Healthcare science: strategic approach

Introduction

Defining Healthcare Science

Healthcare science is a distinct profession that utilises scientific, engineering and technological skills to improve the quality of care and health outcomes of patients across Scotland.

The healthcare scientists working in our NHS are clinical and scientific experts. In Scotland they are the fourth largest professional group working in the NHS and they lead clinical services in 54 distinct specialisms which fall under four broad streams; Life Sciences, Physiological Science, Physical Sciences and Clinical Engineering, and Bioinformatics and Data Science (figure 1 and figure 2).

These specialisms cover all areas of the patient pathway – from primary prevention through to rehabilitation services – with the workforce having an impact on 75% of the clinical decisions made throughout the patient journey and contributing to over 80% of all diagnostics.

Healthcare science is fundamental to the effective and safe delivery of healthcare and improved outcomes for patients. It is continually evolving and will continue to be critical to the delivery of health services in the future, as Scotland, and the rest of the world, responds to the need to reshape the way in which patient care is delivered.

Healthcare Science in Scotland

In Scotland, approximately 7000 healthcare scientists working within the NHS are professionally led by the Chief Scientific Officer for Scotland, who is responsible for the strategic direction for healthcare science across the country.

At Health Board level in Scotland there are currently a limited number of Executive Scientific Directors for Healthcare Science, particularly within territorial Boards. Therefore, those working in the scientific specialisms generally fall under the overall clinical responsibility of either the Executive Medical Director or in some instances the Executive Nursing Director. This approach differs from other UK nations, who have dedicated Executive Directors, or their equivalents, representing healthcare science at the most senior level of decision making within Health Boards.

It is recognised that without dedicated scientific leadership within Health Boards there is an increased risk that the unique contribution that the scientific workforce can make is not considered to the extent it could be, during the planning and delivery of services.

Scotland, alongside countries worldwide, faces significant challenges in respect of the delivery of healthcare services both now and in the future. The recovery from the COVID-19 pandemic, increased service demand and a shrinking workforce are well known issues, and all sit within the context of an extremely difficult fiscal outlook.

There is an opportunity now, to build on previous work and harness the potential of healthcare science to help address these challenges, supporting the improvement of services across the NHS in Scotland and improving patient outcomes.

Previous Work in Scotland:

The Scottish Government published its first healthcare science action plan in 2007. Safe, Accurate and Effective: An action plan for healthcare science focussed on raising the visibility of healthcare science by highlighting the contribution of the profession to improved patient outcomes.

The 2007 action plan set out recommendations to develop a foundation from which the profession could establish itself and to enable NHS Scotland to better utilise the scientific skills and knowledge of this part of the wider health workforce.

Safe, Accurate and Effective enabled healthcare science to establish itself as a profession in Scotland, and led to the development of healthcare science forums within Health Boards. Engagement at this level resulted in the increased awareness of the profession, with some evidence of collaboration and engagement with service providers and the development of patient care pathways.

As a direct output of Safe, Accurate and Effective, NHS Education for Scotland (NES) established a dedicated team to drive forward the development of leadership opportunities and support the development of healthcare science education. This resulted in activity such as the development of a quality assurance system to monitor postgraduate education and the establishment of ‘Practice Educators', who could be described as the first step towards more visible leaders in healthcare science within Boards.

In 2014, the National Delivery Plan, built on the work of Safe, Accurate and Effective by introducing a series of deliverables and improvement programmes relevant to the three streams of healthcare science recognised at the time.

The National Delivery Plan progressed a series of service improvement programmes focussed on the delivery of patient care to enhance healthcare delivery. Programmes included the development of a physiologist-led 3D echo service; the implementation of Radio Frequency Identification tagging of medical equipment and the introduction of next generation sequencing of lymphoid malignancies in Scotland using a custom designed panel.

The 'Final Report' for the National Delivery Plan outlined a range of actions to be considered in future, including education and workforce; workforce data and research, development and innovation.

A number of these actions have been incorporated into other workstreams within the Scottish Government and NES, and in October 2021, directed by the Chief Scientific Officer for Scotland, an education and workforce review was launched.

Education and Workforce Review

The National Workforce Strategy for Health and Social Care in Scotland was published in March 2022. In this strategy, the Scottish Government committed to undertaking a healthcare science education scoping review.

Subsequently, the Healthcare science - education and training provision: baseline review was published in October 2022. This led to further engagement with stakeholders across Scotland, resulting in calls for a wider-reaching healthcare science strategy for Scotland.

Strategic Connections

The unique characteristics of the healthcare science profession, and the breadth of specialties which sit as part of it, provide an opportunity to make connections across the health landscape and beyond in order to support future development and improvement in service delivery.

There are clear links with work happening in diagnostics and genomics for example, and there is a need to think creatively about enhancements in digital capabilities to align to work underneath Scotland’s digital health and care strategy, our Health and social care data strategy, and our Artificial intelligence strategy.

There is also a need for clearer demonstration of the positive economic impact of healthcare science on service delivery and patient outcomes.