Healthcare Science - Life Sciences

Transcription

1 Healthcare Science - Life Sciences Education, training and developing the healthcare science workforce that supports change in the 21 st century NHS March

2 Life sciences: Did you know.. Around 95% of clinical pathways rely on patients having access to efficient, timely and cost effective pathology services Pathology is involved in 70% of all diagnoses made in the NHS >50% of biochemical tests are related to chronic disease management 50 million electronic results reports sent by laboratory s to GPs annually 500 million biochemistry tests, 130 million hematology tests carried out per year 300,000 patients have a pathology tests each working day Nearly 800,000,000 test performed annually ( 14 for each person in England and Wales) Facts from the Institute of Biomedical Sciences (IBMS) (1) Over 60% of the healthcare science workforce resides within the life sciences sector and play a crucial role in helping to improve understanding of illnesses and their treatment. The majority of the staff within this group work at agenda for change band 6 or below (2). Over the last few years the majority of this workforce has undergone significant change and continues to do so. Many of the services within life sciences are now undergoing or have under gone service consolidation, 7 day and 24/7 working (3).Technical advancement has run aside all these changes with automation and information technology changing many processes (4). All of which have had a significant impact on staff and their training requirements. Implementation of changes offers improvement to patient care with additional costs and requires cost efficiencies in other areas. This brings with it threats from the private sector, who can often provide core services at a cheaper rate than the NHS, which is required to provide core and specialised services for our patients. How then do we plan for our NHS workforce education, training and development within life sciences for the next 15 years with an ever changing political landscape, an aging population, new treatments, new science developments / technologies and limited resources? Life sciences are a unique sector in that it has already under gone many aspects of scrutiny for quality assurance. The majority of the laboratory facilities hold a minimum of Clinical Pathology Accreditation (CPA) (5) and are now working towards ISO accreditation. Thus ensuring quality and competency of staff especially associated with record keeping. However, it does not mean that life sciences is ahead of the curve but more that we should be better prepared to deal with changes that come our way. Currently the specialisms encompassed within life sciences include: Haematology, biochemistry, immunology, cellular pathology, microbiology, toxicology, reproductive medicine, genetics, anatomical pathology, phlebotomy, blood transfusion, cytopathology, histocompatibility and immunogenetics, molecular pathology of acquired disease and tissue banking. All specialisms within life sciences employ staff at bands 2-4, 5, 6, 7, 8 and Consultant level. All staff grades fall within the Modernising Scientific Careers framework (6), which is fully supported by the Department of Health. Staff can be accommodated through this academic career structure should managers chose to follow this route for their staff groups. 2

3 Assistants & Associates (Bands 2 4): Following the Cavendish Review (7), Health Education England (HEE), Skills for Care and Skills for Health have developed the Care Certificate (8), a minimum level qualification. All staff within life sciences employed at bands 2 4 who have personal contact with patients, will from April 1 st 2015 be required to hold such a Care Certificate. Beyond this qualification all staff at bands 2-4 will have the opportunity to be trained with vocational qualifications NVQ/QCF at level 2 & 3 which carry academic APEL, i.e. Healthcare Support, Clinical Healthcare Support, Pathology Support, Laboratory Science and Anatomical Pathology Technology other professional qualifications, which do not necessarily carry APEL carriage, are available for specific specialisms such as cytology and pathology, e.g. IBMS Certificate of Achievement Parts I & II. To sustain vocational qualifications within department s specialism assessors and IQAs are required. This is becoming increasingly difficult to sustain within the current workforce situation and is classed as a future risk on training this sector of the workforce with this qualification. Simultaneously managers do not consider apprenticeships as a practical option due to the difficulty of assessment. Recruitment to Bands 2-4 is currently not a problem in most specialisms within our region, though there are small pockets of recruitment problems such as band 4 staff in cellular pathology. There is an excess pool of biomedical science graduates and other science graduates who use these posts as a step onto the NHS career ladder and to gain laboratory experience. This creates a rapid staff turnover at this staff grade. It does avoid the need for vocational training but adds strain on repeated departmental competency training. Bands 2-4 staff working in life sciences now have access to a Foundation degree in Healthcare Science offered by the University of Sunderland. This is a part time degree programme with a funding package available through continual professional development (CPD) funding from Health Education North East (HENE). The foundation degree following completion allows the staff member to further career progression onto the BSc Healthcare Science degree programme with entry onto the 3 rd year should the employer deem this to be appropriate. The Foundation degree on offer at the University of Sunderland is delivered in modular form which allows staff to access individual modules should they need to gain under pinning knowledge in a specific area of their field to complement their practical work. This is specifically important to staff who may be working out in the community or involved in cross discipline training and emphasises the need of continual learning for bands 2-4 staff. Future developments at the Discovery School, Newcastle upon Tyne or the University Technical College at the University of Sunderland will require careful consideration of the impact on our band 2-4 workforce and the needs / pressures that this may exert on our employers and ambassadors, who will be required to engage in this adventure. 3

4 Recommendations: 1. To ensure the bands 2-4 workforce continue to access vocational qualifications. As a regional approach which includes the development of an apprenticeship programme for Healthcare Science- life sciences. We need to involve external agents who can provide the assessment package and QA of the programmes. This may include the employment of specialism assessors who will act as assessors throughout the region. 2. Ensure CPD funding budget from HENE involves monies for Bands 2-4 staff from HCS to access foundation degrees and CPD modules 3. Engage at all stages with the University Technical College provided by the University of Sunderland in the development of programme delivery for Healthcare Science. 4

5 Practitioners (Bands 5-6): Life sciences are well supported within the region via the BSc Healthcare Science degree programme (practitioner training programme (PTP)) offered by the University of Sunderland. However, the engagement of employers to offer placements and the interest of students to take up placements has, been low. This is partially due to the very popular Biomedical Science degree programmes offered by the regions three universities along with the complex integrated placement component of the Healthcare Science degree programme. After recent employer / university discussions, as of September 2015, the integrated placement of the Healthcare Science degree programme will be changing making the programme more favourable for both employers and students. Students will now be able to graduate within 3 years instead of 3.5 years, saving them monies on accommodation, increasing employment prospects or undertaking further post graduate studies by an academic year. Employers will have the students on placement throughout the academic year rather than in blocks and will now have the opportunity to support their own staff through the degree programme similar to a part time degree programme. To ensure all streams of the programme are successful i.e. blood sciences, cellular sciences, infection sciences and genetics; employers need to offer placements and engage with the university to ensure that the right students are selected. Students on the PTP programme, full time, gain financial assistance in the form of excess travel reimbursement from HENE. Due to an historical arrangement between the regional foundation trusts and the local education training board (LETB), following the dissolution of the Strategic Health Authority (SHA) in 2012, non-medical tariff payment for PTP is not eligible for payment to trusts until To support future employees on the PTP programme careful consideration should be given on how we can fund the tuition element of the course along with the time out of service. Based on future workforce planning and potential risk. Could HENE assist in elements of back fill perhaps? Practitioners upon graduation and registration can be appointed within the NHS to a band 5 pay band. Following subsequent, additional specialist training and usually via application, they can work at a band 6 grade. Practitioners once qualified and registered, whether that is with the Health and Care Professions Council (HCPC) or Voluntary Registration Council (VRC) with the Academy of Healthcare Science (9), will still be required to complete CPD. CPD which will be beneficial to the individual and also to the department could be mentorship courses, practitioners in transfusion course (PITs), specialist portfolios, accredited specialist scientific practice (ASSP) programmes (e.g. offered by the Association of Clinical Embryologists), leadership, training or quality courses. Some trusts offer preceptorship programmes for all newly statutory registered (Health and Care Professional Council (HCPC)) healthcare scientists. A question to be raised here is why not all newly registered Healthcare Scientists; voluntary and statutory? CPD funding is therefore essential to support this workforce. This workforce will be required to provide patient care and service provision 24/7 at high levels of efficiency and competency to meet the demands of our service users, which is aligned with the NHS 5 year forward view. However, it is essential that managers take into account their training capacity when this 5

6 service provision is accounted for to ensure that our workforce remains fit for purpose. Recommendations: 1. Wherever possible ensure that Healthcare Science (HCS) practitioners have access to appropriately funded mentorship programmes, to avoid competitive CPD funding bids within Trusts 2. Commissioned HCS courses, e.g. Practitioners in Transfusion (PITs), are available to all within the region using good communication networks 3. CPD funding is recognised by all Trusts for HCS 4. HENE to consider assisting employers supporting employees on the life sciences Healthcare Science degree programme to suit future workforce needs / demands. 6

7 Clinical Scientists (Band 6-8a): Within life sciences many believe that the need for the Healthcare Scientist is limited, there are few roles available for them and that they are solely replacing the Clinical Scientists we previously trained. In fact there is a huge opportunity to alter our HCS workforce and align it to the new world of the HCS workforce in the 21 st century (10), giving the HCS workforce a voice and demonstrating that we have skills that we can share with all the healthcare sector, which can improve patient care and outcomes. Sadly to commence these changes we need some investment of time from our employers to support these new training programmes and for managers to think laterally of future needs, not just present needs and also for the medical and technical workforces to work together for better outcomes for patient care. Health Education England support national recruitment of the scientist training programme (STP), absorbing all supernumerary costs and Health Education North East provides further support to the trainees, contributing financially to academic travel and accommodation costs. For each trainee this is in excess of 100K. Local employers do have the opportunity to have in-service trainees, where 75% of the fees are paid by HEE, 12.5% by HENE and the employer is required to pay 12.5%. This will allow the employer to backfill a post at band 5 for the STP training duration of 3 years. Within the North East we have workforce shortages within Immunology, which is forecast to get worse due to impending retirement, medical recruitment difficulties and overall work volume increasing. Currently, we are training one scientist within this area but we do need more. This is a problem in its own right as the major immunology department within the region has reportedly, training capacity issues with both consultant and technical staff. Service provision work volume has increased but staffing remains the same. The current STP trainee has a shared training programme between two Trusts, to share the training burden between consultant staff but this is not easing the training burden on senior technical staffs, which are equally committed to training and technical duties. Many of the STPs, which are full time programmes, are small in size with low cohort numbers, which will necessitate trainees spending time away at university to complete the academic element of their master s course. The placement aspect; competency and practical training will be a devised training programme which may involve several training centres which can give a rounded training experience throughout the region. This obviously requires coordination and planning and can be more onerous on some facilities compared to others, e.g. genetics are required to host all life science trainees in their first year for 12 weeks. Life Sciences do not only have to accommodate life sciences STP but also Physiological Sciences STP, albeit for a short period for the Clinical Assessment module. It still requires planning and coordination. For this reason, HENE have insisted that within each business case submitted for an application for an STP all additional placements must be agreed and signed by host departments whether that be within your own Trust or external organisation. This will also assist in any future Human Resources contractual arrangements for the trainee, visiting host Trusts. The regions STP training capacity can be further strained by external organisations that also have access to the STP and require to access training facilities within our Trusts 7

8 laboratories. Training Managers are torn when late requests enter the frame, as they do not want to jeopardise relationships with these organisations. It is up to each individual Trust to assess whether they have the training capacity to accommodate the external STP trainee but it must not put at risk, the STP trainee who is supported and funded by HEE / HENE. Wherever possible HENE will engage at a national level to ensure that timely negotiations can begin with Trusts and external organisations to assist with forward planning. Concern within smaller specialties, e.g. Reproductive medicine, in future years, is the unsustainability of continual training of STP trainees who after qualifying are subsequently poached into the private sector on higher salaries. Discussion needs to take place on how this can be addressed and future proofed. Can training be shared between other centres, rather than one sole provider? Could trainees have a bond agreement to stay within region for a number of years? Recommendations: 1. HENE to support with backfill arrangements in those areas of training where senior levels of technical training is essential e.g. genetics and immunology. 2. Conceptual proposal; Introduce Regional Blood Science Consortia supported by HENE where a training coordinator will be appointed at band 7. If the blood science consortia works and there is a future demand for any of the other life sciences streams the model will role out to other streams with equivalent support. (Appendix 1) 3. HENE to continue to work at national level with external organisations to ensure timely notification given of STP trainees in region and communicated to employers 4. Explore and discuss future possibilities to protect our posts following training, e.g. local bond agreements in high risk posts. Once qualified and registered as Clinical Scientists the education of our scientists does not stop and this workforce will be required to have access to funding to complete CPD, which will be aligned to the individual and be of benefit to service delivery. This could be linked to the accredited expert scientific practice (AESP) programmes that the Academy of Healthcare Science are currently rolling out with academic institutes or the IBMS Diploma of Expert Practice in Histological Dissection or the Certificate in Advanced Practice in Cervical Cytology. 8

9 Consultant Clinical Scientists (Bands 7 8d): This level of the workforce has only recently been introduced in late 2014 with more posts becoming available as the academic programmes have been released in Some specialties are already grasping the importance of this workforce in areas of recruitment shortfalls both in Clinical Scientists and in Medical Consultants where the qualified and in time experienced Higher Specialist Scientist Trainee (HSST) will be capable of bridging the gap of a Clinical Scientist and certain aspects of the Medical Consultant within the Life Sciences arena. It is therefore essential that within life sciences we work hand in hand with our medical colleagues to ensure that we produce a senior HSST workforce fit for purpose. It is anticipated that the majority of our HSST workforce will come from our existing workforce pool that will complete a part time 5 year taught doctorate whilst working within their role. Depending on their previous experience / qualifications APEL carriage may be sought via the Academy of Healthcare Science following the equivalence route which may reduce their period of study (11). In areas of staffing short falls, lacking existing Clinical Scientists but with experienced Biomedical Scientists holding advanced practitioner status, e.g. in Cellular Pathology. Test case equivalence financial support may be sought in the future. The training programme is part funded for academic course fees and 1 day/week back fill equating to 16K / year. Nationally recruited HSST can be sought via the National School of Healthcare Science commissioning route. Two HSST posts in biochemistry one in-service and one via national recruitment, have been secured in 2015 in our region. Employers again must be acutely aware of their training capacity for these trainees, curricula requirements and the onus on our medical and senior clinical scientist colleagues who will be expected to carry the burden of training at no additional recompense, similar to the training of their medical trainees. External organisations will have access to the HSST programmes, requiring access to training facilities, which must be negotiated within Trust organisations without risking the HSST s funded by HENE. Cellular Pathology in conjunction with the Royal College of Pathologists and the IBMS are delivering a training programme to training Advanced Practitioners on cutting and reporting to support Pathologists who currently are difficult to recruit. This programme was chosen in the absence of the approved HSST programme as an interim measure and is being supported by HENE. Recommendations: 1. Employers and HENE to work in conjunction with the Medical & Dental Subgroup to ensure appropriate workforce planning is carried out within all specialties 2. Promote the role of HSST to service managers more widely within Trusts, providing alterative service model options away from rare medical positions, raising the scientist workforce profile away from that of the familiar nursing workforce. 3. Cellular Pathology to review current training programme at cohort end and provide detailed report on outcomes and future training plans / options for regional cellular pathology to include HSST programme 4. Submission of business case by Cellular Pathology to fund three Test case equivalence portfolios for three Advanced Practitioner Biomedical Scientists to gain Clinical Scientist status on application of three HSST roles. 9

10 Specialist Areas: 1. Point of Care Testing Point of care testing (POCT) is a unique area within life sciences and has been under development for several years bringing new and better care to patients in the community, at home, in acute care and when attending clinics. Recent strategy documents such as the Pathology Quality Review (12) and the NHS Five Year Forward View (13) indicate that POCT is undoubtedly the way forward for NHS care provision. This means that there will be a greater requirement for POCT implementation, training and support in both primary and secondary care. Learning how to use a POCT device may be taught in a classroom, but education and training about the governance of POCT, safe integration into a care pathway, quality assurance, and the limitations and other issues related to the use of the POCT equipment can only be delivered and monitored by people with a responsibility for and experience of delivering and supporting a POCT service. There are many aspects to POCT that require expertise, and within the northeast region we are fortunate to have a group of POCT experts who are award-winning innovators in this field, and from whom we can call on knowledge, skills, and experience to guide us in POCT. The North East Pathology Point Of Care Action Learning Set (NEPOCT) are a group of Scientists with interest, experience, and accountability for POCT in hospitals, academia, and increasingly community and primary care services. NEPOCT discuss issues such as the best way to deliver large scale training for POCT within organisations, and learn from the experiences of each other. The members of NEPOCT are primarily the people who organise, support and deliver POCT education and training to all grades and roles of clinical and technical staff across the region, including all staff identified in the Life Sciences Strategy document. Recommendations: 1. HENE to commission NEPOCT to produce a 'future strategy' report on the education, training and development on POCT within our region over the next 15 years, to be presented to the Healthcare Science Subgroup in November HENE to provide a small budget to NEPOCT to cover facilitation costs, and project work in order to allow NEPOCT to work as an expert group on any related POCT HCS strategy projects. 3. HENE to request from relevant north-east NHS organisations that NEPOCT members are made available to the HCS Subgroup to provide expert advice and opinion on any issues and materials related to POCT. Similarly should NEPOCT feel that the HCS Subgroup require alerting to pertinent information on POCT, a representative of NEPOCT will present information at the earliest opportunity. 2. Anatomical Pathology Technicians The APT workforce is a small workforce, predominately in the lower bands whose work is reliant on the number of post mortems carried out each year, performed by Consultant Pathologists. The number of post mortems is reducing, as is the numbers of Consultant Pathologists available to perform this task (14). Technology is also changing with virtual imaging becoming more accessible especially in the private sector, which is more appealing for many, including certain ethnic groups. Should our APT workforce look towards alternate skills to future proof their security? 10

11 3. Genomics Genomics will be a future area of development for HCS within life sciences. Our regional genetics centre is involved in the K genomes project (15) which will require additional staffing of all bandings; bands 2-4, practitioners, scientists and higher specialist scientists. Scientists are already low in numbers due to the changes in recruitment since 2009 and it is therefore expected that the STP training recruitment will continue within genetics on an annual basis. Our regional centre has recently been nominated as one of 11 national genetics education and development centres within the UK. From 2015 the centre will in earnest support the training and education of genetics, genomics and bioinformatics for future years. This will necessitate the centre increasing its training workforce to maximize its training capacity to support this additional training. Submissions for three additional HSST trainees have already been approved by the NSHCS to commence in 2015 with prospective in-service candidate interviews pending. These HSST posts are: two in genetics and one in molecular pathology of acquired disease. Genomics is a new area of sciences for many, not only within life sciences but within the healthcare sector and it is up to us as HCS to promote a greater understanding of this science / subject and educate our colleagues raising awareness of genomics and the many advantages this area can bring to patient care, the future of medicine and healthcare. Many existing boundaries will be broken when this science is introduced fully onto the healthcare arena. Recommendations: 1. Raise awareness of genomics and its benefits to patients, the future of medicine and healthcare to the wider healthcare sector. 4. Bioinformatics There will be increasing amounts of data to be dealt with from genomic technologies (array CGH, large gene panels, whole exome sequencing and whole genome sequencing). However, it is not clear to what extent commercial packages will be available to allow existing Clinical Scientists to interpret data, potentially avoiding the need to specifically train bioinformaticians in large numbers. Genetics are prepared to train bioinformatic trainee s genomic modules and are currently participating in this training but the Northern Genetics Service does not anticipate taking on a specific STP trainee in the future. 5. Toxicology Staff working in this specialism are not provided for academically under the MSC umbrella. Graduates entering at band 5/6 are expected to have a science degree with subject material covering pharmacy / physiology which can then be followed with a part time masters qualification in medical toxicology at Cardiff University. This will allow them to work at a scientists level within the national poisons unit. Further study will allow the employ to work towards the RCPath in Toxicology. There are four of these units throughout the UK, one being based within Newcastle as a partnership with Newcastle Hospitals, Newcastle University and PHE. This is a highly specialised area of work providing advice 24/7 to both the public and NHS on how to treat patients who have been exposed to poisons substances. As pharmaceuticals 11

12 continue to expand and more substances are produced with easier access via the Internet a greater understanding of drugs etc. is required. The service that these HCS provide is essential and their training requires future and sustained support. Recommendations: 1. HENE to support via CPD funding Toxicology Scientist training whilst no alternative training route is available. 12

13 Conclusion: Life sciences consist of a large body of workers and as the future unfolds with more automation being introduced the majority of this workforce will become centralised into large laboratory facilities, with smaller hot lab facilities, (hubs), being based within the hospitals for specialised and urgent work. Within the large laboratory which will work 24/7, the workforce teams will be made up of a high proportion of bands 2-4 staff who will deal with high volume through flow work, similar to factory production. These will be overseen by a few bands 5 and 6, acting as team managers and troubleshooters ensuring the analysers will stay online 24/7. Band 7 staff will be specialised within areas of training, quality, infection control, specials lab, health & safety etc. providing advice and guidance to managers. All staff should be involved in training of other staff and competency assessment and be given the appropriate protected time required to complete these tasks and ensure that their own CPD is up to date to meet these requirements. The National School of Healthcare Science (NSHCS) accredit all of the Healthcare Science undergraduate, post graduate and doctorate academic programmes, working closely with Higher Education Institutes (HEIs), Local Education Training Boards (LETBs) and employers. To ensure that these integrated programmes remain viable, current and technically valid the NSHCS ask that employers play an active role in curricula reviews, assessor interviews, observed structured final assessments (OSFA) etc. (16). The NSHCS offer full training and support to trainers / employers who participate in any activity offered by the NSCHS and regionally HENE ask that our employers hosting any healthcare science trainees participate in such training events, being duty bound to do so by agreement with their Trust signing the LETB local development agreement (LDA). There will be some specialisms that do not require 24/7 nor 7 day working as the clinical impact to the patient does not warrant this service e.g. genetics. However, all services would be reviewed annually to ensure patient service provision is appropriate to meet clinical needs. HCS should be involved on any strategic patient care pathway initiatives at all grades to ensure that our services and delivery are considered and the HCS team can contribute in an effective and appropriate manner to maximize patient care. Services within the community and the development of digital technology will have a greater impact on life sciences over time but will be dependent on the cost implications, political climate and laboratory budget constraints as to whether these new technologies are to be embraced. Although technologies may be available within the NHS the advancement of change is often constrained by many other factors and the change requires influencing with significant research models, which our many STP/HSST trainees could use as part of their studies and bring innovation into our North East region. The education, training and development strategy for life sciences for the next 15 years will be subject to the many changes that are to take place within the organisations. Once these are established the education and training of the future workforce can be embedded and a way forward can be progressed. Until that time managers will be unable to plan beyond a few years and the status quo of our workforce will remain the same and undeveloped for the 21 st Century. The strategic plan of pathology and life sciences within the region is essential in the first instance by all our organisations to the 13

14 future planning of the education, training and development of our HCS workforce. This strategy was created for and endorsed fully by Health Education North East s Healthcare Science Subgroup March

15 References: 1. Institute of Biomedical Science Congress 2015 Programme & Booking Form Poster. IBMS Workforce Planning & Forecasting for 2015 Investment Consultation - Healthcare Science investment-consultation(accessed ) 3. NHS Improving Quality in collaboration with NHS England. NHS services open seven days a week: every day counts. Improving Quality. November National Pathology Programme Digital First: Clinical Transformation through Pathology Innovation. July Clinical Pathology Accreditation Information for Laboratories mation_for_laboratories.asp (accessed ) Healthcare Science Workforce. NHS, Health Education England. February Equivalence: Academy Healthcare Science (accessed ) 12. Pathology Quality Assurance Review. Dr. Ian Barnes, NHS England. January NHS 5 year forward view. October Coroners statistics 2013 England & Wales. Ministry of Justice Statistics Bulletin. 15. The 100,000 Genomes Project genomes-project/ (accessed ) 16. National School for Healthcare Science Training Officers (accessed ) 6. NHS Employers, Modernising Scientific Careers explaining the facts. mployers/documents/plan/explainingthe Facts_Br0935_6a%20as pdf (accessed ) 7. The Cavendish review: An independent review into Healthcare Assistants and support workers in the NHS and social care settings. July The Care Certificate background. (accessed ) 9. Voluntary Registration: Academy Healthcare Science (accessed ) 10. The Delivery of 21 st Century Services The implications for the evolution of the 15

16 Appendix 1 Laboratory Medicine (NuTH) STP Trainee Strategy Background Regional workforce planning has identified certain areas of risk in the future. One of these areas lies within Laboratory Medicine due to the potential shortage of consultant medical staff providing clinical input and leadership to the laboratory service. Consultant medical staff have historically worked in laboratories while maintaining their clinical work on wards and departments. Some disciplines within Laboratory Medicine have Clinical Scientists who provide an essential role in scientific research and development and clinical result interpretation. In Clinical Biochemistry this is well-established and clinical scientists support a small number of medically qualified consultants. Haematology, Blood Transfusion, Immunology, and Microbiology still predominantly rely on medically qualified staff to lead and direct laboratory services; with the ever increasing demands on their clinical role, posts become more difficult to fill. Cellular Pathology have already identified a shortfall in Consultant Pathologists within the region and have taken steps to alleviate the problem in the immediate term by developing existing Biomedical Scientists. Changes within the NHS, problems of an ageing workforce and loss of experience will also mean we have less medical consultant input to laboratory services. Therefore we must design alternative ways to cover this deficiency by initiating the training of Clinical Scientists (Healthcare Scientists) in all areas of Laboratory Medicine to provide a workforce able to take the service forward. The recently published NHS Five Year Forward View document would also suggest in increasing role for Healthcare Scientists in the future with its emphasis on Primary Care, supported self-care for patients, introduction of new technologies and 7 day services. Modernising Scientific Careers provides us all with a longer term solution, in that staff may be trained via the STP (Scientific Training Programme) and HSST (Higher Specialist Scientist Training) to a Consultant Clinical Scientist level. They will gain knowledge and skills enabling them to take on clinical roles whilst also having the scientific background to lead and develop laboratory projects. Newcastle Hospitals NHS Foundation Trust All departments within Laboratory Medicine recognise the importance of STP training for the future. We have had some experience of providing training for STP Trainees, mainly from Genetics and Reproductive Medicine. Blood Sciences have already taken their first trainee in Immunology and are hoping to have a Haematology and Blood Transfusion trainee from September Microbiology are planning to submit business cases for trainees for September 2016 whilst Cellular Pathology are seriously considering providing STP training in the future. We would hope that HSST training would follow on once STP training was established. Overall, the rotational trainees have impressed the departments associated with their training (Cellular Pathology and Blood Sciences). They have been of high calibre, very enthusiastic and self-motivated. The trainees spend considerable time in the laboratory where the majority of their training occurs. This requires intensive and high quality input from the existing laboratory staff, usually Section Leaders. Medical staff and Clinical Scientists are also involved in the student s exposure to the clinical implications of laboratory testing. Representatives, clinical and managerial, from all departments of Laboratory Medicine met recently to discuss how we could take STP training forward as a Directorate. With the above factors in mind we initially discussed how we could provide the training from a NuTH perspective however it soon became 16

17 more logical to take a regional approach. The reasons for this are given below: a) The work based learning syllabus is so specialised that many Trusts would be unable to provide the full range of laboratory testing required. This would require the Host Trust to negotiate with other Trusts in the region to cover the missing elements or modules of the syllabus. This has been experienced directly; both planned and unplanned when we have been asked to provide training at short notice. All departments will try, where possible, to balance their training commitments with the needs of the service and any additional training requirement causes pressures to staff and service provision. Ideally, the STP training requires planning in advance so that staff are fully aware of both their and the department s commitments, therefore a regional approach to placement allocation would be beneficial. Laboratory Medicine within NuTH provides both routine and a large range of specialised tests that would, with very few omissions, cover the work based learning syllabus. It would therefore follow that NUTH either provides or co-ordinates the STP training to ensure there are no surprises with last minute requests. b) Experience has shown that it is beneficial to take 2 STP trainees through the same syllabus at the same time. This maximises the benefits of the training programme and is manageable for the laboratory and the trainees. The trainees also benefit from the support of their fellow trainee especially through the rotational first year. c) The laboratory based training is given by experienced BMS staff (usually Advanced BMS - Section Leaders) or in departments such as Genetics, by experienced Clinical Scientists, which takes up a considerable time. Once a training plan has been established, our experience shows that it becomes embedded into the department and becomes easier to deliver over time. d) The first year rotations for Blood Sciences require an Immunology and a Genetics placement of approximately weeks in each department. This essentially provides the pinch point for Blood Sciences, as regionally we have one Genetics laboratory (NUTH) and few Immunology laboratories able to provide the necessary repertoire of assays. The Genetics laboratory at NUTH has agreed to commit to a maximum of 4 trainee placements per year for the region. Ideally the training of the 4 STP Trainees would be given concurrently over the same 12 week period each year to reduce the impact on their service and staff. As it is likely that Genetics will have a limited number of their own trainees in the future we must also ensure that we do not place too much of a burden onto them to continually train for others. Immunology services regionally are under pressure with a shortage of suitably trained staff and an increasing workload which acts as a vicious circle as it limits their capacity for training others. These factors limit the yearly regional intake of Blood Science STP trainees to 4. e) One of the first year rotations for Infection Sciences requires a placement with Public Health England. As this has close links with the NuTH Microbiology Department, the organisation of the rotations would be simplified. All of the learning outcomes could also be achieved by the Microbiology Department. f) The Cellular Pathology department within NuTH is also able to cover learning outcomes for the STP syllabus in Cellular Sciences. g) It is important to offer the trainees a security and stability of placement over the 3 year training period. 17

18 Although Laboratory Medicine at NuTH can cover the majority of the learning outcomes for each discipline, where possible, as many of the Trusts in the region should be given the opportunity to participate in the training placements. This would give the trainees the opportunity to work in different environments, with different instrumentation and techniques, and have an insight into what each Trust is like to work in. It would also share the training burden, and give experience of specialisms within different Trusts. Again, this would definitely require co-ordinated planning but the trainee would benefit overall. Going Forward We currently have little information of the intentions of other Trusts in the region to proceed with STP training in the future although a regional approach has been supported by CDDFT and South Tees NHS Trust. Therefore the following requirements are based purely on discussion held within Laboratory Medicine at NuTH and represent the opinions reached by the group. If STP training is ultimately to be provided regionally and across all disciplines of laboratory medicine, a full time coordinator would be required. Requests from other sections of the NHS, i.e. NHSBT would also be accommodated. To adequately provide the best outcomes within each discipline we feel it would be essential to appoint an Advanced BMS (band 7) in each department as backfill. This would relieve some of the pressure on Section Leaders and provide support in their sections whilst specialist training is being delivered to the STP. This BMS would not be expected to deliver the laboratory training, as this is undertaken by our current specialised Section Leaders. However, the post holder would be expected to deliver training in Quality Management, Audit and Risk Assessment. They would be expected to assist with the training directly or support Section Leaders involved in training. A list of possible duties would be; a) Assist with coordinating the training programme. b) When training is given in other sections they would support Section leaders with managerial and supervisory tasks: i. Quality issues ii. Staff supervision iii. Audits iv. Competency reviews v. SOP reviews vi. Validation and verification c) Set up laboratory practical work d) Assess DOPs e) Act as OLAT reviewer. f) Project guidance alongside Clinical Tutor. g) Co-ordinate and supervise R&D as required. The number of STP trainees assigned to this person in each department would need to be restricted to ensure adequate support can be given during training. This would be expected to be no more than 4. From a clinical perspective we do not envisage any major issues with trainee support across the disciplines, however as previously mentioned Immunology regionally is very stretched. A Band 6 BMS post for Immunology at NuTH has been suggested as essential to free the current Section Lead to deliver the specialist Immunology training. As previously mentioned, Immunology training provision is one of the limiting factors of the Blood Sciences programme. 18

19 References: HEE Strategic Framework HENE Workforce Strategy Report (Life Sciences) NHS Five Year Forward View (October 2014) 19