example
is the range of health care professionals who can now prescribe and supply medicines
(Department of Health, 2000). Lower in the skill range is the use of nurse assistants in
monitoring vital signs (Royal College of Nursing, 2007).
Greater understanding internationally of the scale of medical errors and their
consequence for patient safety is highlighting the inter-dependence of workers and,
therefore, the importance of teamwork. These errors are increasingly understood in
terms of systemic problems rather than the failings of individuals (Kohn et al., 1999)
and responses include seeking a better understanding of the organizational factors that
contribute to errors and means of reducing them (Leape and Berwick, 2005, Leape et al.,
2009; Benn et al., 2009) with several factors important for success, including:
[. . .] senior management and board commitment, fostering receptivity to change, engaging
clinicians in quality improvement, implementing quality reporting processes, developing
safety culture and fostering staff-driven process improvement that engages the frontline.

Team work also influences the likelihood of learning occurring, a study of nurses in
Belgium and The Netherlands showing how work location and the composition of
nursing teams are influential (Timmermans et al., 2011) while a large scale survey in
the Spanish health sector identified motivation and organizational support facilitating
transfer into practice what is learned on training programmes (Pineda-Herrero et al.,
2011). Many studies and interventions in the health sector focus on the high skilled, for
example in obstetric emergencies (Ellis et al., 2008) and emergency departments (Morey
et al., 2002; Shapiro et al., 2004; Wears et al., 2010), but lower skilled workers also
matter:
I caught her [member of domestic staff] with a cloth wiping the floor and then wiping the tea
trolley, but if you say something here youre made to look the big baddy (Healthcare
assistant) (Dixon-Woods et al., 2009).

As well as illustrating the benefit of all health sector workers understanding risks from
poor hygiene, the comment also shows how organizational culture can affect patient

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safety through breakdowns such as this between different groups of workers,

including the lower skilled.
Modes of education and training
The health sector has its own evidence base on effective modes of education and
training, drawing upon systematic reviews of randomised controlled trials and
quasi-experimental studies. Reviews of the continuing education of physicians indicate
that there are no magic bullets for improving the quality of health care (Oxman et al.,
1995), but identify the value of: assessment of learning needs; interaction among
physician-learners with opportunities to practice the skills learned; and sequenced
multifaceted educational activities (Mazmanian and Davis, 2002). A systematic review
of studies of health professionals showed that interactive workshops rather than
relying on lectures alone can improve professional practice (OBrien et al., 2008). This
evidence on effective modes of education and training contributes to the research
design.
Data sources and research design
Data sources
While the NHS is the generic name for the organization providing publicly funded
health care in the UK, each devolved administration within the UK has its own
organization. Within each of these organizations, there are management and
budget-holding units known as Trusts, some of which are direct providers of
healthcare (Acute Trusts and Mental Health Trusts) while Primary Care Trusts are
largely management units. This study is limited to England and these three types of
Trusts. All these Trusts are required to participate in an annual National Staff Survey
and the Surveys of 2006 and 2009 are our data sources, chosen because these two years
include the longest available consistent questions on training[1]. All full- and part-time
staff directly employed by these Trusts are eligible to take part. Excluded from the
survey are general practitioners (GPs) and their employees as they are not directly
employees of the NHS, but contracted to provide their services. Also excluded are
agency staff, who work in the NHS but whose employment contract is with another
employer. The response rates are 54 per cent and 53 per cent for 2009 and 2006
respectively with no breakdown by occupational group. The survey captures
information on socio-demographic characteristics, organizational characteristics and a
range of measures of staff satisfaction and opinion. It has detailed occupational groups
(33 categories, including Others) and, for the focus of this paper, we classify these
groups into high- and low-skilled staff.
High-skilled staff are: allied health professionals (AHPs)[2], Medical/Dental
(consultant, in training and other), registered nurses and midwives[3], central
functions/corporate service (e.g. human resources, finance and IT) and general
management (commissioning managers, social care managers and other managers);
and the low-skilled are: nursing or healthcare assistants, administrative and clerical,
maintenance/ancillary (e.g. housekeeping, domestic staff, facilities and estates) and
general support (support to AHPS, Scientific and technical, healthcare scientists, and
social care). Ambulance-related staff and Other (please specify) are not included in
either of these specifications and later analysis. We also restrict our sample to

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162

respondents aged 21 to 65[4]. Table I shows the sample means for the raw occupation
categories across year.
Design
In this section we describe how our four dependent variables have been constructed
and list the independent variables included in the model.
Dependent variables. The range of questions on training has allowed us to develop
four variables that combine information on specific types of training with respondent
assessments of the effect of training for their professional development. As with other
large data sets that include questions on training (e.g. the Labour Force Survey) the
questions ask whether the respondent has experienced a certain type of training rather
than its volume.
On the type of training, a question asks: In the last 12 months, have you taken part
in any of the following types of training, learning or development, paid for or provided
by your Trust? Six yes/no options are provided:
(1) Taught courses (internal or external).
(2) Any supervised on-the-job training.
(3) Having a mentor.
(4) Shadowing someone.
(5) E-learning/online training.
(6) Keeping up-to-date with developments in your type of work (e.g. by reading
books or journals, or by attending seminars or workshops).
(7) Other methods of training, learning or development (please specify).
We have created four categories from these options, combining supervision, mentoring
and shadowing into one and ignoring other methods. This approach was informed
by the literature cited earlier on learning by acquisition (e.g. formal learning) and
participation (e.g. informal learning) and its situated nature (Sfard, 1998; Lave and
Wenger, 1991) and, more substantially, by a set of learning processes at or near the
workplace identified by Eraut (2007) in a typology of early career learning. We used
these as the basis for our own classification in Table II, where, within the context of

Table I.
Sample means for the raw
occupation categories
across year

High-skilled
AHPs
Medical/dental
Registered nurses and midwives
Central functions/corporate service
General management
Low-skilled
Nursing or healthcare assistants
Administrative and clerical
Maintenance/ancillary
General support
n

2009

2006

All

0.667
0.178
0.058
0.312
0.069
0.050
0.333
0.079
0.173
0.043
0.038
123,330

0.637
0.164
0.071
0.330
0.046
0.026
0.363
0.080
0.203
0.043
0.036
100,586

0.654
0.172
0.064
0.320
0.059
0.039
0.346
0.080
0.187
0.043
0.037
223,916

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these other frameworks, we have sought to take account of the possible resource and
economic significance of the different forms of learning processes.
Formal learning, such as taught courses, has the greatest immediate economic
impact as it takes people away from their work and involves some amount of resource
provision by employers. Informal learning, such as being supervised, mentored or
shadowing, includes activities that occur in the immediate workplace and, as more
likely to be part of the daily routine and integrated with work processes, are likely to
incur a lower loss of productive activity than formal learning. E-learning may or may
not occur in employer time and, in the case of the latter, incurs no direct cost for
productive activity. The examples of Keeping up-to-date seem to suggest
independent learning or personally chosen activities and, as such, are more likely to
be done in a workers own time. While this classifies items by their likely immediate
cost, however, it is not a comment on their effectiveness, although we note some
parallel between this grouping both in terms of worker perceptions and evidence on the
effectiveness of different learning activities cited earlier (Eraut, 2007; Mazmanian and
Davis, 2002; Kuwan et al. 2003, p. 302, cited in Muller and Jacob, 2008; OBrien et al.,
2008). Table III shows the percentages of these four categories between the high- and
low-skilled across years.
From Table III, we see that participation rates increased between 2006 and 2009 in
almost all categories and for both groups, the exception being no change in keeping
up-to-date for the high-skilled. Formal training and keeping up-to-date are the highest
percentages in 2006 and 2009 with online training/e-learning showing the biggest
increase. Across all four types of training, the high-skilled have higher levels of
participation but, between 2006 and 2009, the difference between the high and low
skilled narrows for formal, informal training and keeping up-to-date, while, for online
learning, the difference widens from 0.06 to 0.15.
The training reported in Table III undoubtedly includes certain routine NHS health
and safety training, such as fire, lifting or resuscitation. We have, therefore, tried to
narrow the scope of training by adding evaluations that respondents provided on

Formal learning processes

(a) Taught courses (internal
or external)

Formal training
Informal training
Online training/e-learning
Keeping up-to-date
n

Informal learning
processes

Independent learning
processes

(b) Being supervised (e) E-learning

(c) Being mentored
(d) Shadowing

High-skilled

2009
Low-skilled

0.80
0.47
0.49
0.84
84,528

0.61
0.38
0.33
0.44
42,799

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163

Independent learning
processes
(f) Keeping up-to-date

Dif.

High-skilled

2006
Low-skilled

0.19
0.09
0.15
0.40

0.77
0.44
0.24
0.84
67,111

0.54
0.32
0.18
0.39
38,673

Table II.
Learning processes and
economic activity

Dif.
0.23
0.12
0.06
0.45

Table III.
Training between the
high- and low-skilled
across year

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whether their training contributes to their continuing development. The questions on

the effect of training asks respondents to consider their reply to the earlier question on
types of training received, asking:

164

Thinking of any training, learning or development that you have done in the last 12 months
(paid for or provided by your Trust), to what extent do you agree or disagree with the
following statements?a. My training, learning and development has helped me to do my job
better; b. It has helped me stay up-to-date with my job; and c. It has helped me stay up-to-date
with professional requirements. Respondents are asked to choose on a five-point scale from
strongly disagree to strongly agree.

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Table IV shows the distribution of responses. As most respondents reported more than
one type of training, the results represent their composite assessment of all forms of
training and, among these, the most frequent combinations are formal training and
keeping up-to-date and formal and informal training and keeping up-to-date,
Our assessment is that as all these questions were related to their development in work,
it was valid to combine the results into a single measure that represented their overall
assessment of the effectiveness of their training for their progress at work. To specify
this single measure of effectiveness, the scores of respondents, from 1 (strongly
disagree) to 5 (strongly agree) were aggregated for all three questions, so that a
maximum score would be 15. In defining a standard for effective training, we then set
two restrictions. A response is treated as positive (coded 1) only if a respondent had
reported some training; and (restriction 1) the sum of answers to the three statements
on effectiveness were equal to or greater than 12 and (restriction 2) at least one
response was strongly agree. Our reasoning in relation to these restrictions has three
elements: requiring one of the statements to be scored at the highest level ensures one
very positive response to training; a minimum of 12 points requires a high overall
2009
High-skilled

Table IV.
Effect of training

To do the job better

Strongly disagree (5)
Disagree (4)
Neither A nor D (3)
Agree (2)
Strongly agree (1)
To stay up-to-date with job
Strongly disagree
Disagree
Neither A nor D
Agree
Strongly agree
To stay up-to-date with prof dev
Strongly Disagree
Disagree
Neither A nor D
Agree
Strongly agree
n

2006
Low-skilled

High-skilled

Low-skilled

0.03
0.05
0.20
0.55
0.17

0.03
0.07
0.31
0.47
0.12

0.04
0.06
0.22
0.53
0.15

0.05
0.09
0.32
0.44
0.10

0.03
0.05
0.16
0.58
0.18

0.03
0.08
0.29
0.49
0.11

0.04
0.06
0.17
0.59
0.14

0.06
0.11
0.30
0.46
0.08

0.03
0.05
0.15
0.58
0.19
83,354

0.03
0.07
0.35
0.44
0.10
41,045

0.04
0.05
0.16
0.59
0.15
65,572

0.06
0.11
0.38
0.38
0.07
35,636

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response but still allows some disagreement (e.g. 5, 5 and 2); and it omits those who
select agree (4) to all three statements, a decision that makes the outcomes on
effectiveness substantially more discriminating. Table V shows the effect of these
restrictions: restriction 1 reduces the percentage of the high-skilled rating their formal
training in 2009 as effective from 80 per cent to 58 per cent and adding restriction 2
reduces it to 20 per cent. When the levels of participation in WRCET shown in Table III
are adjusted by applying the effectiveness criterion, the results in Table VI show a very
large fall, only about a quarter of those who participated in WRCET rating it as
effective.
It is the responses based on these two restrictions that provide us with the four
dependent variables shown in Table VI. As with the data on overall participation, in
both years there is an increase in levels of participation with the high-skilled reporting
greater levels of effective training. There is, however, little change in differences
between both groups when 2006 is compared with 2009, the largest being a widening to
6 per cent in relation to e-learning.
Independent variables. The independent variables selected reflect the wider
literature but also relevant aspects of NHS policy discussed earlier, such as the
importance attached to appraisal and teamwork. The survey collects information on
gender, age, ethnicity, length of employment in the Trust, working hours per week,
whether or not a line manager within the Trust, the size and quality of the work team
and whether respondents have had an appraisal in the last 12 months. We also have
data on the size and type of Trust in which they are employed. The first columns of
Tables VII and VIII present the sample means of independent variables included in the
regression models for the high- and low-skilled in 2006 and 2009 respectively.
Personal characteristics. Around 80 per cent of respondents are women, which is
consistent with the percentage of women in the NHS labour force[5]. Age is captured by
four dummy variables: 21-30, 31-40, 41-50 and 51-65. Ethnic background is grouped
into seven dummy variables: White (British and Irish), Other White, Asian/Asian

2009
High-skilled Low-skilled
Formal training (no restriction)
Formal training (with restriction 1)
Formal training (with restrictions 1 and 2)
Dif. (between res 1 and res 1 and 2)

Formal training
Informal training
Online training/e-learning
Keeping up-to-date
n

0.80
0.58
0.20
0.38

High-skilled

2009
Low-skilled

0.20
0.14
0.13
0.21
81,283

0.12
0.09
0.07
0.11
35,119

Work-related
education and
training
165

2006
High-skilled Low-skilled

0.61
0.39
0.12
0.27

0.77
0.52
0.18
0.34

0.23
0.31
0.10
0.21

Dif.

High-skilled

2006
Low-skilled

0.08
0.05
0.06
0.11

0.18
0.12
0.06
0.19
63,922

0.10
0.07
0.03
0.09
28,837

Table V.
Formal training
(comparison)

Dif.
0.08
0.04
0.03
0.10

Table VI.
Distribution of dependant
variables

Table VII.
Average marginal effect
for Probit regressions on
training participation in
2006

Notes:

0.227

0.205
0.124
0.242
0.241
0.133
0.259
0.502
0.113
0.315
0.227
0.168
0.178
0.059
0.157
0.250
0.203
0.116
0.215
0.686

0.255

0.178
0.150
0.236
0.233
0.120
0.262
0.605
0.060
0.235
0.246
0.193
0.266
0.077
0.151
0.236
0.186
0.103
0.247
0.796

0.010

2 0.026

2 0.018
2 0.021
2 0.042
2 0.029

0.059
0.007
2 0.007
2 0.004
0.039
0.011
0.008
2 0.010

**

***

***

***

***

***

***

***

***

**

**

***

***

**

***

***

***

***

***

***

HS

0.50
1.53
2.25
1.25
21.49

2 4.95
2 3.04
2 3.77
2 3.04

3.17
1.58
0.31
2 0.96
2 2.85
7.02

1.86

2 7.82

2 4.12
2 4.52
2 8.51
2 4.04

5.36
0.75
2 0.49
2 0.27
2.19
3.31
2.65
2 2.39

***

0.015
0.017
0.006
0.015
0.073

2 0.003
0.011
0.023
0.027

2 0.015
2 0.035
2 0.047
2 0.049
2 0.061
0.019
0.04
2 8,855.7
27,521

0.003

0.013

2 0.014
2 0.022
2 0.041
2 0.013

0.053
0.002
0.025
0.007
0.019
0.022
0.009
2 0.006

Taught
z statistic

significant at 5 per cent;

0.003
0.01
0.017
0.008
0.089

2 0.033
2 0.021
2 0.026
2 0.021

0.021
0.01
0.002
2 0.007
2 0.018
0.028
0.02
2 28,634.2
61,521

0.156
0.135
0.207
0.309
0.349
0.889
0.023
0.038
0.035
0.009
0.002
0.004
0.517
0.140
0.568

0.218
0.165
0.280
0.342
0.214
0.807
0.039
0.048
0.076
0.012
0.008
0.009
0.647
0.454
0.566

Significant at 10 per cent;

Men
21-30
31-40
41-50
51-65
White British
Other White
Black (British)
Asian (British)
Mixed
Chinese
Other ethnic
Appraisal
Manager
Acute
Primary care
(PCT)
Mental health
(MHLD)
, 1000
1,000-1,999
2,000-2,999
3,000-3,999
4,000
Qua team
Not in a team
2-5 persons
6-9 persons
10-15 persons
. 15 persons
, 1 year
1-2 years
3-5 years
6-10 years
11-15 years
15 years
$ 30 hrs
Pseudo R 2
Log L
n

Mean
HS
LS

0.017

2 0.019

2 0.027
2 0.032
2 0.050
2 0.018

0.064
0.017
0.002
0.008
0.039
0.008
2 0.005
0.015

0.006
0.014
0.018
0.015
0.068

2 0.013
2 0.003
0
0.006

2 0.011
2 0.034
2 0.045
2 0.056
2 0.059
0.022
0.04
2 21,381.5
61,558

2.15
2.04
0.69
1.69
12.54

2 0.37
1.24
2.34
2.76

2 2.20
2 5.76
2 7.76
2 7.64
2 10.50
4.16

0.52

2.45

2 2.46
2 4.17
2 8.03
2 1.11

3.00
0.13
1.08
0.15
0.59
4.94
1.56
2 1.19

z statistic

***

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***

***

***

***

**

***

***

***

***

***

***

**

***

***

**

***

***

***

***

***

***

HS

1.48
2.59
2.81
2.65
18.22

2 2.22
2 0.46
0.07
0.86

2 2.62
2 8.94
2 11.86
2 14.38
2 16.30
6.40

3.48

2 6.99

2 8.56
2 9.87
2 15.06
2 3.21

6.49
2.25
0.17
0.56
2.58
2.94
2 2.23
4.02

0.011
0.01
0.013
0.012
0.066

0.004
0.017
0.025
0.042

2 0.027
2 0.045
2 0.060
2 0.055
2 0.068
0.010
0.06
2 6,883.9
27,537

0.004

0.014

2 0.008
2 0.011
2 0.020
2 0.014

0.061
0.019
0.022
2 0.022
0.036
0.010
2 0.011
0.011

Informal
z statistic

***

***

***

***

***

***

***

***

***

**

***

***

***

***

**

***

LS

0.004

0.003

2 0.005
0.003
2 0.002
2 0.011

0.009
0.010
2 0.004
0.007
0.013
0.016
0.010
0.002

***

***

***

HS

2 0.0004
*
2 0.006
0.003
2 0.002
***
0.044

***
2 0.018
***
2 0.014
***
2 0.016
***
2 0.017

2 0.005
**
2 0.007
***
2 0.013
***
2 0.013
***
2 0.018
***
0.018
0.02
2 13,989.6
61,633

1.75
1.40
1.56
1.53
12.07

0.48
1.92
2.62
4.13

2 5.73
2 11.31
2 16.85
2 14.42
2 20.04
2.71

0.67

3.02

2 1.80
2 2.45
2 4.55
2 1.58

3.69
1.40
1.10
2 0.72
1.24
2.74
2 2.67
2.54

z statistic

significant at 1 per cent; all Probit regressions include a constant

***

***

***

***

***

**

***

**

***

**

**

***

***

***

***

**

**

LS

2 0.12
2 1.81
0.77
2 0.50
13.66

2 4.91
2 3.61
2 4.19
2 4.54

2 1.52
2 2.20
2 3.75
2 3.47
2 5.40
6.58

1.22

1.37

2 1.74
1.07
2 0.62
2 2.62

1.46
1.70
2 0.46
0.68
1.20
6.87
4.78
0.77

LS

**

***

**

***

2 0.0001
2 0.007
*
2 0.008
2 0.006
***
0.038

**
2 0.010
**
2 0.011
2 0.006
2 0.004

0.0002
2 0.006
***
2 0.016
***
2 0.012
***
2 0.019
***
0.008
0.04
2 3,984.2
27,670

2 0.0004

0.004

2 0.004
2 0.005
2 0.011
2 0.014

0.003
2 0.006
2 0.011
2 0.004
0.015
0.017
0.009
0.003

Online
z statistic

0.006

2 0.025

2 0.020
2 0.019
2 0.028
2 0.036

0.068
0.013
2 0.009
0.002
0.030
0.008
0.012
2 0.006

***

**

***

***

***

***

***

***

HS

2 0.0004
0.007
0.011
0.009
***
0.097

***
2 0.041
***
2 0.029
***
2 0.033
***
2 0.035

**
0.015
0.003
2 0.003
**
2 0.018
***
2 0.025
***
0.027
0.02
2 29,178.8
61,214

2 0.01
2 1.57
2 1.74
2 1.25
7.98

2 2.38
2 2.39
2 1.12
2 0.76

0.03
2 1.37
2 4.28
2 2.80
2 5.30
2.89

2 0.09

1.07

2 1.31
2 1.42
2 3.41
2 2.20

0.39
2 0.80
2 1.11
2 0.18
0.73
5.16
2.44
0.84

z statistic

2 0.07
1.16
1.46
1.32
22.94

2 6.16
2 4.23
2 4.77
2 5.17

2.26
0.44
2 0.46
2 2.52
2 3.93
6.49

1.10

2 7.30

2 4.37
2 4.10
2 5.33
2 4.95

6.04
1.40
2 0.64
0.10
1.72
2.40
3.71
2 1.42

0.006
0.006
2 0.005
0.005
0.071

2 0.001
0.016
0.021
0.029

2 0.013
2 0.028
2 0.033
2 0.039
2 0.045
0.021
0.04
2 7,887.4
27,493

2 0.004

0.021

2 0.019
2 0.020
2 0.030
2 0.022

0.043
0.002
0.021
2 0.019
0.038
0.023
0.015
2 0.003

Up-to-date
z statistic

166

2006

Downloaded by Universiti Teknologi MARA At 07:40 20 August 2015 (PT)

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***

***

***

**

***

**

***

***

***

***

**

***

***

***

***

LS

0.98
0.75
2 0.56
0.58
12.31

2 0.10
1.72
2.12
2.92

2 2.00
2 4.79
2 5.52
2 6.13
2 7.79
4.82

2 0.73

3.98

2 3.73
2 4.01
2 6.21
2 2.17

2.64
0.13
0.94
2 0.53
1.21
5.29
2.78
2 0.71

z statistic

JWL
24,3

0.148
0.126
0.288
0.224
0.145
0.217
0.608
0.044
0.245
0.262
0.200
0.250
0.100
0.141
0.182
0.228
0.114
0.235
0.789

2 0.004
2 0.008
2 0.003
2 0.006
0.097

2 0.050
2 0.035
2 0.032
2 0.027

0.007
0.002
2 0.020
2 0.027
2 0.039
0.033
0.03
2 39,099
79,302

2 0.008 * *

0.351

0.414

0.172
0.095
0.276
0.234
0.157
0.238
0.523
0.087
0.312
0.236
0.168
0.197
0.101
0.152
0.185
0.232
0.123
0.207
0.679

2 0.016

2 0.025
2 0.030
2 0.056
2 0.047

0.036
2 0.019
2 0.028
2 0.035
2 0.013
0.061
0.014
2 0.019

0.148
0.132
0.182
0.310
0.375
0.884
0.022
0.035
0.040
0.011
0.003
0.005
0.638
0.123
0.476

0.199
0.146
0.251
0.350
0.252
0.830
0.036
0.042
0.067
0.011
0.007
0.008
0.736
0.424
0.438

***

***

***

***

***

***

***

***

***

***

***

***

**

**

**

***

***

***

***

***

***

***

***

**

***

**

***

**

**

LS

***

***

***

***

***

***

***

**

***

20.016 * * *

0.012

20.005
20.011
20.037
20.027

0.050
20.001
0.01
20.011
0.072
0.044
0.019
20.006

0.007
0.007
0.006
0.005
0.080

20.017
0.008
0.012
0.029

20.026
20.044
20.066
20.072
20.088
0.022
0.05
211,809.4
33,799

20.97
21.75
20.65
21.13
26.77

27.58
25.11
24.60
23.88

1.29
0.31
24.07
24.90
27.83
9.15

22.06

25.01

26.18
27.30
212.99
27.10

3.70
22.48
22.24
22.33
20.88
16.56
4.69
24.63

z statistic

Taught

0.005

20.011

20.029
20.038
20.057
20.041

0.040
20.009
20.024
20.012
0.003
0.050
20.005
0.011

20.003
20.007
0.001
20.001
0.083

20.022
20.002
0.002
0.013

20.025
20.040
20.059
20.064
20.077
0.022
0.05
230,708.4
79,309

1.10
0.94
0.75
0.65
15.01

22.21
0.85
1.24
2.97

24.65
28.74
214.47
215.12
220.54
5.28

23.21

2.24

20.90
22.03
27.34
22.45

3.02
20.10
0.53
20.34
2.33
9.08
3.33
21.14

z statistic

***

***

***

***

***

***

***

***

***

**

***

**

***

***

***

***

***

***

HS

2 0.007

0.014

2 0.010
2 0.007
2 0.025
2 0.022

0.044
0.004
0.003
2 0.023
0.057
0.031
2 0.008
0.013

0.005
0.007
0.012
0.005
0.074

0.006
0.023
0.027
0.048

2 0.039
2 0.058
2 0.073
2 0.073
2 0.092
0.011
0.07
2 9,700.3
33,820

2 0.75
2 1.86
0.30
2 0.22
24.32

2 3.64
2 0.36
0.25
1.80

2 6.71
2 11.61
2 19.08
2 18.95
2 24.93
7.03

1.37

2 4.19

2 9.38
2 11.98
2 18.04
2 7.44

4.59
2 1.41
2 2.36
2 0.94
0.22
15.08
2 2.11
2.94

z statistic

Informal

***

***

***

***

***

***

***

***

**

***

***

***

**

***

**

***

**

***

LS

***

***

***

***

***

***

***

HS

***

***

***

***

***

***

***

***

***

***

**

***

***

2 0.007 * *

0.004

2 0.010
2 0.014
2 0.027
2 0.022

0.005
2 0.01
2 0.012
2 0.023
2 0.017
0.053
0.017
2 0.021

0.013
0.021
0.011
0.032
0.076

2 0.035
2 0.024
2 0.022
2 0.019

2 0.007
2 0.007
2 0.020
2 0.023
2 0.035
0.025
0.03
2 29,446
79,334

0.90
1.06
1.68
0.73
14.62

0.77
2.53
2.79
4.72

2 10.44
2 17.40
2 24.96
2 24.59
2 35.70
3.15

2 1.59

3.10

2 2.11
2 1.51
2 5.81
2 2.44

2.98
0.33
0.17
2 0.95
2.16
7.53
2 1.81
2.78

z statistic

Notes: * Significant at 10 per cent; * *significant at 5 per cent; * * * significant at 1 per cent; All Probit regressions include a constant

Men
21-30
31-40
41-50
51-65
White British
Other White
Black (British)
Asian (British)
Mixed
Chinese
Other ethnic
Appraisal
Manager
Acute
Primary care
(PCT)
Mental health
(MHLD)
, 1,000
1,000-1,999
2,000-2,999
3,000-3,999
4,000
Qua team
Not in a team
2-5 persons
6-9 persons
10-15 persons
. 15 persons
, 1 year
1-2 years
3-5 years
6-10 years
11-15 years
15 years
$ 30 hrs
Pseudo R 2
Log L
n

2009

HS

Mean
HS
LS

3.43
4.88
2.39
6.21
22.54

2 6.64
2 4.31
2 3.93
2 3.29

2 1.66
2 1.87
2 5.45
2 5.45
2 9.21
8.30

2 2.01

1.27

2 2.91
2 4.00
2 7.61
2 4.01

0.70
2 1.64
2 1.18
2 1.88
2 1.48
15.80
6.89
2 6.52
***

**

***

**

***

***

LS

***

***

***

***

***

***

***

**

**

***

***

***

**

20.010 * * *

0.003

20.008
20.014
20.025
20.004

0.035
0.005
0.019
20.034
0.029
0.032
0.011
20.018

0.014
0.019
0.009
0.023
0.057

0.001
0.018
0.019
0.027

20.012
20.019
20.031
20.034
20.042
0.015
0.05
27,783
33,845

z statistic

Online

Downloaded by Universiti Teknologi MARA At 07:40 20 August 2015 (PT)

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**

**

***

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***

***

***

***

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***

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***

***

***

***

***

20.012 * * *

20.014

20.025
20.026
20.044
20.054

0.045
20.016
20.030
20.036
20.016
0.061
0.014
20.013

20.003
20.006
0
20.001
0.105

20.055
20.037
20.036
20.032

0.002
20.002
20.023
20.032
20.043
0.030
0.03
239,670.3
79,194

2.51
3.00
1.36
3.31
12.02

0.11
2.16
2.23
3.00

22.88
24.74
28.52
29.06
212.41
4.65

22.83

0.89

21.88
23.56
26.81
20.40

2.48
0.41
1.12
21.77
1.24
7.77
2.53
24.95

z statistic

HS

0.01
0.008
0.006
0.006
0.088

2 0.007
0.012
0.016
0.036

2 0.022
2 0.035
2 0.056
2 0.057
2 0.067
0.020
0.06
2 10,708.2
33,804

20.72
21.17
20.00
20.20
28.44

28.33
25.41
25.27
24.67

0.38
20.33
24.69
25.65
28.51
8.27

2 0.012 * * *

***

***

***

***

***

***

***

***

***

***

**

***

***

***

22.93

***

LS

0.022

2 0.002
2 0.005
2 0.021
2 0.036

0.043
2 0.003
0.009
2 0.028
0.063
0.052
0.023
0.001

24.13

25.90
26.03
29.85
27.99

4.42
21.94
22.39
22.32
21.02
16.60
4.85
23.19

z statistic

Up-to-date

1.58
1.15
0.81
0.81
16.08

2 0.84
1.30
1.67
3.58

2 4.07
2 7.07
2 12.81
2 11.95
2 15.24
4.84

2 2.63

4.24

2 0.28
2 0.88
2 4.16
2 3.52

2.75
2 0.21
0.46
2 1.01
2.20
10.54
4.04
0.25

z statistic

Work-related
education and
training
167

Table VIII.
Average marginal effect
for Probit regressions on
training participation in
2009

JWL
24,3

Downloaded by Universiti Teknologi MARA At 07:40 20 August 2015 (PT)

168

British (Indian, Pakistani, Bangladeshi and other Asian background), Black/Black

British (Caribbean, African and other Black background), Mixed (White and Black
Caribbean, White and Black African, White and Asian and Any other mixed
background), Chinese and Other. More than 80 per cent of the respondents are White
British.
Job tenure is captured by five dummy variables: Less than one year, one to two
years, three to five years, five to ten years, 11-15 years and more than 15 years.
Contracted-hours per week are identified with a dummy variable taking the value of 1
if people work 30 or more hours per week.
Organizational characteristics. Three types of Trust are included in the analysis[6]:
Acute Trust (including acute specialist), Primary Care Trust (PCT) and Mental Health
and Learning Disability (MHLD) Trust. Trust size is measured by five dummy
variables: Less than 1,000 staff, 1,000-1,999, 2,000-2,999, 3,000-3,999 and 4,000 or more.
There are two types of teamwork variables: one for size and the other for quality.
The variables on size result from combining an affirmative reply to the question Do
you work in a team? with replies to: How many core members are there in your
team? From these, five dummy variables are created: not in a team, 2-5, 6-9, 10-15 and
more than 15. Respondent views on the quality of their team is created from affirmative
replies to the three statements: Does your team have clear objectives?, Do you have
to work closely with other team members to achieve the teams objectives? and Does
the team meet regularly and discuss its effectiveness and how it could be improved?.
Another two dummy variables are whether a line manager within the Trust and had
an appraisal (both Knowledge and Skill Framework (KSF) development review and
other type of appraisal, performance development review) in the last 12 months. The
percentage of line managers among the high-skilled is approximately 30 per cent more
than among the low-skilled in both 2006 and 2009.
Empirical results
Based on the above data specifications, we begin by estimating separate Probit models
for both the high- and low-skilled and for 2006 and 2009, respectively, controlling for
individual and organizational characteristics. We find generally a consistent impact of
these characteristics on effective training in both years and with the wider literature.
For ease of interpretation, Tables VII and VIII present the average marginal effect
(AME)[7] of the Probit regressions for the high-skilled and low-skilled, and for 2006
and 2009 respectively. Gender is a significant predictor for training participation.
High-skilled men are less likely to engage in formal training, informal training and in
keeping up-to-date with developments compared to high-skilled women, and this
relationship weakened slightly from 2006 (approximately 2-3 per cent less) to 2009
(approximately 1-2 per cent less). For the low-skilled, the opposite is the case with men
more likely to have these three types of training. We do not find any gender impact on
online learning for both high- and low-skilled for both years. Our results also show that
the age effect on the probability of training is important and consistent with the
literature: people are less likely to engage in training as they get older. We find this
clear trend for formal, informal training and keeping up-to-date for both the high- and
low-skilled in 2006. In 2009, the same trend occurs for the high-skilled for all four types
of training; for the low-skilled, however, this is mainly for taught courses and online

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learning. The most noticeable change from 2006 to 2009 is for online learning; in 2006
there is no clear age effect but, in 2009, the relationship is significantly negative.
As for the impact of ethnic background, compared to the reference group of Other
White, high-skilled White British are less likely to engage in all four types of training
in 2006, and this relationship strengthened in 2009. Low-skilled White British are also
less likely to engage in online learning and keeping up-to-date in 2006 and, in 2009, this
applies to formal, informal training and keeping up-to-date. Both high- and low-skilled
Black/Black British are more likely to engage in formal training, informal training and
keeping up-to-date in both 2006 and 2009, although the size of the impact declines
slightly for the high-skilled from 2006 and 2009. We also find that high-skilled
Asian/Asian British, Mixed and Chinese are less likely to engage in taught courses and
keeping up-to-date in 2009.
The type of Trust has an effect on training participation but the pattern is not
consistent. In 2009, compared to MHLD Trusts, both the high- and low-skilled in PCTs
are less likely to engage in formal training, online learning and keeping up-to-date. An
exception to this is among the high-skilled in PCTs who are 2 per cent more likely to
have informal learning in 2006, a relationship that disappears in 2009. The high-skilled
in Acute Trusts are less likely to engage in taught courses, online learning and keeping
up-to-date in 2009 but both the high- and low-skilled in these Trusts are more likely to
have informal learning compared with MHLD in both 2006 and 2009.
The relationship of job tenure and informal learning is consistent with the
expectation that, compared to the reference group of those working less than 1 year, the
longer people work in a Trust, such training is less likely. We also find a similar but
smaller negative relationship for online learning and keeping up-to-date; the latter is
more consistent for the low-skilled in both 2006 and 2009. For formal training, while
the overall pattern for the low-skilled is consistent with informal training, the
high-skilled with 1-2 years tenure are more likely to participate in formal training and
keeping up-to-date in 2006 but not in 2009. On contracted hours of work, there is a
strong link with training, those working 30 or more hours per week generally more
likely to engage in all four types of training in both 2006 and 2009, although the impact
is more noticeable for the high-skilled (approx. 2-3 per cent more) than for the
low-skilled (approximately 1-2 per cent more). Our results confirm that part-time
workers are generally less likely to be trained in the NHS trusts.
While the wider literature shows large firms typically offering more training to their
employees (and all these Trusts would be defined as large), the effect of NHS Trust size
on training is less clear. The results generally show a positive relationship for the
high-skilled with informal learning in 2006 and, in 2009, online learning for both the
high- and low-skilled. Compared to Trusts with fewer than 1,000 staff, the high-skilled
in Trusts sized 3,000-3,999 were (2 per cent) more likely to engage in taught courses in
2006, similar to the low-skilled in Trusts sized 1000-2999. The probability of engaging
in formal, informal training and keeping up-to-date in 2009 is not associated with the
size of Trust.
Given the increased emphasis on the importance of team working in the NHS and
evidence on positive relationships between teamwork and performance, we include
assessments of team quality and team size in the analysis. We ran the analysis three
times, the first two included the quality and team size variables separately and the
third included both variables in the model. In the separate analyses, we find a

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significant positive impact of quality and team size on the four types of training and for
both the high- and low-skilled. We do not report the results here but they are available
on request. When both variables are included in the model, the positive impact of team
quality remains for all four types of training and in both years, the magnitude of the
coefficients is larger for the high-skilled than for the low-skilled, but the impact of team
size changes. As shown in Tables VII and VIII, for the high-skilled and compared with
not in a team, in both years team size is negatively related to the probability of
participation in taught courses, online learning and keeping up-to-date. For the
low-skilled who work in a team with more than ten people, a positive impact remains
for taught courses, informal learning, and keeping up-to-date but for online learning
only in 2009. Our results indicate that where respondents rate their team positively in
terms of quality they are significantly more likely to give a positive assessment of the
effectiveness of their training. This applies to both groups and both years but the
impact is greater on the high-skilled.
In 2006 and 2009, there are strong links between whether a line manager within the
Trust and all four modes of training. Being a line manager is positively related to
formal training, online learning and keeping up-to-date but negatively related to
informal training at the workplace. Whether or not staff have had an appraisal in the
last 12 months is also strongly related to a greater likelihood of engaging in all four
modes of training in both 2006 and 2009 and, for each mode, the relationship
strengthens between these years (from approximately 1-3 per cent more in 2006 to 3-6
per cent more in 2009). It is a finding that provides support that staff appraisal (e.g.
KSF review) may be fulfilling its intention in support of progression at work through
access to WRCET that is rated as effective.
Discussion
Data for 2006 and 2009 from the NHS National Staff Survey are used to provide
evidence on participation in different forms of training by high- and low-skilled
workers and to examine the impact of individual and organizational characteristics on
how the effectiveness of this training is assessed in terms of doing my job better and
keeping up-to-date. As far as we are aware, this is the first time these data sources
have been used in this context. The discussion is structured in relation to the research
questions itemised in the introduction.
In terms of the NHS strategic commitment for greater access to training and
professional development for its-low skilled staff, the basic data on access (Table III)
show that participation for both groups increased between 2006 and 2009 and across
all four types of training; they also show the high-skilled had higher levels of
participation. However, the difference in participation between these groups in formal
training, informal training and keeping up-to-date was smaller in 2009 compared with
2006 but, for online learning, the difference increased. When the effectiveness criterion
is included in the data, the overall pattern still shows greater participation in 2009
compared with 2006 and higher levels of participation by the high-skilled remain.
These results are ambiguous in terms of policy achievement. Whilst there is growth in
training participation by the low-skilled, it has also increased for the high-skilled. If
policy is appraised in terms of narrowing the difference in WRCET between the highand low-skilled, the basic access data shows participation by the low-skilled has
increased at a faster rate for formal training, informal training and keeping up-to-date

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but the larger rate of increase in e-learning by the high-skilled prevents a clear
conclusion on the overall distribution of growth between both groups. When the
effectiveness restriction is applied, however, the difference between the two groups
shows almost no change, and such change as occurs shows a widening gap between
the high- and low-skilled.
In terms of individual and organizational factors that influence participation in
effective training, our overall results on individual characteristics are consistent with
key features of the wider international literature, a finding more significant because
these data incorporate respondent views on effectiveness, whereas the bulk of existing
studies are largely confined to measures of participation. Across all types of training
and in both years, the high skilled participated in more training than the low-skilled.
We also found that the young are more likely to participate in training and there is a
negative relationship with training and length of job tenure and part-time working. On
gender, like the wider literature, the evidence lacks consistency: gender is shown to be
a significant predictor but differing between skill levels. Compared with their female
counterparts, high-skilled men are less likely to engage in formal training, informal
training and keeping up-to-date, although these relationships weakened slightly
between 2006 and 2009. The opposite is the case for low-skilled men. The impact of
trust size on training is less clear with the high-skilled working in larger trusts more
likely to have informal learning in 2006 and online learning for both the high- and
low-skilled in 2009. We find evidence of less access to training by White British but
greater participation by Black/Black British into almost all modes of training.
In relation to factors that influence the probability of participating in training
assessed as effective, there is a positive relationship with having had an appraisal.
This is encouraging in terms of NHS policy on developing low-skill workers, as one
aspect is developing staff through appraisals linked to the knowledge and skills
framework, job review and the skills escalator. It may be a matter of concern, however,
that in 2009, 26 per cent and 36 per cent, respectively, of high- and low-skilled staff had
not been appraised in the last 12 months. It is also pertinent to studies elsewhere
showing the importance of supportive organizational behaviour.
There is also evidence relevant to the policy of changing work processes and its
increased emphasis on teamwork. For both the high- and low-skilled, the results show
a strong positive relationship between participation in effective training and
respondents being in a team they rate positively in terms of quality, a finding
consistent with other studies. Evidence on effective training and team size is less
consistent: there is a positive relationship for the low-skilled working in a team with
more than ten people but the high-skilled are less likely to report effective training if
they work in a team and, if they are part of a team, the smaller the team, the lower the
benefit. Being a line manager is positively related to participation in effective
training, except for informal training which is negatively related.
On pedagogic practice, the literature indicates greater effectiveness for less didactic
forms of teaching and the value of workshops and peer support; there is also evidence
that workers perceive these more informal modes of learning as more effective. In
relation to this, the evidence shows e-learning with the strongest growth and formal
training next with informal learning and keeping up-to-date. While we should not infer
too much into these results, they do not suggest a major shift towards the forms of
pedagogies that the extant evidence suggests are the more effective.

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Finally, we consider the strengths and limitations of introducing an effectiveness

criterion into the analysis. Making a distinction between participation alone and
whether participation was viewed as effective has clear benefits in appraising training
policies, and the criterion we have applied shows a very large difference between
participation alone and participation in effective WRCET; for example, in the case of
formal training alone, participation levels for the high-skilled were 80 per cent in 2009
but this falls to 20 per cent when our effectiveness criterion is included. These changes
convey a specific message about training quality in the NHS and a more general
message on the need for studies to include ways of taking account of quality in
assessing WRCET. Set against this, is the weaknesses that the question on the
effectiveness of training covers all training and makes no distinction between the
different types. The restrictions we apply in defining what counts as effective may
also be controversial, although we suggest that a high overall score and one strongly
agree response is a reasonable benchmark.
Conclusion
Between 2006 and 2009 there was greater participation in training across high- and
low-skilled staff but a differential pattern of participation across the four types of
training results in limited clarity as to whether the relative access of the low-skilled
improved. The use of an effectiveness criterion effectively eliminates relative change in
participation rates between these two groups. Among those who participated in
WRCET, only about a quarter rated it as effective.
Appraisal and, in particular, membership of positively rated work teams are
strongly associated with training being rated positively, reflecting findings in studies
cited earlier from a number of countries. However, when we included both quality and
size of team in the model, we found that the high-skilled are less likely to report
effective training if they work in a team. What might explain this relationship? Is it
because more training occurs in teams and, for various (unknown) reasons, the high
skilled are negative about this training? Conversely, does it reflect a response arising
from too little training in teams, hence dissatisfaction with what they regard as
training ill-matched to the needs of their team? It is an area requiring further research
that has implications for practice at a time when the role of teams in the health sector
and elsewhere are increasingly important.
Notes
1. The NHS National Staff Survey was launched in 2003 and has been run each year between
2003 and 2009. Given our main interest in the effectiveness of WRCET, the questionnaires
before 2006 do not include the effect of training.
2. Allied Health Professionals in the questionnaires include Occupational Therapy,
Physiotherapy, Radiography, Pharmacy, Arts Therapy (e.g. art, music and drama
therapy), Other AHPs (e.g. chiropody/podiatry, dietetics, speech and language therapy and
complementary therapy), Other qualified Scientific and Technical or Healthcare Scientist
(e.g. haematology, clinical biochemistry and microbiology).
3. These include Adult/general, Mental health, Learning disabilities, Children, Midwives,
Health visitors, District/community and Other registered nurses.
4. The percentages for those aged 16-20 and more than 66 are 0.5 per cent and 0.6 per cent
respectively.

5. Approximately 79.5 per cent in 2009, and this is calculated based on figures of NHS Statistics
& data collections: www.ic.nhs.uk/statistics-and-data-collections/workforce/nhs-staffnumbers
6. Ambulance Trusts are included in the survey but we do not include them in our analysis due
to the limited numbers of observations.

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7. For detailed discussions of AME see Bartus (2005).

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About the authors
Hywel Thomas is Professor of the Economics of Education and Director of the Centre for
Research in Medical and Dental Education (CRMDE) at the University of Birmingham in the UK.
The principal strand linking his work has been the application of ideas from economics to
education. This has contributed to a diversity of projects, including work on the finance of
schools and colleges, the career paths of graduates, the management of resources and the
deployment of staff in educational institutions.
Tian Qiu is a Research Fellow of the Economics of Education in the Centre for Research in
Medical and Dental Education at the University of Birmingham. Her main research interests are
in the areas of economics of education, health economics, labour economics and economics of
happiness. Tian Qiu is the corresponding author and can be contacted at: t.qiu@bham.ac.uk

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