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  • 1. National Occupational Standards in Healthcare Science Professor Sue Hill Chief Scientific Officer Department 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
  • 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 Life Sciences Clinical Engineering & Physical Sciences Physiological Sciences Common Common Generic & Common
  • 9. WORKING GROUPS OF EXPERTS COVERING ALL LEVELS OF PRACTICE STANDARDS DEVELOPMENT PROCESS Identification of key purpose/functions Functional breakdown of key purpose/functions Development of performance criteria Identification of essential underpinning knowledge PRODUCTION OF OCCUPATIONAL STANDARDS Development of assessment strategy - Discipline specific - Common - Generic - broad brush statements - indepth database Field Testing Revision Piloting - What has to be done - How well - What range COMPETENCY FRAMEWORK
  • 10. Generic functions across sector Function A Develop & maintain equipment & devices Function B Perform investigative, therapeutic & rehabilitation procedures Function 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 This standard relates to the assessment of new equipment for clinical use within local context and for specified purpose. Individuals will be assessed against the standard for each type of equipment within the scope of their normal work activity. Evaluate new medical equipment for clinical use
    • You must know and understand:
    • The principles of the technology used in the equipment under evaluation
    • The clinical implications and use of the equipment under evaluation
    • Capabilities, limitations, classification and key properties of equipment being reviewed
    • The measurement principles and limitations of test equipment used
    • Legislative and regulatory framework for evaluation of equipment
    • Range and type of evaluation methods and how to match these to type and complexity of equipment to be evaluated
    • How to access MHRA and other published sources of evaluation and assessment information
    • How to establish evaluation criteria relevant to equipment functionality, performance, intended use and clinical context
    • How and where to obtain expert advice
    • How to complete risk assessment for equipment
    • How to assess training requirements of proposed users
    • The type, range and level of detail of data required to enable a decision on safety and effectiveness of equipment
    • Peripheral issues affecting use and cost of equipment in use, including location, environment, consumables, risks, training requirements
    • You must be able to:
    • Apply evaluation methods suitable to type and complexity of equipment to be evaluated
    • Determine clear evaluation criteria related to intended use, potential users and clinical context
    • Obtain expert advice from suitably qualified people to assist with evaluation
    • Coordinate evaluation with users and potential equipment suppliers
    • Establish equipment performance parameters and their relevance to clinical need
    • Assess risks associated with equipment use
    • Assess training requirements of proposed users
    • Obtain sufficient data on operation, capabilities and limits of equipment to enable decision on safety and effectiveness of use in context
    • Determine peripheral issues affecting use and cost
    • Design evaluation procedures relevant to the equipment under consideration
    • Document the results of the evaluation in an appropriate format
    Overview Title
  • 12. Equipment maintenance/QC Health & Safety Management Interpretation and clinical advice Education/Training R&D Generic Standards ( n = 200+)
    • 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
    • -
  • 14. CLINICAL BIOCHEMISTRY Deliver clinical biochemistry services for the prevention, diagnosis and management of disease BC14 Provide point of care testing services BC13 Screen, diagnosis and monitor inherited and congenital disorders BC12 Monitor status and progress of malignancy to assist with diagnosis and treatment BC11 Investigate nutrition, absorption and digestion BC10 Investigate endocrine disorders by measuring hormones and related analyses BC9 Investigate proteins to assist with diagnosis, treatment and monitoring of disease BC8 Monitor concentration of therapeutic drugs (TDM) BC7 Investigate individuals for presence of unspecified harmful substances BC6 Investigate individuals and groups for presence of specified harmful substances Investigate presence and concentration of harmful substances BC5 Perform dynamic function tests BC4 Perform specialised tests to investigate function of major organs or systems BC3 Perform standard tests and profiles to investigate function of major organs or systems Investigate functions of major organs or systems BC2 Select methods, techniques and equipment for planned analysis BC1 Define investigations required to meet clinical need Plan investigations to meet clinical needs Apply analytical techniques in the laboratory or at the point of care to elucidate the composition and/or concentration of biochemical components for prevention, diagnosis and management of disease See Microbiology, Haematology, histocompatability, immunology, immunogenetics, cytogenetics Prepare specimens for analysis See function D – Interpret and Report Interpret and report results of analyses See function J. – Advice Advise on optimum use of services and patient management See function C – Specimens Co-ordinate handling of specimens See function F – Management See function B – Protocols See function E – Health and Safety See function A – Equipment See Function G – Training and Development Plan and configure services to meet actual and emerging clinical needs See Function H Research and development Research services to meet actual and emerging clinical needs
  • 15. Functional NOS Example – Clinical Biochemistry This standard relates to the additional requirements for qualitative and quantitative analysis of proteins and involves techniques such as electrophoresis, immunoassay, chromatography and spectrophotometry for the separation, identification and quantification of proteins . Investigate proteins to assist with diagnosis and monitoring of disease
    • You must know and understand:
    • Personal level of authority, responsibility and competence
    • Procedure, methods for collection of specimens for protein analysis including sample requirements
    • Relevant protocols and guidelines for performance of protein investigations
    • Chemical and physical properties of proteins and their physiological roles
    • Effect of storage conditions on labile proteins
    • Factors affecting selection of analytical methods for individual proteins
    • 7. Relevant use and application of qualitative methods and quantitative assays to clinical problems
    • etc
    • You must be able to:
    • Confirm that specimens have been collected by appropriate method, timing and frequency
    • Determine purpose of intended analysis and relevant associated tests
    • Liaise with professional colleagues to establish signficance and relevance of other tests which may have been undertaken
    • e) Apply rules of interpretation to determine appropriate reflex or cascade testing
    • Specify analysis to be performed with respect to the clinical question
    Overview Title
  • 16. Key purpose Contribute to reduction in the incidence of and mortality from cervical cancer through the provision of cervical cytology laboratory services Judge Cervical Samples to recommend further action in respect of cervical screening Cervical Cytology Monitor information system to ensure follow up action is taken Verify patient identification details prior to examination of cervical sample 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 Recommend management of abnormal results of cervical screening Receive and confirm suitability of cervical samples for examination Screen slides and report findings
  • 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 Syllabus Learning Specification Work Objectives Workplace Assessment Actual workplace performance
  • 21. Using a NOS Framework Assessing 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. Sufficiency of evidence
  • 24. Evaluate new medical equipment for clinical use NOS Title EMD3 NOS Ref Special considerations Has full responsibility and accountability Has responsibility for ensuring this function is performed in full or part Has responsibility for ensuring this function is performed in full or part Performs this function unsupervised Performs this function under supervision or unsupervised in defined circumstances Assists with or contributes to this function Assists with or contributes to this function Assists with or contributes to this function May contribute as part of their training programme Clinical Scientist Grade C Clinical Scientist Higher B / Senior MTO5 Clinical Scientist Mid B / MTO5 Clinical Scientist Lower B / MTO4 Clinical Scientist B8-10 / MTO3 MTO2 SATO ATO Clinical Scientist Grade A / MTO1/ TRAINEE MTO Relationship to grade/level of responsibility – (overview) Evaluation plans and outcomes, risk analyses, minutes of meetings, data analysis reports, etc. Review meetings Observation of appropriate tests carried out Review of documentation Face to face discussion on critical aspects of process, including scientific aspects and clinical application of equipment Observation in the workplace Type Source Acceptable sources and types evidence for this NOS As equipment is likely to be on trial, there may be limited periods during which observations may be made. Issues affecting sufficiency of evidence:
  • 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. CONSULTANT PRACTITIONERS Staff working at a very high level of clinical expertise and/or have responsibility for the planning of services. 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. 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. PRACTITIONERS Most frequently regsitered practitioners in their first and second post-registration / professional qualification jobs. 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. 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) SUPPORT WORKERS Frequently with the job title of ‘Healthcare Assistant/technician - probably studying for of have attained NVQ Level 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. 9 3 8 7 6 5 4 9 2 1 SKILLS AND COMPETENCIES LEARNING AND DEVELOPMENT
  • 26. Healthcare Scientist Career Pathway Assistant 1-2 Senior Assistant 3 Associate Practitioner 4 Practitioner 5 Specialist Practitioner 6 Advanced Practitioner 7 Consultant Practitioner 8 Consultant Director 9
  • 27. NOS Framework Career Pathway Stage (Discipline) Generic Common Discipline Stage 9 Stage 8 Stage 7 Stage 6 Stage 5 Stage 4 Stage 3 Stage 2 Stage 1 Discipline Specific NOS 1 NOS 3 NOS 6 Related Disciplines NOS 27 NOS 45 Common/Generic NOS A2 NOS B4 NOS D2 NOS E1
  • 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 Role 2 – (title) Discipline Specific NOS 3 NOS 6 Related Disciplines NOS 45 Common/Generic NOS A2 NOS D2 NOS E1 Module 1 ___________________ Module 2 ___________________ Module 3 ___________________ Module 4 ___________________ Module 5 ___________________ Module 6 ___________________ Stage 9 Stage 8 Stage 7 Stage 6 Stage 5 Stage 4 Stage 3 Stage 2 Stage 1 Discipline Specific NOS 1 NOS 3 NOS 6 Related Disciplines NOS 27 NOS 45 Common/Generic NOS A2 NOS B4 NOS D2 NOS E1
  • 29. HEALTHCARE SCIENTISTS CAREER PATHWAY Level Learning R e g u l a t i o n 7 Advanced Professional Examinations/Vocational Awards Higher Degrees 8/9 Consultant Management/Leadership programmes Workload and Roles Careers 6 Senior or Specialist Postgraduate Qualifications Professional Examinations/Vocational Awards 5 Basic Qualified Vocational Degrees/Diplomas/Awards 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 / Qualification Framework / Skills Escalator Model Academic Vocational Underpinning Competence Framework
  • 31. HCS Competence Assessment Generic & Common NOS Discipline Specific NOS Individual Role/Job Profile for Grade /Role AfC KSF
  • 32. Using a NOS Framework Role/Job Profiling Grades/Roles/Jobs   4   3  2    1 D C B A NOS Titles
  • 33. 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 ___________________ Module 4 ___________________ Module 5 ___________________ Module 6 ___________________ - - - - - Module 66 __________________ Module 67 __________________
    • Local Job descriptions – (title)
    • NOS 1 – Specific overview, p.c.
    • Level of knowledge
    • Locations
    • NOS 27 -
    Relevant modules selected
  • 34. HCS Competency Framework 1 2 3 4 Associate Practitioner Registered Practitioner Specialist Practitioner Advanced Practitioner 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)
    NOS Framework (800 + NOS)
  • 36. Changing primary secondary care landscape REGIONAL & SUB-REGIONAL CENTRES COMMUNITY-BASED, HOME-BASED AND SELF CARE Technology links Shared teams Science Governance Working Times Medical Technology Communications Technology Public Expectation
    • 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 Assistant 1-2 Senior Assistant 3 Associate Practitioner 4 Practitioner 5 Specialist Practitioner 6 Advanced Practitioner 7 Consultant Practitioner 8 Consultant Director 9 Underpinned by qualifications and competence assessment Locally driven requirements
  • 38. Healthcare Scientist Profile 2009? 1-2 3 4 5 6 7 8 9 Healthcare Scientist Career Pathway Assistants Associates Specialists Consultants n
  • 39. Competence Development HCS Cancer, CHD, Emergency Care (Access), Mental Health, Long Term Conditions Children / Older People
  • 40. Functions Roles Care Pathway
  • 41. DIAGNOSTIC TESTS RADIOLOGY (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 9 8 7 6 5 4 3 2 1
  • 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 Registered Practitioners Consultant Clinical Support Worker Development opportunities Healthcare Scientists develop competency based roles to meet patient and service demands
    • [email_address]