National Occupational Standards in Healthcare Science Professor Sue Hill Chief Scientific Officer De

1
National Occupational Standards in Healthcare
Science Professor Sue HillChief Scientific
OfficerDepartment of Health

2
CONTEXT- NHS PLAN 1999 and NHS Improvement Plan
2004

• Radical reform and modernisation of health and
  social care system
• Based around delivery of improved services and
  access to healthcare for Patients and the Public
• Delivered by an expanded workforce, working in
  new ways
• Recognition that scientists and other members of
  the healthcare team would develop professional
  roles

3
NHS PLAN 1999 Education and Training
Commitments

• More inter-professional education and training
• Joint training in communication skills and NHS
  principles and organisation
• Development of common learning programmes
• Increasing number of training commissions
• Widening access to education and training
• Greater use of National Occupational Standards
• Investing more in CPD and lifelong learning
• Creating a learning environment that supports
  evidence based practice

4
Making the Change a strategy for the
professions in Healthcare Science

• Outlined need for radical reshaping of education
  and training programmes so that they are
• - strongly aligned with service requirements
• - greater emphasis on validated academic
  outcomes and on ensuring competence
• Delivered by National Occupational Standards
  framework in Healthcare Science ( 4 year NOS HCS
  Project 2001-2005) to support
• - securing and building workforce
• - developing and valuing workforce
• Launched February 2001, Lord Philip Hunt,
  Minister of State for Health

5
DOH Welsh PSAG
Assembly
UK Wide Project 1.6 Million SEMTA SSC
Project Management
NOS PROJECT HEALTHCARE SCIENCE STEERING COMMITTEE
Wide Representation from Key Stakeholders
Strategic Direction Policy Decision
MANAGEMENT COMMITTEE
Reporting responsibilities within DH
NOS DEVELOPMENT
ASSESSMENT linked to AWARDS QUALIFICATION
framework
EDUCATION TRAINING framework
IMPLEMENTATION strategy
PROFESSIONAL BODIES PRACTITIONERS AND OTHER KEY
STAKEHOLDERS
PILOT SITES IN TRUSTS THROUGHOUT UK
6
The NOS HCS Framework

• represents best practice statements based on the
  functions delivered within the occupational area
  ( eg clinical biochemistry)
• delivered through work-based and competence-based
  programmes
• used to develop vocational qualifications and
  awards
• support wider entry gates to professional
  education and training and increase diversity in
  the workforce

7
Principles associated with NOS development

• Functions described within the standards based on
  3 essential features
• Whole work roles rather than tasks
• Outcomes (purposes and functions) rather than
  inputs, processes and methods
• Top Down rather than bottom up method
• Standards were developed at the level of elements
  of function

8
Scope of HCS NOS Project
9
STANDARDS DEVELOPMENT PROCESS
WORKING GROUPS OF EXPERTS COVERING ALL LEVELS OF
PRACTICE
- Discipline specific - Common - Generic
Identification of key purpose/functions
Functional breakdown of key purpose/functions
Development of performance criteria
Identification of essential underpinning
knowledge
- broad brush statements - indepth database
- What has to be done - How well - What range
PRODUCTION OF OCCUPATIONAL STANDARDS
Field Testing Revision Piloting
Development of assessment strategy
COMPETENCY FRAMEWORK
10
Generic functions across sector
Function A Develop maintain equipment
devices Function B Perform investigative,
therapeutic rehabilitation procedures Functio
n C Obtain analyse biological other
specimens Function D Report, interpret provide
clinical advice Function E Promote, develop
maintain health and safety Function F Direct
manage services, developments
resources Function G Education, training
development Function H Research and
development Function I Supporting and assisting
patients and individuals
11
Functional NOS Example
12
Generic Standards ( n 200)
Interpretation and clinical advice
Equipment maintenance/QC
Health Safety
Management
Education/Training
RD
13

• Disciplines included
• - Anatomical pathology
• - Blood transfusion
• - Clinical biochemistry Toxicology
• - Clinical cytogenetics
• - Clinical embryology
• - Clinical immunology
• - Cytopathology incuding cervical cytology
• - Electron microscopy
• - External Quality Assurance
• - Haematology
• - Haemostasis and thrombosis
• - Histocompatibility and immunogenetics
• - Histopathology
• - Molecular genetics
• - Microbiology
• Phlebotomy
• Tissue Banking

ENGINEERING PHYSICAL SCIENCES
LIFE SCIENCES GENETICS
PHYSIOLOGICAL SCIENCES
14
CLINICAL BIOCHEMISTRY Deliver clinical
biochemistry services for the prevention,
diagnosis and management of disease
15
Functional NOS Example Clinical Biochemistry
16
Cervical Cytology
Key purpose Contribute to reduction in the
incidence of and mortality from cervical cancer
through the provision of cervical cytology
laboratory services
Verify patient identification details prior to
examination of cervical sample
Judge Cervical Samples to recommend further
action in respect of cervical screening
Maintain records for audit and reporting
Prepare slides for microscopy
Primary screen slides to evaluate sample
Rapid review negative and inadequate slides to
verify primary screening judgement
Check abnormal and equivocal slides for presence
of abnormal cells
Monitor information system to ensure follow up
action is taken
Recommend management of abnormal results of
cervical screening
17
Discipline Specific Standards ( n 600)
18
Complete NOS Framework ( 900 standards)
19
Summary of NOS Development Programme

• Sector involvement
• 600 practitioners involved in development
• 12,000 responses to field testing
• 140 pilot sites
• Outputs
• 64 sets of standards representing elements of
  function
• 600 discipline specific
• 250 generic/common

20
National Occupational Standards NOS
Knowledge and Skills
Performance criteria and range
Framework for design of training and development
Framework for assessment of performance at work
Training Manual
Work Objectives
Syllabus Learning Specification
Workplace Assessment Actual workplace performance
21
Using a NOS FrameworkAssessing Work Performance
22
Assessment requirements

• Robust work based assessment for both initial
  assessment of competence (across career pathway)
  and ongoing maintenance
• Linked to overarching award and qualification
  structure (being developed in conjunction with
  NHSU)
• Key role for professional bodies in achievement
  of national standards

23

• General Guidance
• All performance criteria must be assessed on each
  and every assessment
• The Primary methods of assessment for these NOS
  should be
• Observation
• Supported questioning
• Other methods of assessment may be used to
  supplement the above methods, these include
• 3a. Simulation
• where there is a lack of opportunity for the
  individual to demonstrate competence at work or
  if significant risk is associated with assessed
• 3b. Written questioning
• as a development tool, (to confirm achievement
  of learning objectives), or as a pre-cursor to
  work-based assessment
• 3c. Skills testing
• as a development tool (to confirm achievement of
  learning objectives) or as a pre- cursor to work
  based assessment where there is lack of
  opportunity for the individual to demonstrate
  competence at work

Assessment should focus on qualitative and not
quantitative results. An individual needs to
demonstrate competence across the relevant
parameters of the overview, consistently, over
time. Issues affecting sufficiency are noted in
this guidance. Assessors must be able to make
confident decisions on competence, based on
evidence from a number of sources.
24
(No Transcript)
25
A Career Framework for the NHS
MORE SENIOR STAFF Staff with the ultimate
responsibility for clinical caseload
decision-making and full on-call accountability.
9
CONSULTANT PRACTITIONERS Staff working at a very
high level of clinical expertise and/or have
responsibility for the planning of services.
8
ADVANCED PRACTITIONERS Experienced clinical
professionals who have developed their skills and
theoretical knowledge to a very high standard.
They are empowered to make high-level clinical
decisions and will often have their own caseload.
Non-clinical staff at level 7 will typically be
managing a number of service areas.
7
SENIOR PRACTITIONERS / SPECIALIST
PRACTITIONERS Staff who would have a higher
degree of autonomy and responsibility than
Practitioners in the clinical environment, or
who would be managing one or more service areas
in the non-clinical environment.
6
SKILLS AND COMPETENCIES
9
PRACTITIONERS Most frequently regsitered
practitioners in their first and second
post-registration / professional qualification
jobs.
5
LEARNING AND DEVELOPMENT
ASSISTANT PRACTITIONERS / ASSOCIATE
PRACTITIONERS Probably studying for foundation
degree or BTEC HND. Some of their remit will
involve them in delivering protocol-based
clinical care that had previously been in the
remit of registered professionals, under the
direction and supervision of a state registered
practitioner.
4
SENIOR HEALTHCARE ASSISTANTS / TECHNICIANS Have a
higher level of responsibility than support
worker, probably studying for of have attained
NVQ Level 3, or Assessment of Prior Experiential
Learning (APEL)
3
SUPPORT WORKERS Frequently with the job title of
Healthcare Assistant/technician - probably
studying for of have attained NVQ Level 2.
2
INITIAL ENTRY LEVEL JOBS Jobs such as Domestics
or cadets requiring very little formal
education or previous knowledge, skills or
experience in delivering, or supporting the
delivery of healthcare.
1
26
Healthcare Scientist Career Pathway
Consultant Director 9
Consultant Practitioner 8
Advanced Practitioner 7
Specialist Practitioner 6
Practitioner 5
Associate Practitioner 4
Senior Assistant 3
Assistant 1-2
27
Career Pathway Stage (Discipline)
NOS Framework
28
Career Pathway Stages - NOS
Roles
Development Modules
Role 1 (title) Discipline Specific NOS 1 NOS
3 Related Disciplines NOS 27 Common/Generic NOS
A2 NOS B4
Module 1 ___________________ Module 2
___________________ Module 3 ___________________ M
odule 4 ___________________ Module 5
___________________ Module 6 ___________________

Role 2 (title) Discipline Specific NOS 3 NOS
6 Related Disciplines NOS 45 Common/Generic NOS
A2 NOS D2 NOS E1
29
HEALTHCARE SCIENTISTS CAREER PATHWAY
Level Learning
8/9 Consultant Management/Leadership programmes

Workload and Roles
R e g u l a t i o n
7 Advanced Professional Examinations/Vocational
Awards Higher Degrees
6 Senior or Specialist Postgraduate
Qualifications Professional Examinations/Vocati
onal Awards
Careers
5 Basic Qualified Vocational Degrees/Diplomas/Aw
ards
4 Associate Foundation Degrees /
Certificates NVQ based awards
3 Senior Assistant National Certificates / NVQ
based awards
1 / 2 Assistant Work Orientation NVQ Award /
Access Courses
30
Career / QualificationFramework /
SkillsEscalator Model
Vocational
Academic
Underpinning Competence Framework
31
HCS Competence Assessment
Generic Common NOS
Individual Role/Job
AfC KSF
Profile for Grade /Role
Discipline Specific NOS
32
Using a NOS FrameworkRole/Job Profiling
33
Development Modules
Module 1 ___________________ Module 2
___________________ Module 3 ___________________ M
odule 4 ___________________ Module 5
___________________ Module 6 ___________________ -
- - - - Module 66 __________________ Module 67
__________________
Role 1 (title) Discipline Specific NOS 1 NOS
3 Related Disciplines NOS 27 Common/Generic NOS
A2 NOS B4

• Local Job descriptions (title)
• NOS 1 Specific overview, p.c.
• Level of knowledge
• Locations
• NOS 27 -

Relevant modules selected
34
HCS Competency Framework
Associate Practitioner
Registered Practitioner
Specialist Practitioner
Advanced Practitioner
1 2 3 4
Consultant
35
Using the NOS Framework
Two Key Tools
Career Pathway (9 stages)

• Steps
• Match NOS to Career Pathway Stages (gives
  national framework for CP stages)
• Select NOS at each stage to derive roles (gives
  national framework of roles)
• Select NOS from role for local job description
  (to meet local need)
• Provide training and development based on
  selected NOS (modular development)
• Assess application of learning in real work
  activity (competence based assessment)
• Confirm competence against NOS or refer for
  further development (award structure)

36
Changing primary secondary care landscape
Medical Technology Communications
Technology Public Expectation
Science Governance Working Times
COMMUNITY-BASED, HOME-BASED AND SELF CARE
REGIONAL SUB-REGIONAL CENTRES
Technology links Shared teams

• Improving access and choice
• Improving services and outcomes
• Improving overall experience of patients
• Reducing health inequalities
• Bringing together Health and Social Care

37
Facilitates Flexible Careers and New Ways of
working
Underpinned by qualifications and competence
assessment Locally driven requirements
Consultant Director 9
Consultant Practitioner 8
Advanced Practitioner 7
Specialist Practitioner 6
Practitioner 5
Associate Practitioner 4
Senior Assistant 3
Assistant 1-2
38
Healthcare Scientist Profile 2009?
Assistants Associates
Specialists Consultants
n
1-2 3 4 5 6 7 8 9
Healthcare Scientist Career Pathway
39
Competence Development
Cancer, CHD, Emergency Care (Access), Mental
Health, Long Term Conditions
Children / Older People
HCS
40
Care Pathway
Roles
Functions
41
DIAGNOSTIC TESTSRADIOLOGY (CT, MRI, ULTRASOUND,
OTHER), BIOPSY, BLOOD TESTS, OTHER
Radiologist Head of Medical Physics Service
Radiography General Manager Consultant Imaging
Radiographer Specialist Registrars (Senior)
Associate Specialist (Oncology) Consultant
Clinical Scientist in Radiation Protection
Advanced Practitioner Radiography Radiography
Section Manager Advanced Practitioner
Sonographer Laboratory Clinical Co-ordinator
Biomedical Scientist Undertaking Specimen
Dissection Clinical Technologists Reporting
Nuclear Medicine Scans MRI Research Scientist
Specialist Registrar (New Entry) Endoscopy
Practitioner
Radiographer Extended Role Radiography Team
Leader Specialist Radiographer (diagnostic)
Pharmacy Technicians SHO Trainee Endoscopy
Practitioner
Radiographer Practitioner Biomedical Scientists
Assistant Practitioner in Radiography Medical
Secretary Medical Laboratory Assistant
Supervisor Cytology Screener Higher Level
Endoscopy Technician
Senior Clinical Support Worker Medical
Secretary Senior Lab Assistant Specialist
Reception Medical Laboratory Assistant Cutting
Histology Sections Cervical Cytology Screener
Booking Clerk Department Receptionist Clinical
Support Worker Medical Laboratory Assistant
Phlebotomist
Medical Records Clerk Film Archives Nurse
Cadet Domestic Porter Catering Assistant
Medical Laboratory Assistant
42
Potential applications of NOS HCS Competency
Framework (1)

• Regulatory purposes
• Higher specialist training
• CPD requirements
• Job design and evaluation
• Career and pay progression
• Role expansion
• Rationalisation of education and training
  programmes and integration of core skills

43
Potential applications of NOS HCS Competency
Framework (2)

• Definition of requirements for competent
  performance in Healthcare Science functions for
  all healthcare professionals
• Identification of common approaches to education
  and training provision across the health sector
• Supporting lifelong learning approaches and the
  skills escalator

44
Benefits of NOS HCS Framework

• Common approach for all disciplines with
  boundaries and progression pathways clearly
  identified
• Assurance of quality and fitness for purpose
• Increased capability to meet needs of Clinical
  Governance
• Simplification of staff development, performance
  appraisal job design
• Identification of common approaches to education
  and training delivery
• Flexibility transferability to accommodate
  local needs (multiskilling)

45
New ways of working Creative possibilities
Development opportunities
Clinical Support Worker
Registered Practitioners
Consultant
Healthcare Scientists develop competency based
roles to meet patient and service demands
46
WEB SITE FOR NATIONAL OCCUPATIONAL STANDARDS IN
HCS PROJECT

• WWW.NOSHCS.CO.UK
• Sue.hill_at_dh.gsi.gov.uk