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Safe, Accurate and Effective: An Action Plan for Healthcare Science in NHSscotland

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CHAPTER 1: HEALTHCARE SCIENCE TODAY

HEALTHCARE SCIENCE ( HCS) REFERS TO A WIDE RANGE OF SPECIALIST DISCIPLINES THAT SERVE TO UNDERPIN DIAGNOSTIC, TESTING, INTERPRETATIVE AND DIRECT TREATMENT SERVICES FOR PATIENTS.

HCS does not enjoy a high profile or high visibility in its impact on health systems as well as the NHS, which creates problems in attempting to define the HCS workforce and its education and training needs. Healthcare scientists ( HCSs) nevertheless play a key role in delivering the health services people need and are central to enabling NHS Boards to meet waiting times and HEAT targets (Box 1) for the benefit of patients and communities.

Modern healthcare depends to a large extent on science and technology. Up to 70% of all patient journeys may involve HCS staff working in hospital-based laboratories, 1 while the contribution of staff in physical and physiological sciences accounts for another 10%. Yet healthcare scientists make up no more than 5% of NHSScotland's workforce. It is therefore vital that HCS expertise is used to best effect in delivering safe and effective care.

Box 1. HEAT targets in Scotland
HEAT targets are related to:

  • Health improvement for the people of Scotland - improving life expectancy and healthy life expectancy;
  • Efficiency and governance improvements - continually improving the efficiency and effectiveness of the NHS;
  • Access to services - recognising patients' need for quicker and easier use of NHS services; and
  • Treatment appropriate to individuals - ensuring patients receive high-quality services that meet their needs.

Local Delivery Plans set out a delivery agreement between the Scottish Government and each NHS Board, based on key targets. Local Delivery Plans reflect the HEAT Core Set - the key objectives, targets and measures that reflect priorities for health.

WHO ARE HEALTHCARE SCIENTISTS?

Healthcare scientists form a distinct staff group within NHSScotland and encompass nearly 50 scientific disciplines distributed across three primary streams: life sciences, physiological sciences and physical sciences (Table 1).

Table 1. Healthcare science disciplines across the three HCS streams

Life sciences

Physiological sciences

Physical sciences

Main function
Analysis, testing and interpretation of clinical samples and products

Main function
Observation and objective measurement of human performance

Main function
Using physics and engineering for patient imaging, measurement and treatments

Anatomical pathology
Andrology
Blood transfusion
Cervical cytology
Clinical biochemistry
Clinical cytogenetics
Clinical embryology
Clinical immunology
Electron microscopy
External quality assurance
Haematology
Haemostasis & thrombosis
Histocompatability & immunogenetics
Histo & cytopathology
Molecular genetics
Microbiology
Phlebotomy
Tissue banking
Toxicology
Virology

Audiology
Hearing therapy
Autonomic neurovascular
Cardiac physiology
Clinical perfusion
Gastrointestinal physiology
Neurophysiology
Ophthalmic science
Renal dialysis
Respiratory physiology
Sleep physiology
Urodynamics
Vascular technology
Vision science

Biomechanical engineering
Clinical measurement
Diagnostic radiology
Equipment management
Information technology
Maxillofacial prosthetics
Medical electronics
Medical engineering & design
Medical illustration
Nuclear medicine
Radiation protection
Radiotherapy physics
Rehabilitation engineering
Renal technology
Ultrasound

Adapted from Scottish Forum for Healthcare Science and the UK Federation for Healthcare Science definitions.

More broadly, six distinct professional groups that deliver NHSScotland's HCS services can be identified. Who they are, a very brief synopsis of what they do and their general entry requirements are presented in Table 2.

Table 2. Professional groups in HCS

Group

What they do

Broad entry requirement

Biomedical scientists

Analyse specimens from patients to provide data to help doctors diagnose and treat disease. Work ranges from hands-on, protocol-based laboratory investigations to assuring the clinical validity of increasingly complex and automated tests.

Approved degree co-terminous with HPC registration, or degree plus one year's in-service training. Optional science discipline-specific MSc to enable specialisation.

Clinical scientists

Oversee specialist tests for diagnosing and managing disease. They work across all streams of HCS, advising doctors on using tests and interpreting data. They also carry out research on diseases and therapies.

Science degree plus four years' basic-grade training which incorporates MSc-level specialisation. Also MRC Path route for biochemists and others in life science.

Clinical physiologists

Carry out physiological tests related to human performance such as audiology, respiratory and neurophysiological measurements and interpretation, cardiology measurements and pacemaker set-up. Their particular front-line clinical contact with patients gives them high public visibility.

The physiologist group is emerging as a separate degree-only stream.

Clinical technologists

Have a presence across all three HCS streams and undertake diverse hands-on aspects of service delivery. Examples include involvement in medical equipment services, radiation physics and genetics.

Mix of qualifications depending on discipline: vocational degrees, other science degrees and further education certificates/ diplomas.

Other healthcare scientists

Practice in areas such as clinical photography and maxillofacial prosthetics and technology.

Mix of entry qualifications up to MSc level.

Clinical/scientific assistants

HCS has a complement of support staff in a variety of roles who enable higher-level scientists to concentrate on more analytical and clinical tasks. Some HCS support staff, such as those in anatomical pathology and cervical cytology, perform specific higher-level analytical tasks under supervision that demand SVQ-level qualifications.

For most, no formal entry or professional body qualification. Option of SVQ-level qualification to supplement work-based learning. Specific groups may require up to level 3 ( SCQF) equivalent qualification.

Some healthcare scientists work directly with patients and may deliver highly visible services - clinical physiologists working in audiology, respiratory, neurology and cardiac services and clinical scientists and technologists in rehabilitation for example - while others work to provide patients and clinicians with vital information and data upon which diagnostic and treatment decisions depend.

But wherever they work, healthcare scientists, common denominator is science - the observation, identification, description, experimental investigation and explanation of illness and disorder as a prelude to delivering effective treatment.

HOW ARE HEALTHCARE SCIENTISTS REGULATED?

"Biomedical scientist" and "clinical scientist" have been regulated professional titles with the Health Professions Council ( HPC) since July 2003. Clinical physiologists, technologists, photographers and maxillofacial prosthetists currently operate "shadow" registers to HPC; they expect to become HPC regulated, possibly by 2009. Another shadow register, the Voluntary Registration Council ( VRC), has engaged in dialogue with HPC to take forward the regulation of, for example, cytology screeners, critical care technologists, phlebomists and anatomical pathology technologists.

The Scottish Government is currently participating in reform of the United Kingdom's system for the regulation of health professionals. Future regulation may define only "Healthcare scientist" as the protected title; for the purpose of this action plan, existing and aspirant professional titles are used.

WHAT IS THE NHSSCOTLAND CAREER FRAMEWORK?

The NHSScotland career framework 2 heralds a new classification for non-medical healthcare staff structures. The framework envisages opportunities at advanced and consultant/leader level and the unambiguous emergence of a cadre of associates and support grade HCS staff (Table 3).

Table 3. NHSScotland career framework 2

Level

Grade

9

More senior staff

8

Consultant/principal practitioners

7

Advanced practitioner

6

Senior or specialist practitioner

5

Practitioners

4

Assistant practitioners

3

Senior healthcare assistants

2

Support workers

1

Initial entry-level jobs

HOW DO HEALTHCARE SCIENTISTS NETWORK?

The Scottish Forum for Healthcare Science ( SFHCS) was formally established in 2003 to begin to unite the HCS staff group in Scotland.

The forum consists of professional body representatives from the three HCS streams, national workforce planning services, trade unions and the Scottish Government. SFHCS is also aligned with the Federation for Healthcare Science ( FHCS).

The SFHCS:

  • identifies common areas and provides unity of opinion among different HCS groups; and
  • acts as a common point of reference on matters of health policy, including being a lead stakeholder in the development of this action plan.

HEALTHCARE SCIENTISTS - THE NEXT STEPS

Wherever they work and however they are defined, healthcare scientists make vital and positive contributions to effective patient outcomes. But like all healthcare workers, their roles must now expand to meet new needs and new challenges.

NHS services in Scotland are changing from a hospital-based focus to one that is firmly embedded in people's communities. The challenge for healthcare scientists is to forge new and innovative roles that will reflect the community-based model of care delivery. An action plan for Scotland is therefore needed, and this document sets out that action plan.

In developing Safe, Accurate & Effective, we set out to:

  • reinforce the healthcare science identity and engage with practitioners on how HCS practice can be developed to reflect current policy for NHSScotland;
  • conduct a national healthcare scientist-led survey to improve understanding of workforce issues and to identify the profile of staffing across the HCS disciplines; and
  • develop an action plan for change.

Outcomes from exercises related to the first two objectives were instrumental in the development of the third.

Information from a series of consultation events held with healthcare scientists and other stakeholders and from the healthcare scientist-led survey of workforce dimensions can be accessed from the CD- ROM provided with this document. The action plan, inspired by all these data, can be found at the end of the document.