Healthcare science - education and training provision: baseline review

4. Aims 1 and 2: Overview of education and training

To identify the training and education programmes utilised by each HCS specialty across the career framework as outlined in Modernising Scientific Career Framework

To identify the training and education programmes/pathways through which HCS staff progress to attain voluntary or statutory registration

4.1 Placements and Internships

Survey 1 posed several questions covering the following topics:

• Placements and/or internships offered to young people
• Apprenticeships and the education provided utilised
• Qualifications required for recruitment into associate /assistant roles

4.1.1 Placements

Figure 8 provides an overview of the provision of placements across the HCS specialisms. The survey highlighted locally arranged placements arranged on an ad-hoc basis across the various specialisms.

Although many HCS specialisms are willing to offer work experience placements to young people, there is a requirement for improvements to access that would build on the current programme of placement support for university students.

4.1.2 Internships

The survey highlighted there are similar findings in the offer of internships (Figure 9). Although there is a broad spread of opportunities offered to undertake work required for registration purposes, there are no generic dedicated internship programmes offered.

4.2 Qualifications required to enter the HCS profession

Survey 1 posed several questions covering the access routes into the professions:

• Qualifications required to enter the profession
• Apprenticeship programmes

4.2.1 Qualifications

Assistant/Associate staff entering the professions will do so with either a Higher National Certificate (HNC) or Higher National Diploma (HND) qualification, although a range of qualifications are accepted including professional and vocational qualifications.

There is no consistency in relation to the level of qualifications required for Band 2 or Band 3, as roles differ between specialisms and health boards. There is a consensus across all specialisms that Band 4 roles require, as a minimum, an HND level qualification.

Many HCS specialisms, such as Medical illustration; Reconstructive Science; Vascular and Gastrointestinal physiology, do not employ support workers and recruit directly into a Band 5 role following completion of the academic programme for registration.

There are locally developed early career programmes such as those for Clinical Technology and some Boards utilise the level 3 apprenticeship (Laboratory Associated Technical Activities) to support school leavers into the profession.

4.2.2 Apprenticeships

The survey showed a general lack of knowledge and awareness in relation to the availability of apprenticeships within HCS although many of the specialisms noted interest in exploring Graduate Apprenticeships.

Concerns raised were in relation to hosting apprenticeship programmes in particular,

• Equality of employment in relation to pay and scope of practice.
• Infrastructure and resource requirements.

4.3 Registration and Specialist Training

Survey 2 posed questions covering the education programmes undertaken for registration and specialist training

• The minimum qualifications required for registration and the routes through which these are achieved.
• The further education/training that is required to achieve specialist level following registration.

Registration for HCS Specialities is a complex landscape. Biomedical Scientists and Clinical Scientists are statutory registered and regulated by the Health and Care Professions Council.

All other HCS practitioners may be voluntarily registered under accredited registers overseen by the Professions Standards Authority (PSA). The majority of these registers are held by the Academy for Healthcare Science (AHCS) however, some are held by the professional bodies. Registration details are outlined in each of the specialty sections.

4.3.1 Laboratory Sciences

In order to achieve Health and Care Professions Council (HCPC) Registration, Biomedical Scientists must undertake an Institute of Biomedical Science (IBMS) accredited Biomedical Science honours degree programme and complete the Certificate of Competence Registration Portfolio.

These Biomedical Science degrees, are delivered as full time programmes in 5 universities across Scotland:

• Glasgow Caledonian University
• University West of Scotland
• Strathclyde University
• Abertay University
• Robert Gordons university

Each programme offers a placement to complete the Registration portfolio enabling the student to be eligible for HCPC registration on graduation. Placement allocation is dependent on availability and performance of the student.

Students not successful in obtaining a placement during the university programme will undertake the registration portfolio in house to gain HCPC registration, a process taking approximately 12 months. Costs (£137 for the portfolio) and resources are borne by the employing Health Board.

Those who enter the profession with an unaccredited degree are required to have their degree transcript assessed by the IBMS. This cost (£309) is borne by the staff member or by the Health Board and results in a list of academic modules to be completed before the registration portfolio can be undertaken. Students are required to undertake the modules in a university offering an IBMS accredited degree. Top up costs will be borne by the staff member or the department and can range from £600 - £1000 per module. The number of modules required by an individual is dependent on the undergraduate degree and previous education undertaken.

Following HCPC registration there is a consensus that the Biomedical Scientist will complete the IBMS Specialist Diploma relevant for the specialism. This provides specialist knowledge and, although not mandatory, most departments consider the completion of the Specialist Diploma as the benchmark for sole/out of hours working. However, this is not standardised across Scotland and some Health Boards choose to recruit into the specialist level without this Diploma.

Registrants within Blood Transfusion Manufacturing opt for the British Blood Transfusion Society (BBTS) Specialist Certificate in Transfusion Science Practice, which offers a qualification aligned to a practitioner's scope of practice. The University of Manchester delivers this qualification.

4.3.2 Anatomical Pathology

Many technologists will enter the profession with national 5/higher/advanced higher qualifications and undertake the Royal Society for Public Health (RSPH) Level 3 and Level 4 Diploma in Healthcare Science (Anatomical Pathology Technology).

The University of North Tees provides both of these qualifications, and they are delivered through blended learning with observational and written exams.

Completion of the Level 4 Diploma allows entry into a Foundation Degree and a BSc Healthcare Science (Anatomical Pathology Technology) within England.

4.3.3 Decontamination Science

The majority of decontamination staff within Scotland are employed at Band 3 and require completing the Institute of Decontamination Science (IDSc) Technical Certificate.

This qualification, normally funded by the Health Board, is formally accredited by Scottish Qualification Authority (SQA) at Level 6 (Higher) on the Scottish Qualification Framework and is supported by modules delivered by e-learning via NHS Education for Scotland (NES). On completion, this allows the individual to register as a Decontamination Scientist on the accredited register held with the AHCS.

4.3.4 Clinical Technology

Clinical Technologists are a large staff group employed within various specialisms in Medical Physics: Clinical Engineering; Clinical Measurement; Diagnostic Radiology and Magnetic Resonance Physics; Imaging; Medical Equipment Management; Non Ionising Radiation; Nuclear Physics; Radiotherapy; Rehabilitation Engineering and Renal dialysis.

Clinical Technologists are able to achieve registration with the voluntary accredited Register of Clinical Technologists (RCT) by successfully completing the Clinical Technologist training scheme operated by the Institute of Physics and Engineering in Medicine (IPEM) or by undertaking an equivalence programme.

There are 2 programmes, which provide routes through which staff can attain registration: the 4 year SQA accredited Modern Apprenticeship programme delivered between NHS Greater Glasgow & Clyde and Glasgow and Clyde College and an in house band 5 clinical engineering training programme, which is fully funded by the Board and with staff employed in substantive posts. On attainment of accredited voluntary registration with the RCT, specialist level training through a variety of routes including in-house training and manufacturer training courses will be undertaken.

4.3.5 Medical Illustration

Medical Illustrators/clinical photographers may register with the accredited voluntary register held by the AHCS. To be eligible to register, practitioners require a minimum of a BSc. (hons) Clinical Photography followed by a Postgraduate Certificate (PgC) Clinical Photography.

2 universities: Staffordshire University and Cardiff University, deliver the PgC in Clinical Photography by distance learning and is only available to those who are working within a clinical photography/medical illustration department within the UK. The Cardiff university programme is due to close for any further student intake in 2022.

Following registration, there is no supported career framework and most undertake local training specific to their department delivered by the clinical photography management team to gain specialism within their field.

4.3.6 Reconstructive Science

Maxillofacial Prosthetics/Reconstructive Science is a graduate entry profession with entrants employed as Trainee Clinical Scientists after which they follow an equivalence pathway leading to HCPC registration. Due to their scope of practice, Reconstructive Scientists are also required to hold registration with the General Dental Council (GDC).

Kings College London deliver the supporting academic programmes, MSc. Maxillofacial Prosthetic Rehabilitation or MSc. Maxillofacial and Craniofacial Technology.

4.3.7 Audiology; Cardiac; Neurophysiology; Respiratory and Sleep Physiology

Physiologists within these 5 specialisms may be registered with the accredited register held by the AHCS and require, as a minimum, a BSc. (hons) Clinical Physiology.

Glasgow Caledonian University (GCU) delivers the undergraduate programme on a biennial basis for these specialisms. The 4 year programme at GCU requires trainees to be in a substantive training post and funded by their board, typically at Annex 21 Band 5 (Annex 21 Band 6 for Neurophysiology), with fees for year 1 of the programme funded by NES, with the Health Board funding years 2-4.

Queen Margaret University (QMU) offers a MSc. Audiology programme, which provides a route for graduates who hold a relevant physiology degree to specialise in Audiology. On completion of the 2.5-year full time programme students are eligible to register with the accredited register held by the AHCS. The course relies on sufficient numbers and placement availability and does not provide part time opportunities for those in service.

Equivalence Practitioner Training routes are utilised primarily in Cardiac, Respiratory and Sleep Physiology and has often been the approach taken by some Health Boards in those years between university (GCU) intakes. Health Boards utilising this approach will recruit trainees with a relevant undergraduate degree and will follow an in-house training programme to achieve registration.

Each of the specialty areas offer post registration training to achieve specialist practitioner level, this may be attained through a mixture of in house training programmes and professional body led courses, funded by a variety of routes.

4.3.8 Gastrointestinal Physiology and Vascular Science

Both Gastrointestinal and Vascular Physiology have a small workforce and as such, their workforce is predominantly comprised of Clinical Scientists who are registered with HCPC.

4.3.9 Ophthalmic and Vision Science

Ophthalmic and Vision Science is an extremely small specialism within Physiological Sciences. Currently there are no approved practitioner training programmes available and practitioners follow an equivalence programme to attain accredited voluntary registration with the AHCS.

The professional body, the Association of Health Profession in Ophthalmology, deliver programmes similar to the second year of the BSc. Neurosensory sciences/Ophthalmic and Vision Science curricula. A portfolio of evidence based on the standards of proficiency is gathered and assessed. On completion, the AHCS will award the certificate of equivalence providing eligibility to apply for accredited voluntary registration with the AHCS.

Clinical Scientist routes are provided via the Scientist Training programme (STP). The academic component, MSc. Healthcare Science (neurosensory sciences), is delivered by Manchester University.

4.3.10 Clinical Perfusion

Clinical Perfusionists are required to register with the Society of Clinical Perfusion Scientists of Great Britain and Ireland. This is a professional accredited register and although not a statutory register, there is an agreement throughout the UK that all Clinical Perfusionists employed within the NHS setting hold registration.

Trainee Clinical Perfusionists follow an in-house training programme alongside a 2 year academic programme, MSc. in Perfusion Science, that is delivered at the University of Bristol by block release. At graduation, trainees are expected to pass an observation and viva before being awarded the Certificate of Accreditation in Basic Clinical Perfusion Sciences which enables registration.

Following registration, there is a requirement to maintain competence and specialism through a Continual Professional Development (CPD) process, which includes an annual presentation of a prerequisite number of perfusions and a 3 year assessment of underpinning knowledge.

4.4 Clinical Scientist/Consultant Scientist

Survey 3 posed questions covering the following topics:

• The support for both the Clinical Scientist and Doctoral level Scientist training programmes
• The academic programmes utilised
• Challenges experienced in utilising these programmes

4.4.1 Clinical Scientist Training

There are 2 routes to Clinical Scientist registration:

• Scientist Training Programme (STP)
• STP equivalence

NES supports both of these routes and provides each trainee with a National Training Number. NES monitors progress through an Annual Review of Competence Progression (ARCP).

NES commissions the STP trainee Clinical Scientist posts with the recruitment process managed by specialism specific consortiums or heads of service. These posts are advertised on an annual basis based on workforce requirements for the specific service (Expressions of Interest Process)

STP Trainees are appointed into a host board to fulfil a 3 year supernumerary post and are expected to attend an MSc. programme by block release (if 1 has not already been attained). This is delivered at 1 of a number of universities offering the discipline specific MSc. A portfolio of evidence and viva voce are undertaken prior to registration with the HCPC. NES monitor progress through the programme. On completion, The National School for Healthcare Science (NSHCS) will issue a Certificate of Completion that enables statutory registration with the HCPC.

STP equivalence trainees are appointed into a service within a Health Board, usually into substantive posts, and are expected to undertake an equivalence programme. This requires the trainee to prepare a portfolio of evidence based on the AHCS Good Scientific Practise (7). The trainee is required to pass a viva voce prior to the attainment of the AHCS Certificate of Attainment. This route can take more time than the conventional STP route.

Survey returns received across the various specialisms noted that, although well-structured and managed by NES, there are difficulties in delivering these programmes:

• Challenges providing appropriate clinical rotations due to departmental resources
• Challenges in providing the trainee with sufficient time to complete the programme
• Demand for Clinical Scientists within the services greatly outweighs the available places each year.
• Retention of staff into Clinical Scientist posts following the completion of training. Many specialisms note that if posts are not available upon completion of the STP programme, newly registered Clinical Scientists will take up posts in other Health Boards in Scotland or elsewhere in the UK.

There are many HCS specialisms currently undertaking workforce profiling with a view to implement Clinical Scientist roles within their specialty.

4.4.2 Consultant Scientist – Doctoral level training

From a national perspective, the Higher Specialist Scientific Training (HSST) Programme is not as developed across Scotland as the Clinical Scientist training programmes.

Within Laboratory Medicine; Haematology and Microbiology have both reported through the survey that there is a known national shortage of qualified medical staff within these specialisms. All laboratory medicine specialisms recognise that investing in scientific training at consultant/doctoral level could alleviate the service pressure of the medical staff shortage and enable resilience in workforce planning.

For those scientists wishing to progress to Consultant level roles within Laboratory Medicine the only route available is to undertake the Royal College of Pathology (RCPath) Part 1 and Part 2 exams within their specialism. Many undertaking this training will do so in conjunction with their medical trainees however, this is not standardised across Scotland. There is no consistency of funding and resource available for those in training at this level. Many rely on Health Board resource and funding or will self-direct and fund.

In 2020, national non-recurring funding was secured for a cohort of 20 scientists to undertake the HSST equivalence programme. This programme required the candidate to submit an extended curriculum vitae that provided a detailed overview of their learning and experience to date, outlined the gaps within their training and a proposal of a detailed training plan to ensure that they would be able to meet the HSST learning outcomes. Those who have benefited from this funding have been able to access a number of academic courses in order to supplement their learning including Doctor of Clinical Science (DClinSci) programmes from University of Manchester; Edward Jenner programme and Rosalind Franklin programme.

All specialisms have noted that progression to Consultant Scientist is challenging:

• There is no formal route for all specialisms to follow.
• No funding is available to support local or professional routes such as those programmes delivered by RCPath.

Survey feedback suggests that there has been no scoping performed within physiological sciences to support the progression to consultant level roles although there is an appetite for this work to be carried out.