Partnership Quality Assurance Framework for Healthcare Education in England

Introduction and context

The NHS in England spends almost £4 billion on training, education and development of healthcare staff. Much of this investment is managed in the form of education contracts between higher education institutions and Strategic Health Authorities (SHAs). This funding directly supports pre-registration training of many healthcare professionals, including nurses, midwives and allied health professionals. It also provides for some continuing education. NHS Trusts, with the independent and voluntary sectors, also make a considerable contribution as co-providers of professional programmes of higher education through the provision of practice placements.

To be effective and cost efficient, quality assurance arrangements for healthcare education need to meet the needs of different stakeholders.

SHAs/Workforce Development Confederations, which commission professional healthcare education, to meet present and future healthcare needs with a focus on fitness for purpose.
Regulatory bodies, which have a statutory duty, to ensure that programmes are of appropriate quality to lead to registration or recording to meet fitness to practice requirements.
Professional bodies, which have an interest in overall professional standards and roles.
Education providers, which are responsible for the standards and quality of the awards.
Students, as direct recipients of education provision.
Service users, the ultimate recipients of healthcare.
NHS Trusts and other healthcare providers, who have a responsibility to provide a workforce, to patient and service needs.

For quality assurance to be effective, arrangements need to contribute to a health service designed around patients, ensuring that:

responsibility for the quality of learning becomes standard practice for all stakeholders
learning experiences and outcomes are quality assured to agreed national standards
the shared framework reflects healthcare policy
the outcomes of quality assurance inform healthcare policy and healthcare education
quality assurance outcomes are derived from evidence which is transparent and publicly available
quality monitoring is seen as secondary to quality enhancement.

Prior to the development of the Partnership Quality Assurance Framework for Healthcare Education in England (PQAF), a range of quality assurance regimes were in place, derived from each stakeholder’s own processes. This resulted in a duplication of effort and therefore did not always result in shared and public outcomes. The development of the PQAF seeks to address this by the establishment of a framework developed in partnership and which accommodates all partner stakeholder needs.

Initial arrangements were outlined in the Streamlining Quality Assurance in Healthcare Education; Purpose and Action publication (Department of Health (DH) March 2003). This involved the DH establishing a number of working groups and national forums, including local reference groups in collaboration with SHAs. The intention was to engage as many partners and stakeholders as possible. Partners in this context are the Health Professions Council (HPC), Nursing and Midwifery Council (NMC), SHAs and higher education institutions. Stakeholders are other interested parties, including voluntary and private healthcare providers. The Quality Assurance Agency for Higher Education (QAA) played a particular and valuable role. While not a partner, it has been involved in the development and delivery of the PQAF under contract to the DH.

National consultation at key points in the development process has been a key strategy for the involvement of partners and stakeholders. This second National Conference was held with a view to continuing the process of consultation with stakeholders. Reports of outcomes of this process are available on the QAA website

Students and service users have also been involved in the development of the PQAF through dedicated consultation events held in 2003 and 2005. Reports from these events are available on the DH website and the QAA and Skills for Health websites.

From October 2004, the operational responsibility for the development of the PQAF transferred from the DH to Skills for Health, under the terms of a service-level agreement through which Skills for Health is accountable to DH.

New partnership working arrangements

Following transfer of the PQAF work programme to Skills for Health, two national partnership groups have been proposed:

the Quality Assurance Framework Management Group advising on the operation and delivery of PQAF
the Quality Assurance Key Stakeholder Advisory Forum providing a strategic policy steer and advice regarding the future development of PQAF.

In addition to these two groups there are:

the Statutory Bodies Alliance Group providing a forum for DH, Skills for Health, the HPC and the NMC to discuss the statutory bodies’ needs in relation to PQAF and
local reference groups providing a wider forum for debate on the impact and implementation of the PQAF.

A key feature of the PQAF is that it is a streamlined framework, developed through partnership, which can accommodate the different needs and responsibilities of all stakeholders. It enables each stakeholder to engage differently with the framework while still maintaining a shared approach. This is supported through the following strategies embedded within the process of each element of the PQAF.

Streamlining through reduction of quality assurance processes thereby reducing the burden on all partners.
Provision of public information resulting in enhanced confidence in quality assurance outcomes and processes.
The use of self and peer evaluation against agreed standards and evidence base.
Enhancement of quality through the inclusion of action plans.
The recognition of placement providers as educators in their own right and therefore giving equal emphasis to campus as well as practice learning.

Within the PQAF are shared standards relating to 10 aspects, which are relevant to all elements. These are:

management and organisation
effective use of resources
curriculum
learning outcomes
student selection, progression and achievement
student support
learning and teaching
assessment
quality enhancement and maintenance
values, equalities and diversity.

Five elements make up the PQAF. They are:

benchmarks and quality standards
Approval of programmes
ongoing quality monitoring and enhancement (OQME)
Major Review
the evidence on which conclusions and judgements are based.

Continuous quality improvement of healthcare education

The First National Conference on the PQAF, held in April 2004, sought to outline the elements of the PQAF, disseminate information about partnership working arrangements and give specific feedback upon Major Review arrangements. A total of 250 delegates drawn from higher education, practice providers and other stakeholders were present. The Conference evaluated positively but the need to offer a further conference with an increased delegate capacity was identified and this informed the planning for the second conference event.

Focus and aims of the Second National Conference

The Second National Conference sought to:

provide an update on the last year’s activity pertaining to the PQAF
disseminate the emerging findings of the prototype activity relating to OQME/Approval/evidence base/shared standards
highlight other PQAF related activities including Major Review emerging trends
provide an opportunity for delegates to comment on the processes and standards associated with the PQAF, and
provide networking opportunities in the context of the PQAF.

Delegate attendance

Some 420 delegates attended, as detailed below.

Table one: Pattern of delegates attending

Designation/sub divisions	Percentage attending
Providers of campus education Higher education staff	31.8 31.8
Providers of practice education Practice learning leads (coordinator/facilitator) Service managers Practice staff	57.5 23.8 18.4 15.3
Strategic Health Authority staff/commissioner	8.8
Professional/statutory bodies/professional organisations	7.6
Other (including independent sector representatives/organisations)	4.2
Event support staff	2.4

Conference programme (see appendix for slides)

Session one

Chris Pearson (Director of Development, Skills for Health), Chair for the morning's proceedings, welcomed delegates to the event on behalf of Skills for Health. He outlined the role of Skills for Health in respect of progressing development of the PQAF on behalf of partners and stakeholders and reiterated the importance of the PQAF especially in the context of the level of public funding involved and the need for public information concerning the quality of provision to inform choice.

Session two

John Ennis (Head of NHS Quality Assurance (Education)) outlined the rationale for the development of the PQAF and its current and potential scope in the future. He reminded the audience of the key elements of the PQAF and their iterative development to date. He also highlighted the potential key policy links to the PQAF and outlined the proposed next steps in the development of the PQAF.

Session three

Nic Greenfield (Director-Model Career Portfolio, DH) provided the morning's keynote address. During his address, he located the role of quality assuring healthcare education within service policy initiatives, notably

the development of a patient-led NHS
systems reform and
an increased emphasis upon health rather than solely ill health needs.

Nic acknowledged the importance of practice learning in the development of competent health professionals, together with the subsequent impact of this upon the quality of patient care. Additionally he acknowledged the need to ensure healthcare education quality arrangements address fitness for award, practice and purpose especially in the context of meeting changing health workforce and skill requirements. This served to identify a key thought for the conference proceedings of

'Build quality assurance in as a commitment; do not inspect it out'.

Session four

This session was presented jointly by Val Musson (Independent evaluation of the prototype activity, Homerton School of Health Studies, Cambridge) and Patricia le Rolland (QAA). Both offered their perspective of emerging themes from mid point evaluation of Approval, OQME, shared standards and evidence prototype activity. (Final evaluation outcomes will be available in published reports at the end of September.) The presentations highlighted emerging benefits of the processes subject to evaluation and issues for further consideration, revision and refinement.

Session five

Linda Merriman (Dean, Coventry University) on behalf of Coventry University and its partner SHAs offered a perspective on Approval arrangements within the PQAF arising from participation as a prototype site. Again, Dr Merriman highlighted perceived benefits, areas for refinement and emerging issues for wider consideration.

Session six

Paul Holmes, acting in the capacity of Chair for the remaining sessions, offered a brief summary of key messages received thus far in the proceedings and highlighted the focus for discussion within those remaining.

Session seven

Nic Dean (Head of Review Coordination and Wales Strategy team) and Tania Clarke (Concordat Development Manager) representing the Healthcare Commission (HCC), jointly presented this session. They provided a summary of the purpose and developmental milestones pertaining to the establishment of the HCC and indicated the next step in the organisation development through a concordat agreement with a wider stakeholder engagement over the next few months. The need for, and value in, establishing overt links between the work of the HCC and the arrangements within the PQAF was acknowledged, particularly in terms of agreeing shared and reciprocal evidence and data sets, with this being one possible future measure of success for HCC.

Session eight

Miriam Price, on behalf of North Central London SHA, and Jan Williams, representing University of Middlesex, offered a perspective on OQME arrangements within the PQAF arising from participation as a prototype site. Perceived benefits, areas for refinement and emerging issues for wider consideration were highlighted. Additionally, this presentation highlighted the implications and challenges of a truncated timescale for the purpose of the prototype activity particularly in respect of preparing staff for involvement and completion of self evaluation/exception reporting.

Session nine

This session was dedicated to seven workshop activities that delegates chose to attend.

Workshop topics

Student and service users in relation to the PQAF - presented collaboratively by Jane Fox (Skills for Health QA team), Susan Campbell (Healthcare student, Edge Hill College of Higher Education) and Rachael Hawley (Commissioning Development Manager, Trent SHA).
Major Review trends – Patricia Le Rolland (Assistant Director, QAA).
Major Review and the role of SHAs and the Practice Review Facilitator within this - presented jointly by Ray Walker (Head of Professional Education, Training and Development , Cheshire and Merseyside) and Sue Hooton (Greater Manchester SHA).
Other work programmes within Skills for Health and their links to the PQAF - Chris Pearson (Director of Development, Skills for Health).
The statutory bodies’ perspective in relation to the PQAF. It had been intended that a presentation would be given by both the HPC and the NMC on the day. However, due to staff changes, only the NMC were able to be present, with Garth Long and Roger Thompson both representing the NMC in their capacity as Education Advisors.
The Council of Deans and Heads of UK University Faculties for Nursing and Health Professions perspective on the PQAF was given by Mr Paul Turner (Executive Officer). He posed a number of questions for future deliberations.
Further insights and perspectives derived from involvement in prototype testing of both Approval and OQME were offered in a collaborative presentation by Pam Parker/Christine Coakley (City University/North London SHA), Paul Tubbs/Maureen Wilkins (University College Chester, Cheshire and Merseyside SHA) and Miriam Ingham/Ian Clarke (University College/Leicestershire Northampton and Rutland SHA), Helen Langton (Coventry University).

Session ten

This provided an opportunity for delegates to pose any questions or offer any observations directly to a panel. The panel consisted of John Ennis (Head of NHS Quality Assurance- Education, Skills for Health), Roger Thompson (Education Adviser, NMC), Patricia le Rolland (Assistant Director, QAA), Linda Merriman (Dean Coventry University) and Val Musson (Associate Dean, Homerton School of Health Studies).

At the conclusion, of this session, the Chair, Paul Holmes, invited each panel member to offer their own personal view or aspiration for the future of quality assurance of healthcare education.

Session eleven

Final and closing remarks were offered by John Ennis who highlighted the following as a personal summary of key messages provided during the conference:

support for the emphasis given to practice learning within the PQAF
PQAF process were evidently facilitating and supporting partnership working
the need to ensure quality enhancement was privileged over simply monitoring or inspection regimes
there was still much to be done in learning from the prototype evaluations and subsequent development of a PQAF that met the needs of all stakeholders to achieve the original aspirations of streamlining, quality enhancement and providing public information, and
development to date and future development was contingent upon partnership and stakeholder involvement.

Conference activities

In order to address the aim of providing an opportunity for delegates to comment on the processes and standards associated with the PQAF; changes they would wish to occur in relation to the PQAF; principles they thought were important to retain within the PQAF; and issues arising from any implementation of the PQAF they thought should be considered in future development, three periods were allocated within the conference programme against delegate 'activities'.

The activities took the form of leaving a message for the Skills for Health Quality Assurance Team and prototype evaluators (QAA and Homerton School of Health Studies) to consider through:

a dedicated message wall
speaking to a video camera
written postcards.

In total, 246 responses were received through the planned activities (191 messages on the wall, 41 postcards and 14 spoke to video). Detailed analysis of responses/messages is given below for each activity. However, overarching themes were:

PQAF’s potential to strengthen partnerships between education providers and commissioners
support for giving at least equal attention to practice learning within PQAF arrangements
the need to consider support and funding arrangements for practice-based learning, including the role of practice facilitator/education lead
the value of sharing at this point emerging themes from PQAF activity and development but the equal importance of continuing this as more information becomes available , including the development of implementation guidance and preparation/training
the need to evidence outcomes/benefits, eg through a cost/benefit analysis of the PQAF itself and, in particular, enhancement of student/patient experiences
recognition that there is still more work to be done including further refinement and modification of elements within and across the PQAF, especially in relation to the shared standards
the need to strengthen direct involvement of students and service users and the independent and voluntary sectors in the PQAF processes.

Detailed analysis of activity responses

Message wall

Theme/sub theme	Total number of responses/sub theme number
Practice facilitator/education lead role Good to see role valued Needs appropriate and secure funding	19 7 12
Practice education Strengthen this/retain as equal emphasis Fund mentor role/time Good to locate ownership with NHS trusts and not HEIs Review and unify arrangements for practice assessment Don't dilute this in the PQAF modifications post evaluation	34 15 9 7 2 1
Enhance student/service user input within the PQAF Increase involvement and provide guidance as to how to achieve this Ensure discussion between service users (eg mental health) and students about needs is compulsory in the curriculum Consider the specific needs of different categories of students(full/part-time etc)	10 8 1 1
Modification of shared standards within PQAF Reduction in number Increase no/emphasis on standards pertaining to practice learning Publish mapping of these standards to others Convert to precepts and guidance to aid flexibility Only those standards which have joint responsibility are needed	10 3 3 2 1 1
Evidence effect/outcomes of the PQAF Undertake a cost benefit analysis Enhancement of practice Enhancement of the student's experience Enhancement of the patients experience Enhancement of students competence	23 8 6 5 2 2
OQME Retain principles of self evaluation/exception reporting and action planning Single audit tool of practice learning appropriate Strengthen/make more overt the links to clinical governance Urgent implementation needed/sustain Major Review outcomes Sampling of practice areas not good enough Sampling of practice areas OK Develop information technology self evaluation/collation tool Publish tool kits to aid implementation Vehicle to allow integration of action planning/good practice Good-retain practice focus This will work - need lead in time for preparation Lock into HEI's internal quality assurance systems	26 7 4 3 2 2 1 1 1 2 1 1 1
Major Review Is this needed in the future if OQME is introduced /no longer cost effective	4
Approval Uncertain if /how this differs from traditional/validation arrangements	3
PQAF (General ) Need to widen to involve other staff groups eg medical education Supportive of PQAF/reduction in duplication Potential tension regarding integrated and shared arrangements/professional specific Agree strengthen enhancement and reduce monitoring Offers learning experience itself Strengthens partnership working Strengthen involvement of independent/voluntary sector Need to secure involvement of senior trust staff/Boards Strengthen direct involvement/preparation of practice staff Build quality assurance in = good theme for the day Good progress being made Complete formal learning arrangements before moving to informal Increase funding to HEIs Increase inter-agency/professional focus Challenge divergence of fitness for purpose and other fitness Agree needs to be ultimately patient focused Need appropriate lead time for implementation	49 2 3 1 5 2 6 3 6 5 5 4 1 1 2 1 1 1
Shared evidence base Requires clarity regarding partner use/purpose	1
Workforce planning issues Shortfall of posts for qualifying physiotherapists Shortfall of posts for qualifying nurses Commission more dentist/dental therapists/GPs/clinical psychologists	5 1 1 3
Communication and training for PQAF Specific preparation needed: for practitioners clinical mangers	8 7 1
More information required about PQAF Nature of impact/effect Prototype outcomes Implications for continuing professional development provision Timing and sequencing Links to SHA contracting Integration of elements in the PQAF	15 2 6 1 1 2 3
Event itself More student/service user representation Poor toilet facilities Good venue Good lunch Poor coffee/queues Label lunch provision More speakers from practice Quality of speakers/presentation materials	19 2 4 3 2 3 1 2 2
Interface with other processes/more information and development Healthcare Commission Skills for care QAA Clinical governance	15 12 1 1 1
Professional and statutory bodies Professional bodies should consider greater engagement Professional bodies should modify their traditional role More information regarding NMC alignment to approval arrangements	8 3 3 2
Other Use of skills laboratories to learn practice skills	2

Video

Theme/sub theme	Rank order	Illustrative quotation
Practice learning More funding for innovative approaches Increase emphasis Support and value mentors/practice facilitators Raise on NHS trust board agendas	1	'my message...more funding looking at ways to teach students and practice their skills' 'need to look at innovative ways to teach students and that's not through traditional mentorship route' 'really pleased that the importance of practice education has been valued and feel that this process will help it' 'develop some templates whereby the issue of practice learning could be raised to board level through clinical governance agendas'
PQAF potential Partnership Quality enhancement	2	'I am hugely excited about OQME it has come at a valuable time' 'I believe OQME is the framework to deliver enhancement opportunities - I hope people…are not going to hold this up in any way because it is hugely important to us' 'The new QA arrangements in the partnership framework are providing an excellent opportunity to work through existing partnerships and strengthen those' 'I have found the PQAF is providing a wonderful opportunity to look at developing new and strengthening current relationships across health' 'The Major Review and OQME development is better and has been much more positive in terms of what we have got to date.' 'what we are doing is giving them an opportunity to tell us what they do well - creating a forum in which service can get together'
Service user and student involvement in the PQAF	3	'finding new and innovative approaches to involving service users and carers in really creative and meaningful ways' 'one of the most important learnings so far - developing appropriate systems to support meaningful involvement of service users and carers - and developing mechanisms for support' 'this isn't very accessible to service users…make sure that the service users voices are heard and also the students because I think their opinions are equally as valuable - coming together…is very valuable to the enhancement part of OQME'
More emphasis on practice required in the event	4	'The significant voice left out…no one from practice came forward and said anything about how they felt'
Number of standards within PQAF	4	'need to review number'
Need to consider time and costs	5	'Major Review as a Trust employee took up an enormous amount of time in preparing clinical areas…practice visits - and some of the evidence that QAA reviewers needed' 'they pointed out - the level of hard work that all of them were putting in to make sure the documents were effective'

Postcards

Message theme	Ranking/number of responses
Important to give equal emphasis to practice learning/experiences Need to give financial support/staff time recognition in implementation and supporting practice learning	1/7 1/7
Strategy for preparation and training of staff to support implementation required	3/6
Good progress achieved/important not to lose momentum Continue to recognise the value of support in practice learning (mentors/practice facilitator roles) PQAF does strengthen partnership working Reduce the number of standards in the PQAF	4/5 4/5 4/5 4/5
Present the PQAF as a whole to show integration not as separate elements Involve more practice staff in the PQAF development/targeted preparation More direct involvement of students and service users required More information as to the effect of PQAF - reduction of duplication?	8/4 8/4 8/4 8/4
Increase importance of clinical facilitators recognised but need to secure funding for these roles Concern about cost/resources to support initial introduction of PQAF Concern about involvement/commitment of statutory bodies in the streamlined arrangements	12/3 12/3 12/3
Agree needs less inspection more emphasis on enhancement Need to consider leadership capacity/abilities to support use of PQAF Concerned as to how to involve NHS Trust Boards in the process	15/2 15/2 15/2
Single responses Recode standards to show level of responsibility within the organisation Increase the number of standards coded as joint responsibility/retain these only More consideration of application to small care/practice learning providers Leave quality assurance arrangements to HEIs More details as to how this would work in practice areas who provide learning for multiple HEIs Increase scope of PQAF eg NVQ provision Increase links of the PQAF to Healthcare Commission arrangements More information needed regarding application to informal learning Issues outwith the PQAF eg payment to GPs for practice learning provision Still confused about the PQAF Good to learn/be inspired by others progress Can it really all be brought together in the PQAF - a real challenge Concern about range/type of evidence needs of different bodies

Message theme

Ranking/number of responses

Important to give equal emphasis to practice learning/experiences

Need to give financial support/staff time recognition in implementation and supporting practice learning

1/7

Strategy for preparation and training of staff to support implementation required

3/6

Good progress achieved/important not to lose momentum

Continue to recognise the value of support in practice learning (mentors/practice facilitator roles)

PQAF does strengthen partnership working

Reduce the number of standards in the PQAF

4/5

Present the PQAF as a whole to show integration not as separate elements

Involve more practice staff in the PQAF development/targeted preparation

More direct involvement of students and service users required

More information as to the effect of PQAF - reduction of duplication?

8/4

Increase importance of clinical facilitators recognised but need to secure funding for these roles

Concern about cost/resources to support initial introduction of PQAF

Concern about involvement/commitment of statutory bodies in the streamlined arrangements

12/3

Agree needs less inspection more emphasis on enhancement

Need to consider leadership capacity/abilities to support use of PQAF

Concerned as to how to involve NHS Trust Boards in the process

15/2

Single responses

Recode standards to show level of responsibility within the organisation

Increase the number of standards coded as joint responsibility/retain these only

More consideration of application to small care/practice learning providers

Leave quality assurance arrangements to HEIs

More details as to how this would work in practice areas who provide learning for multiple HEIs

Increase scope of PQAF eg NVQ provision

Increase links of the PQAF to Healthcare Commission arrangements

More information needed regarding application to informal learning

Issues outwith the PQAF eg payment to GPs for practice learning provision

Still confused about the PQAF

Good to learn/be inspired by others progress

Can it really all be brought together in the PQAF - a real challenge

Concern about range/type of evidence needs of different bodies

Delegate pack/additional information

Delegates were provided with copies of the:

programme for the day
delegate list
presentation slides
frequently asked questions concerning PQAF
summary paper provided by Homerton School of Health Studies
instruction for participating in the delegate 'activities'
latest edition of QA News
workshop details
evaluation form.

Conference evaluation

124 evaluation forms were completed and submitted (20% of delegates attending)

Overall rating of the Conference

Very good	22/17.7%
Good	66/53.2%
Satisfactory	33/26.7%
Poor	3/2.5%

Best aspects of the Conference - themes/ranking

Opportunity to network, interact and share	1
Learning about development personal experiences/prototype evaluation outcomes	1
Specific speakers/presentations	3
Workshops	3
Balance of programme - giving workshop opportunities	5
Venue location	6
Materials/pack	6
Interaction and contribute as a delegate/activities	6
Organisation/keeping to time/helpful staff	9

Worst aspects of the conference - themes/ranking

Conference venue/facilities and catering	1
Quality and diversity of speakers/presentations	2
Balance of conference programme - more workshops	2
Insufficient attention given to practice/service issue/presenters rather than HEI concerns	4
Repetition of messages/speakers	4
Insufficient network time	6
More questions raised than answers given	7
Use of jargon	7

Suggestions for future conference programmes - themes/rank order

Increase number of workshop delegates can attend	1
Restructure programme to allow more workshops/breakout groups	1
Run workshops to allow real debate/detail to be given eg case studies, practical application, personal experiences, details of PQAF elements and scenario debates	1
Communication - provide Post prototype information regarding outcomes and changes across PQAF all delegates with a report email contacts for speakers and delegates copies of all presentations including keynote address	2
Venue/catering Cold food if no seating Good venue/use again Poor venue/too crowded/queues for refreshments Day other than a Friday Poor seating capacity in workshop	3
Greater diversity of speakers More from practice/students/service users	3
Less jargon/provision of abbreviation list	4

Other comments - examples

'Please try to bring all QA processes together'

'Need a common practice tool (learning environment audit and standards) sooner not later'

'Greater investment in continuing professional development provision'

'Don't lose the emphasis on practice learning'

'Thank you for organising this'

The evaluation and feedback received indicated that the aims for the conference had been achieved.

Acknowledgements

The Skills for Health Quality Assurance Team would like to thank the following people for their contribution:

the Quality Assurance Agency for Higher Education who organised the event
PQAF partners and stakeholders for their support and assistance in initial design and planning of the conference
the Chairs, Chris Pearson and Paul Holmes
speakers and workshop presenters: Nic Greenfield, John Ennis, Val Musson, Patricia le Rolland, Linda Merriman, Paul Holmes, Nick Dean, Tania Clarke, Miriam Price, Jan Williams, Susan Campbell, Rachael Hawley, Roger Thompson, Garth Long, Paul Turner, Sue Hooton, Ray Walker, Paul Tubbs, Maureen Wilkins, Maria Ingham, Ian Clarke, Helen Langton, Pam Parker and Christine Coakley
all delegates for their attendance and contribution to the debates
venue staff.

Appendices

Appendix 1: Copy of presenters slides

Appendix 2: Copy of supportive materials