Analysis of Responses to the Consultation Document A New Special Health Board for Education in NHSScotland
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Learning Together 1, the education, training and lifelong learning strategy for NHSScotland, signalled the intention to create an umbrella forum for educational support for all staff. In June 2001 the Minister for Health and Community Care announced the creation of a new Special Health Board on 1 April 2002 to bring that intention into effect.
This consultation paper offered the opportunity for interested parties to let the Scottish Executive Health Department know their thoughts about the nature and form of the new body, what it should look like in five years' time and beyond, and how it should get there. There were specific questions contained within the document but respondents were also free to add additional comments. The results of this consultation will also inform and assist the new Board as it begins its deliberations and sets its strategic direction for delivering its long-term vision.
The consultation paper was issued on 5 November 2001 and the consultation period closed on 1 February 2002.
181 responses were received across the following categories:
Non NHS Organisations
[Please Note: Some responses covered 2 categories (e.g. primary care nursing) and so have been counted twice in the above table although not in the overall number of responses.
Responses have been classed as individual/personal only where it has not been clear where the respondent's interest lies.]
All responses were summarised and the following analysis made, based on the questions posed within the consultation document. Numbers in brackets refer to the number of responses expressing that particular opinion.
We are grateful to all those who took the time to respond.
1. What name do you favour for the new Special Health Board?
110 respondents commented on this question. The name favoured by the greatest number of people was NHS Education for Scotland (36), with second and third choice being NHS Education Board for Scotland (7) and NHS Learning (4). Most others put forward alternative suggestions and a list of suggestions is attached at Annex A.
Although NHS Education for Scotland was the favoured name, concerns were raised on 3 grounds:
The use of "NHS" could give the impression of excluding those healthcare staff who work outwith the NHS.
The use of "education" calls up a picture of formal, classroom learning and
The possibility of confusion with the Health Education Board for Scotland (HEBS)
2. To what degree should NHS Education for Scotland be responsible for both the national framework to support local employers' learning responsibilities and for structures for learning support for specific staff groups?
130 of the responses received addressed this question. The majority (69) were firmly in favour of NES being given the oversight of the national framework for education, training and lifelong learning in NHSScotland. The advantages of one body having this responsibility were seen to be co-ordination and oversight (5) of the wealth of expertise that already exists; the opportunity to ensure consistency and equity of access to education and training for all staff (13); and the encouragement and dissemination of good practice (4).
It was suggested that the development of the national framework should
reflect national priorities
be developed in partnership with NHS Boards and Trusts, allowing employers to have some influence over it
link with workforce planning and fitness for purpose
aim to produce practitioners focused on patient care
However, most of these (35) recognised the need for local employers and individual staff to also take responsibility for learning. Local flexibility was seen as necessary and several respondents (9) suggested that the deanery structure of SCPMDE could provide a good model for NES to build on. Some respondents (3) felt that the links between NES and the Learning Together agenda and local learning plans needed to be made clear. The specific needs of staff in remote and rural areas should not be forgotten.
Several respondents (20) felt that NES should have some degree of authority to allow it to manage the performance of NHS Boards and Trusts in the area of education and training and staff development. However, 1 respondent felt that its role should be entirely advisory. It was also felt that NES should be given management of the resources associated with education and training (18 respondents), with one respondent suggesting that these activities should be entirely funded by NES and Trusts should not be expected to pay at all.
Those who addressed the issue of structures for learning support for specific staff groups (14) were almost equally divided between those who felt that NES should not be involved with specific staff groups (6) and those who were clear that it should (8). 3 respondents felt that NES should prioritise the groups already covered by SCPMDE, NBS and PQEB before moving on to expanding their remit. On the other hand, others felt that groups such as AHPs and healthcare scientists who did not have existing support structures should be given priority in NES's plans. It was also suggested that no new structures should be set up, but that the support mechanisms should be built on common functions across staff groups.
Several respondents were clear that NES would have to work closely with other agencies, with pre-registration education providers (5), Scottish Credit and Qualifications Framework (1) and voluntary/patient bodies (1) being specifically mentioned.
Other comments related to the development, provision and accreditation of training courses. It was generally felt that there were a good number of training course providers already in existence, but that NES could usefully provide/commission courses where none existed, act a resource for training materials and for the provision of trainers. It was also suggested that NES should consider developing Managed Educational Networks along similar lines to Managed Clinical Networks.
3. What will the new body need to do to cater for the needs of other staff groups, in particular support and administrative staff?
136 responses were received to this question. In general, respondents (74) felt that the best way forward was to consult with the groups involved, either carry out, or facilitate Trusts/NHS Boards to carry out, a needs analysis of the various groups, assess existing opportunities and develop solutions.
Again it was felt that this was an area where local employers had a clear responsibility (11), but that NES could facilitate the development of national frameworks, if appropriate, and disseminate good practice (5). In addition respondents (24) suggested that NES should develop links with providers of education and standard setting bodies such as SQA, as well as other relevant organisations to enable a joined up approach. Some respondents (7) felt that the principles behind the support of all groups of staff should be the same, including a right to study leave. It was also argued (14) that an extended remit should include within it extra resources and that resources already allocated to particular staff groups should not be taken away. Partnership Fora and trades unions have a valuable role to play in developing and extending support to staff groups who feel marginalized at the moment.
There was acknowledgement that such groups of staff were sometimes not given due recognition. Specific groups mentioned included paramedics, ambulance care staff, electricians, technicians, IT staff, shop staff linked to independent retailers and primary care support staff as well as AHPs, healthcare scientists and administrative and support staff. 31 respondents felt that all groups of staff should be included from the outset. However, a significant minority (12) felt that priority for NES's early attentions should be given to clinical staff. This was linked to a concern that NES could take on too much too soon, raise expectations, but then fail to deliver.
It was suggested that motivation and uptake for learning opportunities could be a problem amongst some groups of staff, although specific resource for learning could improve recruitment and retention for some staff groups. NES could play a valuable role in facilitating culture change, marketing the concept of lifelong learning and persuading both staff and their employers that lifelong learning is not an optional extra. It was also suggested that the role of NES could be to ensure that staff groups not directly involved in patient care are integrated with clinical and other staff and have an understanding of the key part that they play in service provision.
Other issues raised were
4. What are your views on this aim for NHS Education for Scotland?
126 responses were provided for this question. Of these 44 indicated in a single word that they were happy with the aim, 2 felt it was "woolly" as set out in the consultation paper and suggested alternative, shorter statements.
Of those respondents who expanded on their reply, several (14) felt that, although the aim as set out in the consultation paper was laudable, they felt that NES would have difficulty delivering on it.
For others (5), the issue was what the timescale for delivery would be and how soon those groups of staff seen to be outside the current system would be brought on board.
It was also felt by some that such an aim would be meaningless without NES having the authority (7) and the resources, both human and financial (12) to back it up. Others (4) expressed their concern about the availability of protected learning time and the implications for other staff that such an approach would have.
Overwhelmingly though, the aim as set out in the paper was welcomed, with respondents (6), seeing the focus on patient needs, rather than individuals' perceived learning needs being particularly significant. However, it was felt (10) that it needed to be made clear that the aim was not the sole responsibility of NES, but that it would need to work in partnership with others, not least with individual staff taking responsibility for their own learning.
Several respondents (9) felt that the contribution to health improvement had been overlooked and that a statement to that effect should be included. Others sought clarification on whether the aim would include staff in all care settings (4) and also on who would monitor NES's own performance (3).
Other comments included:
Who decides what is best practice?
Where does workforce-planning come into the aim of NES?
There is a need to improve the current fragmentation of approach to education and training.
NES must involve professional groups in the planning of their development
5. What are your views on this vision for NHS Education for Scotland?
124 responses were received to this question. Most were supportive of the vision as set out in the consultation paper and 31 indicated this without further comment. 6 respondents felt that the vision was too vague and did not go far enough in setting out what NES should be about. 1 respondent felt it was too narrow.
Those who made additional comments had concerns about the achievability of the vision as set out (15) and about whether NES would have sufficient resources to support such a vision (8).
Again the timescale was for bringing other staff groups on board was of concern (18). The consultation paper was seen as being too vague on this point and it was felt that all groups should be included from the outset. It was also felt that NES should aim for equality amongst all groups of staff with doctors being seen as having been particularly favoured up till now.
9 respondents commented on the multi disciplinary approach set out. 7 felt that this was the way forward, with 2 respondents expressing caution, on the basis that developments should be evidence based. There was also concern (8) about a dilution of uniprofessional standards by the establishment of NES and by such a broad vision.
It was recognised that the vision could not be achieved by NES alone (18), but that it would have to work in partnership with other bodies, particularly HE and FE institutions and professional regulatory bodies. 2 respondents felt it was important to learn from other countries.
Other comments related to the authority that NES would have to achieve (11) the vision and also how NES itself would be monitored (11) and appraised. In addition respondents mentioned the importance of research and development being part of NES' agenda (4) and that NES should work to avoid losing core/generic skills within the health care workforce (2) to help address the needs of remote and rural communities.
6. What are you views on the values and approach suggested here?
121 responses were received. Of those, most were supportive of the values and approach set out, with 24 indicating so with no further comment. 3 respondents felt that the language used was too authoritarian and another that the responsibility of the individual staff members for their own learning needs needed more emphasis. On the other hand, 1 respondent felt that the expressions were not definitive enough.
Again responses (17) to this question revealed a concern that NES should ensure that it works in partnership with other organisations, such as NHS Trusts and Boards, professional regulatory bodies and educational providers. Some respondents (14) were supportive of the values and approach set out but expressed concern about the achievability and 2 queried whether this would improve on existing arrangements. The resources, both human and financial, which would be available to the new Board were of concern to 7 respondents.
It was felt (7) that NES should have a level of authority to ensure that it would be able to carry out its functions properly. It was also important (11) that NES itself should be monitored and its performance evaluated. It should reflect the opinions of staff (3).
The commitment to cross sectoral working was welcomed (4), but some caution was expressed with regard to multi-professional learning (3) and a concern that this should not be at the expense of uniprofessional standards. Alongside this the new organisation should be inclusive (2) and a timeframe should be set down for the inclusion of other staff groups (1).
The importance of local ownership as expressed by the phrase "managed delegation" was welcomed (3) and one respondent suggested building on the SCPMDE postgraduate centre structure.
There were several positive comments on the approach and values set out. 7 respondents welcomed the commitment to openness and transparency, but suggested that the phrase "wherever possible" should be removed; 3 felt that these were values that the whole NHS should aspire to; that it was good to aim high (1); that they were positive and constructive (1) and a good background for the Board's work (1). One respondent described it as an "excellent plan", which should improve things for staff and patients.
Other comments were:
7. What are you views on these functions as a description of the approach that the Board of NHS Education for Scotland should take?
120 responses received addressed this question.
Of this 34 respondents agreed with the functions. Of these 28 agreed absolutely with no further comment. Of the other 6 responses 2 suggested inclusion of workforce planning, one highlighted the importance of communication with stakeholders, one referenced the need for a quality control role, one mentioned resources and one mentioned the possible need of research and development functions.
The overwhelming majority of respondents (79) did not express an opinion either way on the functions but rather offered their views as to what should or should not be included. Many respondents included more than one suggestion.
The strongest view to come forward on this question was the relationship of the Board to stakeholders and partners. 30 respondents highlighted the importance of the Boards relationships with stakeholders and partners. It was cited as a key challenge and crucial to the effective working of the board by 11 respondents. However, articulation of who stakeholders and partners were and the link between SHB and these bodies was unclear (7). 2 respondents mentioned a link with the independent care sector, with 1 specifically mentioning the Clinical Education and Training Advisory Group. It was emphasised that the SHB must have a close role with universities (4) and boards/trusts (3), a robust and open relationship with the SEHD (1), strong links with the SPF.
There was concern that this relationship may not be one of equality but that the board would develop a dictatorial role (3). Yet at the same time several respondents wanted greater emphasis on how the Board could assist with the clinical effectiveness agenda and the development of quality assurance (3). One respondent sought clarity on whether the Board would have a policing role.
The second biggest issue was the relationship between the board and health staff with 17 respondents raising this issue. 10 of these respondents specifically spoke of policies for "all staff" as being essential. The Boards possible role in influencing working practices was voiced as both a negative (1) and a positive (1). The need for "clear and efficient lines of communication" was emphasised by 4 respondents.
There was some debate about the role of the Board in relation to being an education provider or a facilitator and whether it should be involved in research and development with 14 responses raising these issues. Of these 14, 5 respondents stated that NES should be a facilitator and not a provider and 1 questioned further articulation of its role in this area. 3 put forward that NES should commission and promote and fund research. One respondent felt that the link between research and policy should be defined.
13 respondents raised the issue of accountability measures by which the board would measure its performance and 10 respondents made the point that resources is an issue in carrying out the functions of the Board .
9 respondents thought that workforce planning should be incorporated into the functions of the Board . 5 respondents were confused about reference to governance and management and whether the Board would have a policing role over any of its partners/stakeholders. 3 respondents felt that the functions should be written in greater detail. That as currently presented they were too broad.
7 warned of the danger of the Board becoming another bureaucratic layer in the system.
8. Bearing in mind the foregoing discussion and the principles of governance, we would welcome your views on the composition of the Board.
Question 8 contained within it specific questions and most respondents focussed on these.
In total 127 of the responses replied.
Responses to the "sub-questions" were as follows:
1 respondent felt the board should be mainly executive members, 16 that it should be mainly non executives and 3 that there should be equal numbers.
17 felt that the Chief Executives of the existing organisations should be included as executive members, 5 felt they should not.
(This question presupposed that the new organisation would contain within it such committees).
19 felt that the chairs of these committees should be Board members, no respondents felt that they should not.
11 respondents felt that the chair of the NES Partnership Forum should be a Board member, 1 felt that they should not.
No respondents said that a member of SPF should be an ex officio member of the NES Board, 10 specifically said that this should not be the case.
In addition to responding to these specific questions, some respondents added other comments. 21 said that a small board was needed to ensure decision making and accountability. On the other hand 8 respondents specifically stated that the Board should be a large, representative body. 12 stated that, whatever structure was established initially, it should be reviewed after a year.
Some respondents set out which groups they felt should have representation on, or at the least, good communications with, the Board, without being specific about the size of the Board. Individual groups mentioned were:
Primary Care (1)
Ambulance staff (1)
Education sector (6)
Lay members (5)
Public sector (1)
General Practice (1)
9. We would welcome your views on whether the functions proposed at Annex A, taken together, deliver the proposed vision for NHS Education for Scotland
106 of the responses received addressed this question. Of this 106, 6 were classified as "not sure" due to the ambiguity of their answer. 24 respondents answered in absolute terms. 38 respondents agreed in broad terms but indicated the need for the functions to be reviewed in order for the full vision of NES to be achieved. Of this group 9 respondents emphasised the need for inclusion of other occupations not currently covered, 7 put forward the need for generic functions and 14 suggested "other" changes:
quality control statements
reference health improvement rather than just "health care"
pre-registration nurse education
staff shortages (crucial issue for release of staff for training)
training needs of support workers
monitoring and evaluating education provision and professional regulation
should influence undergraduate education
33 respondents answered no, the functions would not deliver the vision. Most (21) respondents cited the immediate need to include other occupational groups not represented by the previous structures. 7 respondents thought it necessary that the functions were re-written and 4 respondents took the opportunity to point out difficulties achieving multi-disciplinary team working under the proposed functions.
The key issue for achievement of the NES vision would therefore appear to be the inclusion of other groups not currently reflected in the functions of the pre-existing organisations of SCPMDE, NBS, PQEB. In total 30 respondents specifically mentioned this issue.
The only difference between respondents was whether this should be dealt with immediately or over time. Whilst one of the objectives of the vision was the inclusion, over time, of all staff groups, 21 respondents chose to reject this and state the need for inclusion of other staff groups from the outset. There was concern that if NES progressed too far down the track under the current functions rigid structures would develop which would make it more difficult to include AHPs on an equitable basis.
Another issue that was mentioned specifically by several respondents was how the functions were to be achieved with current resources.
10. How would you advise the Board of NHS Education for Scotland to establish and evolve its structures?
4 options were offered within Q10:
Option 1: Establish three directorates corresponding to the functions of the current three bodies. This has the advantage of retaining continuity and reducing initial turbulence, helping to ensure that the current day-to-day operations of the three bodies are not jeopardised. It would also give the staff groups concerned a clearly identified and effective support structure and be sensitive to differences in education and training for different staff groups. The Board would have to consider how to develop the directorate structure as additional staff groups were brought into its remit.
Option 2: Establish directorates in a similar way, but organised around staff groups with linked functions (for example, dentists and professions complementary to dentistry, or mental health professionals) rather than groups with similar educational paths (as at present - for example doctors and dentists). Such directorates could respond readily to multi-disciplinary, mixed-skill teamworking approaches and might be straightforwardly expanded in the medium term to take in relevant PAMs.
Option 3: Strong central cross-cutting functions within an enlarged central core could take on generic activities applicable to all staff and have the capacity to expand to better embrace their needs over time. This might encompass cross-disciplinary work on areas already common to the three existing bodies, such as continuing professional development, workforce planning and intelligence, quality assurance, implementation of training programmes, aspects of appraisal, and educational research and development. This central capacity would be additional to functional directorates specific to particular groups of staff, as described in options 1and 2.
Option 4: Activities such as those described in option 3 could, instead of being grouped in a central core, be allocated to a series of cross-cutting functional directorates, with remits which could be straightforwardly extended to include new staff groups as they were brought under the umbrella of the new body. At the same time some operations, and some aspects of the activities mentioned above, would need to remain profession-specific and the structures of NHS Education for Scotland would need to be sufficiently flexible to accommodate this uni-professional work and give it sufficient weight within the organisation.
129 responses were received and most respondents replied in terms of the above options, although some simply provided comments without selecting any of the options.
The majority (67) favoured Option 1 in one form or another, to avoid disruption to the ongoing work of the existing bodies and also because, pragmatically, option 1 was the only 1 achievable at the start. Of these only 18 selected Option 1 without qualification. 15 wanted to see option 1 implemented but with a commitment to a review after a period of time; 32 wanted option 1 to start with but moving to option 3 or 4 fairly rapidly; 2 respondents felt that option 1 should evolve into option 2. By contrast, 5 respondents specifically rejected option 1, on the grounds that it was too close to what already existed and that it did not give enough scope for NES to bring other staff groups on board.
9 respondents favoured option 2, with 3 respondents favouring option 2 followed by option 4.
14 respondents selected 3 as the best option; 8 selected option 4 and 7 selected option 3 or option 4.
2 respondents suggested the establishment of a shadow board for a period of time, to allow the new organisation time to consider what the best structure would be.
11. How do you feel the directorate committees should relate to the main Board at committee chair level?
Again Q11 set out 3 options and responses were made accordingly:
Option 1: The Board nominates the Chair of each directorate committee from among Board members.
Option 2: Each directorate committee selects its own Chair from among its members, who will then be a member of the Board by virtue of his or her office.
Option 3: Option 2 is adopted for a transitional period of say a year, with Option 1 applying thereafter.
99 responses to this question were received. Of these 38 favoured option 2 in some format (34 without qualification, 2 suggesting a review after a year and 2 suggesting option 2 or option 3).
19 respondents favoured option 3, and 19 favoured a version of Option 1.
Of the other respondents 7 had no preference and 5 felt that it would be important to let the Board make such a decision.
12. How should the Board relate to stakeholders and interest groups, including other parts of NHSScotland and other organisations such as universities and colleges?
117 responses to this question were received. This was seen as a crucial aspect of the Board's success. 39 respondents said that one of the main tasks must be to define who the stakeholders of NES are. A variety of methods of communication were suggested and these are listed at Annex B.
10 respondents suggested that profession specific committees should be set up to facilitate uniprofessional communication. 10 respondents suggested that a separate stakeholder advisory committee to oversee the relationship with stakeholders. An alternative, but similar, suggestion (11) was that there should be a network of named link persons in both NES and the stakeholder bodies.
However, a number of people (22) said that NES should build on the systems that already exist if these are working satisfactorily.
Other, individual comments received included:
NES should not just focus on the Central Belt
AHPs should be included from the outset
Stakeholders should contribute to the annual review of NES
NES staff should be seen as stakeholders
13. Any other comments?
Of the responses received 85 chose to make further comments under Question 13.
22 respondents mentioned resources specifically. The main concern was the ability of the new board to achieve its objectives with no additional funding. 3 respondents welcomed ring fencing with one expressing concern that small professions would be disadvantaged if it was removed. Greater financial detail was requested, particularly in relation to study leave.
15 respondents raised the importance of partnerships with other organisations/stakeholders. The types of organisations where relationships should be defined were the Royal Colleges, the Health Professions Council, SQA, SUFI, SCIEH, HE, FE and enterprise networks. In addition, 2 spoke of relationship with social work colleagues, 2 the voluntary sector and 2 the education sector.
13 respondents made comment about "other groups". A majority of these (8) expressed dissatisfaction with not including other groups apart from those already represented by previously existing organisations. One respondent took the view that it is "important to extend to other professional groupings but not at the expense of. (the)..medical profession."
5 respondents thought there should be a greater link with workforce planning.
2 respondents put forward the view that there should be an internal monitoring system by which the Board was reviewed regularly. One respondent mentioned the role of the Board in monitoring and evaluating the performance of NHS Boards in relation to their education and training performance.
Additional comments that the Board may wish to note include:
CPD of medical records staff and medical illustrators should fall within ambit of new Board
Would be very supportive of new body having some responsibility for CPD of clinical academics and with its broader professional base could address the serious anomaly that at the moment you can only really have a clinical academic career with a grounding in medicine.
Hope board will bring recognition of professional status of admin staff, recognised qualifications
Should capitalise on wider educational developments such as Scottish Credit and Qualification Framework and evolving developments from AFC pay competency work
Working with University of NHS, England
Fear loss of professional identity because of the size of the board
Quality information provision for all employees
Several respondents made general positive comment such as:ANNEX A
Board of Education for Scotland's Health Workforce ANNEX B
Continuing Education Health Board in Scotland
Continuing Professional Development for Health carers
Council for Health Carers Continuing Professional Development
Education Board for Scotland's Health Professionals
Education Board for Scotland's Health Workers
Education for a Healthy Scotland
Education for Health in Scotland
Education for NHSScotland
Education Health Board in Scotland
Health Board for Healthcare Education
Health Care Education for Scotland
Health Education and Training Board
Health Education Scotland
Health Professionals Governance Board
Learning and Development Board
Learning Together Scotland
Lifelong Learning in NHSScotland
NHS (Scotland) Education Confederation
NHS Education (and Training) for Scotland
NHS Education (Scotland)
NHS Education and Development
NHS Education and Development for Scotland
NHS Education and Development Scotland
NHS Education and Lifelong Development Board for Scotland
NHS Education and Lifelong Development for Scotland
NHS Education and Training Board for Scotland
NHS Education Board for Scotland
NHS Education for Scotland-
NHS Education for Scotland Health Board
NHS Education in Scotland
NHS Education, Training and Lifelong Learning for Scotland
NHS Learning and Development Scotland
NHS Learning Board
NHS Learning for Scotland
NHS Learning Forum
NHS Learning Matrix
NHS Post qualification Board for Scotland.
NHS Scotland Education and Development
NHS Scotland Education and Development Board
NHS Scotland Professional Education Board
NHS Staff Development Board for Scotland
NHS Staff Development for Scotland.
NHS Staff Learning and Development for Scotland
NHS Training and Education for Scotland
NHSiS Staff Education and Training Board
NHSScotland Board for Education and Lifelong Learning
NHSScotland Education and Development
NHSScotland Education Board
NHSScotland Learning to Care Board
NHSScotland Professional Development
NHSScotland Staff Development and Education
NHSScotland Staff Educational Opportunities
NHSScotland Staff Lifelong Learning
NHSScotland Training and Development
Our NHS: Education and Training for Scotland
SCOLAR-Scottish Centre of Learning, Audit and Research.
Scottish Council for Continuing Healthcare Professional Education
Scottish Council for Healthcare Learning
Scottish Health Education Board
Scottish Health Service Continuing Education Board
Scottish health Service Education Board
Scottish Health Training Board
Scottish Special Health Board for Education
Special Health Board for Education
Ad hoc advisory groups Footnote
Annual conference to act as showcase and sounding board
Biannual public meeting
Build on existing good practice
Bulletin in web
Consult widely on work programmes
Electronic bulletins distributed to named persons in each organisation
Feedback and monitoring
Good use of IT
Interact with public meetings
Internet notice boards
Invite interest groups to attend selected meetings
Multi-media advertising of events/developments
Named officers with a responsibility for 2 way communication
Open board meetings
Public board meetings
Publish annual report
Rapidly disseminate briefing papers
Regular briefing of stakeholders
Regular input from a wide range of staff
Regular stakeholder involvement seminars
1. Learning Together December 1999