Health CommitteeWritten evidence from the Institute of Biomedical Science (ETWP 71)

Summary

The Institute of Biomedical Science (IBMS) is the professional body for biomedical scientists working in the United Kingdom. Biomedical Scientists form by far the largest professional group in healthcare science. There are approximately 15,000 HPC registered biomedical scientists employed mainly in the national health, blood, and health protection agency services in the UK.

The education and training of biomedical scientists is well established and is based on an accredited vocational honours degree leading to statutory HPC regulation which is designed to meet the needs of the UK pathology service.

The implementation of the Modernising Scientific Careers project is causing difficulties for laboratories, which are experienced in undergraduate placement training, due to the inflexibility of the project model and the absence of a clear regulatory outcome from the new healthcare science undergraduate degrees.

The intention to introduce a new system of education and training for biomedical scientists in pathology simultaneously to the biggest reorganisation of pathology services since the inception of the NHS has the potential to impact adversely on biomedical scientist training. Any meaningful attempt at workforce planning for the next three to five years is difficult, if not impossible, due to the uncertainty over the number and location of future pathology providers and whether the services commissioned will include a commitment to train.

The recruitment, education, training and development of the biomedical scientist workforce is not based on commissioned training places therefore workforce planning is conducted at the local level to meet local service needs and as such is not part of a national planning process. This combined with the confusion over workforce titles (biomedical scientist, healthcare science practitioner) and the reconfiguration of pathology services renders any attempt at meaningful workforce planning doubtful and could have serious consequences for future service stability and sustainability.

1. Pathology Modernisation and Transformation

1.1 The reasons for reconfiguring where and how pathology services in England are delivered are recognised and accepted. Scotland is taking the same decisions regarding pathology service reconfiguration and a similar exercise is happening in Northern Ireland. There is duplication of services and the potential for savings to be made. The intention to grow the support worker workforce to deliver a proportion of the work currently undertaken by registered and qualified staff is supported for both economic and logistical reasons but the IBMS would wish to draw attention to the consequences for pathology if the education, training and workforce planning of biomedical scientists in pathology is destabilised.

1.2 Loss of senior posts: The existing workforce is key to delivering training within the workplace. The success of this depends upon appropriately trained trainers supported by sufficient and protected time to deliver training. This will become an increasing challenge within pathology due to the combination of financial constraint and service reorganisation. There is serious concern that the loss of senior experienced biomedical scientist staff through a combination of retirements and reorganisation of pathology services with the sole aim of reducing pathology staff costs will lead to a loss of high level knowledge and skills leading to a reduced service to patients and greater cost inefficiencies further down the patient care pathway. The maintenance and development of the existing workforce does not appear to be adequately recognised or featured in plans for future service delivery.

1.3 Provision of pre-registration training: The production of registered biomedical scientists is dependent upon the completion of a period of training either as a placement part of an undergraduate degree programme or post -graduation in a paid trainee post. The reconfiguration of pathology services coupled with the shift in skill mix towards greater use of support worker grades throws in to question the sustainability of training. Many laboratories currently do not have substantive trainer posts and rely on this role being subsumed by experienced and senior individual alongside other senior level responsibilities. The continued ability to train is thrown in to doubt by the uncertainty as to which elements of pathology services will be provided in which location (small specialist laboratories or large general service laboratories) and whether adequate resources (human and financial) will be available to train.

1.4 Qualified staff and support worker ratios: Currently 70–80% of pathology non-medical staff are regulated by statute (biomedical and clinical scientists). Of this number, biomedical scientists account for approximately 95% of the regulated pathology workforce. It is accepted that the number of support workers will increase and the need for qualified graduate staff will reduce. If, however, the biomedical scientist workforce is replaced over time with a support worker and practitioner workforce subject only to voluntary regulation or “local licensing”, the statutory regulated workforce in pathology could drop to as low as 5%—ie the healthcare scientist/clinical scientists workforce. This cannot be regarded as improved educational outcome for service or employees.

2. Modernising Scientific Careers (MSC)

2.1 Biomedical scientist education and training has evolved to meet service needs. This has led to the introduction of integrated degrees, which involve a laboratory based practical placement element within the degree course and allows statutory registration. Graduates of these courses may have practical experience in one or more pathology disciplines (dependent upon the duration and configuration of the placement) but will have theoretical knowledge of ALL disciplines. This gives the flexibility to permits subsequent employment as a registered biomedical scientist in any of the pathology disciplines and would support mergers and service reconfiguration involving cross-discipline working.

2.2 The Modernising Scientific Careers project has taken a “green field” approach and has not recognised the merit of any existing training and qualifications or attempted to accommodate them within the structure. The consensus opinion from managers and trainers UK wide is that the biomedical science degree is the superior qualification, a view that has strengthened as the MSC project has evolved. The HCS degree requirement for mandatory 10, 15 and 25 block placements over a three year course is causing considerable concern among laboratory managers, training officers and facilitators experienced in managing the BMS degree placements. This inflexibility does not accommodate variations in local resource availability and casts doubt over the feasibility and sustainability of delivery. This concern is further exacerbated by the QIPP and pathology transformation programmes which make unclear how and where pathology services are to be delivered.

2.3 HPC Registration: The original intention of the MSC project was the opening of two new registers—Healthcare Science Practitioner and Healthcare Scientists to eventually replace the current biomedical and clinical scientist registered workforces. In the wake of the DH Command Paper on statutory regulation this will not now happen with the risk of graduates from the new MSC degree courses, some of which may not meet the HPC Standards of Proficiency (SoPs) for biomedical and clinical scientists and therefore ineligible for statutory registration with the HPC. This is not an acceptable outcome in terms of effective workforce planning and is a direct risk to service stability and patient safety. There is a need for a clear statement of intent that the existing biomedical scientist register can be used for both biomedical science and healthcare science degrees providing the latter are responsive to local placement arrangements and that the curriculum satisfies the HPC Standards of Education and Training and SoPs. The inflexibility of the undergraduate healthcare science degree model is the greatest impediment to the implementation of MSC in Life Sciences.

2.4 Support worker training: Pathology has a strong history of support worker development through the availability of part time accredited biomedical science degrees leading to HPC registration. Also many laboratories combine the recruitment of new graduate trainees with a “grow your own” approach. For these two staff groups this involves the combination of laboratory training and day release to attend part time accredited biomedical science degree courses. There is no provision within the healthcare science degree model for part time study, which would be considered by laboratories as an inflexible and retrograde step in what is purported to be a more flexible approach to workforce education and development. Additionally, there are reports of HEIs being forced by their local SHA to withdraw their accredited part-time biomedical science degrees due to refusal to recognise these courses as acceptable training routes.

2.4 In response to concerns about the availability of suitable training programmes for pathology support workers the IBMS is developing qualifications specific for biomedical support workers (career framework bands 1–4 working in clinical pathology laboratories or associated environments) as a priority project for 2011. The aim is to develop competency based professional qualifications for Biomedical Support staff which gives the opportunity for laboratories to develop their own workforce and secure a supply of the right people at the right time with the right skills for local service needs.

2.5 Post Registration Education and Training: A significant number of the biomedical scientist workforce operate at a senior level and hold a combination of vocational and academic qualifications (Masters degrees). There is an apparent absence of recognition of the value these qualifications bring to healthcare. There is much talk of recognition of equivalence within the Modernising Scientific careers programme but to date there has been little information as to how this will operate and there is the considerable concern that this will be used as a restriction to individual professional development and the reinforcement of glass ceilings. In addition, the implementation of the Scientist Training Programme (STP) element of MSC has seen the withdrawal of some previously sustainable and highly credited master’s degrees thus restricting the development of staff not on an MSC STP.

3. Workforce planning

3.1 The local “ownership” of biomedical scientist education and training has enabled effective workforce planning whereby graduates from IBMS accredited biomedical science degrees leading to HPC registration have a very high rate of employability in the NHS which is beneficial from all perspectives. Biomedical science education, training and recruitment has a track record of efficiency and effectiveness. Approximately one third of the current UK pathology workforce is over 50 years which makes any short term views unwise.

December 2011

Prepared 22nd May 2012