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National Occupational Standards in
Healthcare Science
Professor Sue HillChief Scientific Officer
Department of Health
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
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
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
MANAGEMENT COMMITTEE
DOH Welsh PSAG
Assembly
NOS PROJECT HEALTHCARE SCIENCE
STEERING COMMITTEE
NOS DEVELOPMENT
ASSESSMENT linked to AWARDS & QUALIFICATION
framework
EDUCATION & TRAINING framework
IMPLEMENTATION strategy
PROFESSIONAL BODIESPRACTITIONERS AND OTHER KEY STAKEHOLDERS
PILOT SITES IN TRUSTS THROUGHOUT UK
UK Wide Project ~ £1.6 Million SEMTA SSC Project Management
Reporting responsibilities within DH
Wide Representation from Key Stakeholders
Strategic Direction & Policy Decision
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
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
Scope of HCS NOS Project
Life Sciences
Clinical Engineering &
Physical Sciences
Physiological Sciences
Comm
on Comm
on
Generic
& Common
WORKING GROUPS OF EXPERTS WORKING GROUPS OF EXPERTS COVERING ALL LEVELS OF PRACTICECOVERING ALL LEVELS OF PRACTICE
STANDARDS DEVELOPMENT PROCESS
Identification of key purpose/functionsIdentification of key purpose/functions
Functional breakdown of key purpose/functionsFunctional breakdown of key purpose/functions
Development of Development of performance criteriaperformance criteria
Identification of essentialIdentification of essential underpinning underpinning
knowledgeknowledge
PRODUCTION OF OCCUPATIONAL STANDARDSPRODUCTION OF OCCUPATIONAL STANDARDS
Development of assessment strategyDevelopment of assessment strategy
- Discipline specific- Discipline specific- Common- Common- Generic- Generic
- broad brush - broad brush statementsstatements- indepth database- indepth database
Field TestingField Testing
RevisionRevision
PilotingPiloting
- What has to be - What has to be donedone- How well- How well- What range- What range
COMPETENCY FRAMEWORKCOMPETENCY FRAMEWORK
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
Functional NOS ExampleTitle Evaluate new medical equipment for clinical use
OverviewThis 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.
You must be able to:Apply evaluation methods suitable to type and
complexity of equipment to be evaluateda) Determine clear evaluation criteria related to
intended use, potential users and clinical context
b) Obtain expert advice from suitably qualified people to assist with evaluation
c) Coordinate evaluation with users and potential equipment suppliers
d) Establish equipment performance parameters and their relevance to clinical need
e) Assess risks associated with equipment usef) Assess training requirements of proposed
usersg) Obtain sufficient data on operation, capabilities
and limits of equipment to enable decision on safety and effectiveness of use in context
h) Determine peripheral issues affecting use and cost
i) Design evaluation procedures relevant to the equipment under consideration
j) Document the results of the evaluation in an appropriate format
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
Equipment maintenance/QC
Health & Safety
Management
Interpretation and clinical advice
Education/Training
R&D
Generic Standards ( n = 200+)
ENGINEERING &
PHYSICAL SCIENCES
LIFE
SCIENCES & GENETICS
PHYSIOLOGICAL SCIENCES
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
-
CLINICAL BIOCHEMISTRYDeliver clinical biochemistry services for the prevention, diagnosis and management of disease
Research services to meet actual and emerging clinical needs
See Function H Research and development
Plan and configure services to meet actual and emerging clinical needs
See function F – ManagementSee function B – ProtocolsSee function E – Health and SafetySee function A – EquipmentSee Function G – Training and Development
Co-ordinate handling of specimens See function C – Specimens
Advise on optimum use of services and patient management
See function J. – Advice
Interpret and report results of analyses See function D – Interpret and Report
Prepare specimens for analysis See Microbiology, Haematology, histocompatability, immunology, immunogenetics, cytogenetics
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
Plan investigations to meet clinical needsBC1 Define investigations required to meet clinical need
BC2 Select methods, techniques and equipment for planned analysis
Investigate functions of major organs or systems
BC3 Perform standard tests and profiles to investigate function of major organs or systems
BC4 Perform specialised tests to investigate function of major organs or systems
BC5 Perform dynamic function tests
Investigate presence and concentration of harmful substances
BC6 Investigate individuals and groups for presence of specified harmful substances
BC7 Investigate individuals for presence of unspecified harmful substances
BC8 Monitor concentration of therapeutic drugs (TDM)
BC9 Investigate proteins to assist with diagnosis, treatment and monitoring of disease
BC10 Investigate endocrine disorders by measuring hormones and related analyses
BC11 Investigate nutrition, absorption and digestion
BC12 Monitor status and progress of malignancy to assist with diagnosis and treatment
BC13 Screen, diagnosis and monitor inherited and congenital disorders
BC14 Provide point of care testing services
Functional NOS Example – Clinical Biochemistry
Title Investigate proteins to assist with diagnosis and monitoring of disease
Overview
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 .
You must be able to:
b) Confirm that specimens have been collected by appropriate method, timing and frequency
c) Determine purpose of intended analysis and relevant associated tests
d) 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
c) Specify analysis to be performed with respect to the clinical question
You must know and understand:
6. Personal level of authority, responsibility and competence
7. Procedure, methods for collection of specimens for protein analysis including sample requirements
8. Relevant protocols and guidelines for performance of protein investigations
9. Chemical and physical properties of proteins and their physiological roles
10. Effect of storage conditions on labile proteins
11. Factors affecting selection of analytical methods for individual proteins
7. Relevant use and application of qualitative methods and quantitative assays to clinical problems
etc
Key purposeKey purposeContribute to reduction in the incidence of and mortality from cervical Contribute to reduction in the incidence of and mortality from cervical cancer through the provision of cervical cytology laboratory servicescancer through the provision of cervical cytology laboratory services
Judge Cervical Samples Judge Cervical Samples to recommend further to recommend further
action in respect of action in respect of cervical screeningcervical screening
Cervical CytologyCervical Cytology
Monitor information Monitor information system to ensure system to ensure follow up action is follow up action is takentaken
Receive and confirm Receive and confirm suitability of cervical suitability of cervical
samples for samples for examinationexamination
Screen slides and Screen slides and report findingsreport findings
Verify patient identification Verify patient identification details prior to details prior to examination of cervical examination of cervical samplesampleMaintain records for audit Maintain records for audit and reportingand reporting
Prepare slides for Prepare slides for microscopymicroscopyPrimary screen slides to Primary screen slides to evaluate sampleevaluate sample
Rapid review negative and Rapid review negative and inadequate slides to verify inadequate slides to verify primary screening judgementprimary screening judgement
Check abnormal and Check abnormal and equivocal slides for equivocal slides for presence of abnormal cellspresence of abnormal cellsRecommend management of Recommend management of abnormal results of cervical abnormal results of cervical screeningscreening
Discipline Specific Standards ( n= 600+)
Complete NOS Framework ( 900 + standards)
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
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 ManualSyllabus
Learning Specification
Work Objectives
Workplace Assessment
Actual workplaceperformance
Using a NOS FrameworkAssessing Work Performance
NOS Framework
Observe/question/review real work
activity
Role/Grade requirements or
profile
(expectations of performance)
APPLICATION of skills and knowledge
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
General Guidance
1.All performance criteria must be assessed on each and every assessment2.The Primary methods of assessment for these NOS should be:
-Observation-Supported questioning
3.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 assessed3b. 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
Sufficiency of evidence
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.
NOS RefEMD3
NOS Title
Evaluate new medical equipment for clinical use
Relationship to grade/level of responsibility – (overview)
Clinical Scientist Grade CClinical Scientist Higher B / Senior MTO5Clinical Scientist Mid B / MTO5Clinical Scientist Lower B / MTO4Clinical Scientist B8-10 / MTO3MTO2SATOATOClinical Scientist Grade A / MTO1/ TRAINEE MTO
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
Special considerations
Acceptable sources and types evidence for this NOS
Source Type
Review of documentationFace to face discussion on critical aspects of process, including scientific aspects and clinical application of equipmentObservation in the workplace
Evaluation plans and outcomes, risk analyses, minutes of meetings, data analysis reports, etc. Review meetingsObservation of appropriate tests carried out
Issues affecting sufficiency of evidence:
As equipment is likely to be on trial, there may be limited periods during which observations may be made.
A Career Framework for the NHS
MORE SENIOR STAFFStaff with the ultimate responsibility for clinical caseload decision-making and full on-call accountability.
CONSULTANT PRACTITIONERSStaff working at a very high level of clinical expertise and/or have responsibility for the planning of services.
ADVANCED PRACTITIONERSExperienced 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 PRACTITIONERSStaff 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.
PRACTITIONERSMost frequently regsitered practitioners in their first and second post-registration / professional qualification jobs.
ASSISTANT PRACTITIONERS / ASSOCIATE PRACTITIONERSProbably 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 / TECHNICIANSHave 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 WORKERSFrequently with the job title of ‘Healthcare Assistant/technician - probably studying for of have attained NVQ Level 2.
INITIAL ENTRY LEVEL JOBSJobs 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
SK
ILL
S A
ND
CO
MP
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EN
CIE
S
LE
AR
NIN
G A
ND
DE
VE
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PM
EN
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Healthcare Scientist Career Pathway
Assistant
1-2
Senior Assistant
3
AssociatePractitioner
4
Practitioner
5
SpecialistPractitioner
6
AdvancedPractitioner
7
ConsultantPractitioner
8
ConsultantDirector
9
Generic
Common
Discipline
NOS FrameworkCareer Pathway
Stage(Discipline)
Stage 9
Stage 8
Stage 7
Stage 6
Stage 5
Stage 4
Stage 3
Stage 2
Stage 1Discipline SpecificNOS 1NOS 3NOS 6Related DisciplinesNOS 27NOS 45Common/GenericNOS A2NOS B4NOS D2NOS E1
Career Pathway Stages - NOS
Roles Development Modules
Stage 9
Stage 8
Stage 7
Stage 6
Stage 5
Stage 4
Stage 3
Stage 2
Stage 1Discipline SpecificNOS 1NOS 3NOS 6Related DisciplinesNOS 27NOS 45Common/GenericNOS A2NOS B4NOS D2NOS E1
Role 1 – (title)Discipline SpecificNOS 1NOS 3Related DisciplinesNOS 27Common/GenericNOS A2NOS B4
Role 2 – (title)Discipline SpecificNOS 3NOS 6Related DisciplinesNOS 45Common/GenericNOS A2NOS D2NOS E1
Module 1 ___________________
Module 2 ___________________
Module 3 ___________________
Module 4 ___________________
Module 5 ___________________
Module 6 ___________________
HEALTHCARE SCIENTISTS CAREER PATHWAY
Level Learning
Regulation
7 Advanced Professional Examinations/Vocational AwardsHigher Degrees
8/9 Consultant Management/Leadership programmes
Workload and R
olesC
aree
rs
6 Senior or SpecialistPostgraduate QualificationsProfessional Examinations/Vocational Awards
5 Basic Qualified Vocational Degrees/Diplomas/Awards
4 Associate Foundation Degrees / CertificatesNVQ based awards
3 Senior Assistant National Certificates / NVQ based awards
1 / 2 Assistant Work OrientationNVQ Award / Access Courses
Career / QualificationFramework / SkillsEscalator Model
Academic
Vocational
Underpinning Competence Framework
HCS Competence Assessment
Generic&
Common NOS
DisciplineSpecific
NOS
Individual Role/Job
Profile for Grade /Role
AfCKSF
Using a NOS FrameworkRole/Job Profiling
NOS Titles
Grades/Roles/Jobs
A B C D
1 2 3 4
Development Modules
Role 1 – (title)Discipline SpecificNOS 1NOS 3Related DisciplinesNOS 27Common/GenericNOS A2NOS 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
HCS Competency Framework
1 2 3 4
Associate Practitioner
Registered Practitioner
Specialist Practitioner
Advanced Practitioner
Consultant
Using the NOS Framework
Two Key Tools:
NOS Framework
(800 + NOS)
Career Pathway
(9 stages)
Steps
1. Match NOS to Career Pathway Stages (gives national framework for CP stages)
2. Select NOS at each stage to derive roles (gives national framework of roles)
3. Select NOS from role for local job description (to meet local need)
4. Provide training and development based on selected NOS (modular development)
5. Assess application of learning in real work activity (competence based assessment)
6. Confirm competence against NOS or refer for further development (award structure)
Changing primary secondary care landscape
REGIONAL & SUB-REGIONAL
CENTRES
COMMUNITY-BASED, HOME-BASED AND
SELF CARE
Technology links
Shared teams
ScienceGovernanceWorking Times
Medical TechnologyCommunications 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
Facilitates Flexible Careers and New Ways of working
Assistant
1-2
Senior Assistant
3
AssociatePractitioner
4
Practitioner
5
SpecialistPractitioner
6
AdvancedPractitioner
7
ConsultantPractitioner
8
ConsultantDirector
9
Underpinned by qualifications and competence assessment
Locally driven requirements
Healthcare Scientist Profile 2009?
1-2 3 4 5 6 7 8 9Healthcare Scientist Career Pathway
AssistantsAssociates
SpecialistsConsultants
n
Competence Development
HCS
Cancer, CHD, Emergency Care(Access), Mental Health, Long Term
Conditions
Children / Older People
Functions
Roles
Care P
athway
DIAGNOSTIC TESTSRADIOLOGY (CT, MRI, ULTRASOUND, OTHER), BIOPSY, BLOOD TESTS, OTHER
9
8
7
6
5
4
3
2
1
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
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
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
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)
New ways of working – Creative possibilities
RegisteredPractitioners
Consultant
Clinical SupportWorker
Development opportunities
Healthcare Scientists develop competency based roles to meet
patient and service demands
WEB SITE FOR NATIONAL OCCUPATIONAL STANDARDS
IN HCS PROJECT
• WWW.NOSHCS.CO.UK