EPBS: Lucerne 2004

National occupational standards in healthcare science

UK Chief Scientific Officer, Sue Hill, spoke at the EPBS Lucerne meeting on developing national occupational standards, a project that could have a great impact on laboratory work in the UK. A question and answer session and discussions on occupational standards followed the lecture.

Click for Sue Hill's presentation on national occupational standards

About Sue Hill
Professor Sue Hill has been the UK Chief Scientific Officer since October 2002 and is responsible for building the capacity of the healthcare science workforce (which includes biomedical scientists), and to developing healthcare scientists and their roles whilst raising their profile and recognition across the Department of Health.

Sue trained as a Clinical Physiologist and gained a PhD in Respiratory Sciences. She has worked in Respiratory Medicine in the major Teaching Trust in Birmingham and in the Department of Medicine at the University of Birmingham for over 20 years and has had a wide range of responsibilities.
In 2001 Sue was elected as a Fellow of the Institute of Biology and she was recently awarded a personal chair in Respiratory Medicine by the University of Birmingham and with Honorary Membership of the Royal College of Physicians.

She chairs the National Occupational Standards for Healthcare Science Project which has a central role for developing healthcare scientists within the NHS, and in education and training modernisation programmes.

About healthcare scientists
Healthcare scientists is an increasingly used and recognised term in UK political, health and medical matters to describe 50,000 scientists carrying out a variety of vital duties that range from disease diagnosis to rehabilitation engineering. The scientists are grouped into physical sciences and clinical engineering, life sciences (including biomedical sciences) and physiological sciences.

The Federation of Healthcare Science was formed in 2002 as an overarching body for the professional organisations representing healthcare scientists. The government recognises healthcare scientists as vital to the delivery of its reforms. The Federation aims to provide a collective voice for science in the health service to the government, other health care professionals and to members of the public.

Further information on the Federation can be found on its website at www.fedhcs.net.

What are national occupational standards?
National occupational standards (NOS) are based on outcomes, or the measurement of outcomes against national predefined standards. NOS are statements of practice that will ultimately provide a basis for the development of assessment of competency, job descriptions and personal specifications. The standards will have a great impact on laboratory work in the UK.

Each NOS describes a work activity with a defined purpose and context, delivered as a series of functional statements against which are set the common measures of competence. Each standard aims to capture the decision-making process, the knowledge required and the judgement applied.

The UK project
Since 1999 with the launch of the NHS Plan, the UK government has embarked on a reform and modernisation of the health and social care system, to be delivered by an expanded, evolving and flexible workforce competent to practice, ‘fit for purpose’, and able to work in changing professional roles.

The NOS project has so far cost 4 million Euros and has been on-going for four years. 600 practitioners have been involved in developing performance criteria and identifying the knowledge and skills required for best practice. The project has now moved through a field-testing phase and has now completed a pilot phase at 140 pilot sites, assessment documents are being collated for reporting.

There are 64 sets of standards covering the whole of healthcare science. Working groups of experts have developed over 600 for discipline-specific standards for the 40 different disciplines within the healthcare science workforce. There are also around 250 standards generic or common to all disciplines.

Professional bodies, including the Institute of Biomedical Science, have already played a key role in shaping the direction and development of the project. They will also play a role in achievement of national standards and defining assessment criteria.

Although the standards will be nationally defined they will flexible enough to allow for varying local roles and requirements of laboratories in delivering a service.

The standards will be linked to a system of awards and qualifications covered by a quality assurance network to ensure a national standard. Although there are many academic and vocational components biomedical scientists will be credited for real work in the laboratory rather than what they have learnt at university, in other words a competence-based assessment.

NOS will help to demonstrate competency for progression through a new nine-stage career pathway for those working in the National Health Service. Biomedical scientists will enter the profession after graduation and registration at practitioner level or stage. Biomedical scientists will be able progress right to the very top of the career pathway if they can demonstrate skills, expertise and competency through NOS and qualifications.

NOS will also link in to Agenda for Change - the UK government's modernising project to introduce common pay and conditions packages for NHS employees and reduce 500+ salary scales to just three: doctors and dentists, professions allied and supplementary to medicine (including biomedical scientists) and all other staff groups.

Current and future uses
In the UK, as in many European other European countries, there is major shift in terms of delivery. Biomedical scientists are forging new and evolving roles and changes in work environment - primary care is one very good example. There are new opportunities for biomedical scientists and NOS has many potential applications - regulation, specialist training, continuing professional development, job evaluation, carer and pay progression and changing roles. NOS can also be flexible enough to cover roles that don’t always receive formal training.

It was useful to consider NOS in a wider context and how the ddefinition of requirements for competent performance in healthcare science functions could be applied to all healthcare professionals. It also identified a common approach to education and training provision across the health sector and supported lifelong learning approaches and the skills escalator.

Benefits of national occupational standards
The perceived benefits of standards are:

• 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)

Most important of all hospitals will be rated on delivery of patient safety - one major benefit of NOS will be enhanced safety through its assessment of competency to practice

A European context?
With their flexibility and achievement of standard could national occupational standards be useful across Europe? Many people across Europe, and indeed in a global context, could use NOS to agree on transferable common standards, independent of award and qualification agreement.

Questions and answers

Will it be accepted?
The government is fully committed to the project while many practitioners and representatives of professional organisations and work groups have been involved in developing the standards. As the standards will be linked to awards, qualifications and pay, they represent a new mechanism of recognition and so most parties are signed up to the project. The increasing demands for laboratory medicine and developing sophistication of testing pose challenges that NOS tries to answer.

How does the private sector link in?
Any private sector partners who work with the NHS will need to demonstrate competency and some have been involved in the development of the standards. NOS and the demonstration of competence will ensure Public-Private Partnerships (PPPs) will work to the same standard.

Is it worth it and how do we measure its worth?
The standards are not yet implemented so it is early days. However, the education sector is keen to use NOS to define their degree courses. It is anticipated that the standards will be of great benefit.

How will the standards evolve in time?
A mechanism will be put in place for updating the standards on an on-going basis. In fact the standards are already dynamic in the sense that, within the lifetime of the project, some have already evolved with change. As an example point of care testing was, at the start of the project, a concept - now it is a reality and new standards have had to be developed accordingly.

Discussion groups

After the lecture and the question and answer session, the delegates broke up into discussion groups to consider national occupational standards.

Group 1
Austria, Belgium, Croatia CALM, Cyprus, France, Ireland, Italy, Norway, Portugal, Spain, Sweden, Switzerland

Participants in Group one do not have national occupational standards as such although biomedical scientists obviously work to certain set standards.

Spain and Portugal were looking at developing standards similar to the UK’s models of NOS.

Italy has standards but are open to regional interpretation and would like to see the development of national and then European standards.

Delivery of services had government departments of health and education as the stakeholders with the professional bodies working laboratory and government.

It was felt there was a need to define educational standards.

Norway, Ireland and Sweden have laboratory accreditation processes that require professional standards to be examined as well as the scope of practice.

Biomedical scientists carry out different roles across Europe - NOS could be useful for competency. Some work carried out biomedical scientists in one country are carried by nurses in another - NOS could be transferable.

It was felt that the UK’s NOS was in danger of being bureaucratic and over-detailed. Although there were opportunities there were also threats - such a breakdown of laboratory work into tasks minimises the flair and expertise of biomedical scientists who would become pigeon-holed.

It was also felt that it could dilute professional standing by over-emphasising and over-proscribing competency. In their roles of interpretation and clinical advice, biomedical scientists already have documented processes, are entitled to their role of expertise and are not performing in ‘secret’.

Group 2
Austria, Belgium, Croatia CLA, Croatia CALM, Finland, France, Germany, Ireland, Netherlands, Portugal, Slovakia, Switzerland

Netherlands, Austria, Belgium, Austria and Croatia all have different levels of education so it was difficult to compare standards. However, in every country biomedical scientists practice to standards - normally ISO and Good Laboratory Practice standards.

It was not easy to implement standards in such details and clearly there would have to be harmonisation of education to start from the same level. A key point was the cross-national exchange of standards to achieve cohesion amongst countries.

All professions in the group 2 countries have competencies but again difficult to compare although it was felt that would be a useful exercise to further develop standards.

Group 3
Croatia CLA, Cyprus, France, Germany, Iceland, Italy, Norway, Portugal, Slovakia, Sweden, Switzerland

Do we need standards? Once you have a system in a dynamic situation could standards slow down progress in an environment where change is constant? However, NOS would bring professional and financial benefit and would provide a system of competency by common agreement.

Where’s the patient? It was felt that the benefits and interests of the patient was well-addressed by the UK model.

The healthcare system across Europe was not always national-based and in some countries the private sector accounted for 50% of service delivery. NOS would need national implementation for maximum benefit - in the UK with emphasis on the NHS this was achievable. In other countries though, such standards could instead be set through ISO or accreditation systems.

Baseline for standardisation is education with minimum standards - something that the EPBS has been working towards although this was a difficult process with diverse national differences.

Group 3 also noted that biomedical scientists worked in a ‘crowded’ professional environment where conflict with was sometime unavoidable.

In Iceland entry to the profession after 1985 was graduate based - this set-up a divide with those who entered the profession before 1985 without a degree but, nonetheless, still have to prove their worth - a system of NOS could make that easier. The Icelandic profession is currently talking to their departments of health and education to standardise older ‘systems’ or levels to assess competency. There was also the question of professionals who are specialists in scientific and academic sectors.

It was agreed that NOS was workable through a career pathway and that much depended on the willingness of government ministries to implement such systems and deal with legal issues. Coherent and effective organisation with other health groups and professions was a crucial element.

It was felt that accreditation and job description should always work together.

There was a note of caution in that care had to be taken that NOS would not slow down a dynamic environment.

Chairman: concluding comments (Martin Nicholson)

Graduates become professionals via competency criteria set by the professional body, the regulatory body and the government. This allows a first step onto the career structure where progression is set by further education and training for biomedical scientists to move to more advanced levels. In the UK the current system has taken a long time to change and is still in a flux of reform and modernisation. The aim of the lecture was to provide one model example for other countries to consider eventually developing transferable standards and competencies in a European dimension. Sue Hill is hoping to organise a European group to begin work with this aim.

Further information
The standards will be published at the project website at http://www.noshcs.co.uk