Modernising Scientific Careers - update 18^th April 2009

The final date for responses to the Modernising Scientific Careers (MSC) consultation process was March 6th 2009; a formal response document was submitted on behalf of Ophthalmic & Vision Science by the Association of Health Professions in Ophthalmology (AHPO); the submission received the endorsement of the Association of Ophthalmic Science Practitioners, The British Association of Retinal Screeners (BARS), the British Society for Clinical Electrophysiology of Vision (BriSCEV) and the Ophthalmic Imaging Association (OIA). This single step represents a unique level of cross profession cooperation and underlines the importance of the MSC programme to healthcare scientists working within the field of ophthalmology. The full response can be viewed below ». In short, it stated

“The consultation document provides an essential framework for education and training for Ophthalmic & Vision Science where in some instances, none exists. Currently there are many ways of entering the profession creating variable skill levels and as a consequence, the career pathway is inconsistent and there is no national parity. Career progression can be restricted. The professional disciplines consist of highly skilled healthcare scientists at all levels, who have currently been let down by the lack of career structure and professional development, particularly at the lower levels. Ophthalmology has advanced dramatically over recent years, with increasing emphasis on diagnostic imaging, disease screening, physiological measurement and clinical investigation. These changes require a robust scientific workforce, which at his time does not exist in sufficient numbers.

Clinical resources within ophthalmology in the UK are stretched to the limit, in many trusts; outpatient numbers for ophthalmology exceed the combined workload of all other clinical disciplines. If ophthalmologists are to meet these increasing levels of service demand then disease screening, investigation and treatment monitoring must be devolved to healthcare scientists. Supporting training in these circumstances will need to be resourced, both financially and in terms of staffing.
Of concern is workforce planning as to how supernumerary trainees within the PTP and STP will be supported and where the specialist expertise and trainers will be drawn from, to facilitate training. Currently this role would have to be carried out by senior staff working within the ophthalmic HCS, which, if taken out of the workplace to assist in training, would have a detrimental effect on service provision.

Recruiting specialists from outside the NHS is a concern. Even if we can manage without them, we run the risk of developing a homogeneous workforce, which may limit our ability to think ‘outside the box’.
There is no mention of transitional arrangements or how will staff be mapped across to the MSC career pathway.
What, if any, are the grandfathering arrangements for all points on the MSC Career pathway?
Modernising Scientific Careers seeks to improve standards of patient care and at the same time provide uniformity of education, training and career progression to the scientific professions. Ultimately this will raise the profile of healthcare scientists and giving them a voice equivalent to their medical and nursing colleagues. Ophthalmology and Vision Science supports these goals and wishes to work towards an effective and structured career pathway for the workforce. MSC offers a framework for training and development that in some instances has not been available or is at an embryonic stage and therefore needs support. However, in creating a new career structure we should not loose sight of our successes, clinical scientist training within ophthalmology, creates registered practitioners of the very highest standard, any new training programme must emulate or exceed these standards and not diminish them.”

The first phase of the process has been completed; the preparation of role descriptor templates defining all stages of the career pathway from Healthcare Science Assistant to Consultant Healthcare Scientist and the submission of a formal response to the consultation document. The MSC advisory team for Ophthalmic and Vision Science is now awaiting feedback from the MSC Programme Team regarding the consultation. The next stage of the process will be to work on the curricula for the Practitioner and Scientists Training Programmes, this work will take place during May, June and July and will involve input from AHPO, AOSP, BARS, BriSCEV & OIA. From this point forward we should have a clearer understanding of what the career pathway for ophthalmic and vision science might look like, how it will be underpinned by education and training and how this will link to regulation and statutory registration of ophthalmic healthcare scientists.

What is still not clear is how the different professions will be able to map their roles and training onto a common career spine, it is relatively straight forward to see how ophthalmic technicians, ophthalmic photographers, OSP’s and ophthalmic electro-physiologists/clinical scientists would migrate to the generic MSC career pathway. Also the role descriptor documents have been designed in such a way as to be sufficiently flexible as to include retinal screeners, although it is far too early to say whether this will happen or not. BARS and the English National Screening Programme for Diabetic Retinopathy Screening will be involved in the PTP & STP curricula development and from that point forward it should be possible to determine whether there is merit in future collaboration. What is less clear is how clinical photographers would be included within the Ophthalmic and Vision Science career pathway, clearly there is crossover in roles in terms of angiography and photography service provision, but educational requirements at this time are very different, hopefully there will be greater clarity once clinical photography has worked through the process of developing role descriptors and curricula for MSC.

The MSC Programme is gathering pace and as new developments unfold OIA will do it’s best to keep members informed, so continue to watch this space. Remember regulation of healthcare scientists is likely to form an important part the of any new career pathway, transitional arrangements for MSC will almost certainly consider voluntary registration when mapping staff to the new career points, if you haven’t voluntary registered with VRC maybe now is the time to download the application forms.

The Full Response

Below are the responses made on behalf of Ophthalmic & Vision Science by the Association of Health Professions in Ophthalmology (AHPO); the submission received the endorsement of the Association of Ophthalmic Science Practitioners, The British Association of Retinal Screeners (BARS), the British Society for Clinical Electrophysiology of Vision (BriSCEV) and the Ophthalmic Imaging Association (OIA). Responses are of course marked in blue.

The Challenges of Modern Healthcare
1) Are there any other challenges that have not been outlined that the Healthcare Science (HCS) workforce face?

NO RESPONSE

The Healthcare Science Workforce: The Case for Changing Training and Careers

2) Please rank the issues in terms of how pressing they are for you, where:

1 = Important, 2 = Neutral and 3 = Least Important:

Workforce planning

Response: 1

Education and Training

Response: 1

Transparent Career Pathway

Response: 1

Other (please specify)

The issues will vary across disciplines of electro physiology, angiography and imaging, physiological measurement and retinopathy screening and across career stages. There is significant detail on the HCS training schemes but little information on HCSP or HCSA training. The above issues are very important but many groups have already implemented successful training schemes at the three career stage levels and these should be incorporated into the MSC framework rather than create new schemes which may not be necessary.

3) Are there specific problems in Workforce Planning which need to be addressed?

There is a lack of structured workforce planning within the field of Ophthalmic & Vision Science. Workforce development in general is planned at a local level to meet immediate service needs. Recent examples of failure to adequately plan service development nationally have been seen in the introduction of therapies for age related macular degeneration. These therapies rely on high quality angiography and diagnostic imaging; at this time there are insufficient trained Ophthalmic Healthcare Scientists to meet demand, hampering the roll out of new treatment services at a DGH level.

The national programme for screening for sight threatening retinopathy has however been introduced with due consideration to workforce planning and has appropriate numbers of trained staff, however a significant degree of inequality has become apparent. The fragmented Ophthalmic & Vision Science Workforce crosses different clinical and professional boundaries and would benefit from a structured workforce survey, to identify numbers and level of qualification of healthcare scientists in practice.

It should be recognised that in some areas, training and experience may rest with an individual, or be concentrated within very small groups, where service provision is very much at risk from retirement and sickness etc.

Registration and regulation preclude importation of experts from outside the NHS. There must be a mechanism for direct entry at various stages for individuals with industrial experience; this is of particular importance to the field of electrophysiology.

The Vision for Healthcare Science

4) Are there any other potential benefits that have not been outlined that can be achieved by modernising the Healthcare Science (HCS) workforce?

MSC should seek to establish new training and education in disciplines where none currently exist. If successful training programmes exist they should be continued.

The Modernising Scientific Careers Programme

5) Are there any additional overarching principles you would add, in modernising the Healthcare Science (HCS) workforce?

Historically the barriers between the different disciplines have been too strictly defined and do not allow for flexible training programmes to suit local needs. New technology and investigation methods have blurred these once separate roles; imaging, physiological measurement and visual assessment are now often combined into a single procedure. Therefore the demands of Ophthalmic & Vision Science for the future will require HCS’s across the three MSC career points with specialised knowledge scientific principles, clinical ophthalmology and investigation procedure. Training programmes must reflect the need for entry from both clinical and physics and engineering backgrounds.

There is concern that in order for those wishing to progress to HCSP/HCS it will be necessary for them to leave secure employment at HCSA / HCSP to undertake supernumerary training without guaranteed employment on completion. The prospect will be distinctly unattractive to anyone with a family / mortgage. Therefore a parallel workplace based training scheme is essential.

The Proposed Training and Career Pathways

6) How can we make careers in Healthcare Science under Modernising Scientific Careers as attractive as possible:

Clearly defined training and career pathways with entry open at a range of levels to take account of external experience and training.

Flexible training programmes.

Opportunities for further education such as part-time degrees and post-graduate courses should be available at every level.
The supernumerary scheme is excellent for those who do not know which area/s they wish to specialise in, and for creating a flexible workforce. However, whilst a broad grounding in other subject areas is essential, we see no reason why there should not be a link to employment from the earliest stages of training for those in highly specialised areas. It would seem wasteful to train everybody in an area where there are going to be very few jobs, as very few people would ever have the chance to utilise what they had learnt.

Healthcare Science Assistants (HCSA)?

Clear training and documented steps to regulation.

A requirement for a minimum qualification of FdSc, with a requirement for employer funded training.
Funded training is welcome, but there must be a clear possibility of career progression without loss of employment.
Healthcare Scientist Practitioners (HCSP)?

Greater clarity in career progression to career pathway stage 8 without transferring to the HCS pathway.
For HCSPs the proposed career pathway looks unattractive, and would have a detrimental effect on recruitment. 18 month training period is likely to result in low level HCSPs with inadequate experience; minimum two year training period is recommended.

Healthcare Scientists (HCS)?

Allow flexible training programmes. Programmes should not be confined to the examples in the MSC document. For example combination of clinical engineering and physiological measurement or ophthalmology (ophthalmic science) and medicine (diabetes & retinopathy). Regulation as a clinical scientist in electro physiology of vision currently requires a four year training programme. This should be maintained. No equivalent training programmes exist for the other healthcare science disciplines within ophthalmic & vision science (imaging, physiological measurement or retinopathy screening)

7) Do these proposals enable sufficient flexibility for the workforce to meet the anticipated changes in:

Delivering high quality patient care (Yes No)

No: At HCS level, training is too broad and not sufficiently focused on the needs of ophthalmology, not flexible and not in sufficient depth. The proposed link to audiology in the STP is inappropriate.
Generic 6-month courses may not provide high quality skill levels.
Please comment

Technology and scientific advances in the disciplines (Yes No) Please comment

No, Significant technological and scientific advances will be restricted if training programmes are limited by the artificial barriers.
The scheme is currently unfunded and we therefore do not know if the resources will be sufficient to train Healthcare scientists to the desired level.

New models of care (Yes No)

Yes: Must retain flexibility for different needs throughout the country.
Please comment

Skills mix arrangements (Yes No)

No: Too much time spent on generic skills leaving a shortage of staff with specific skills.
Please comment

8) Do you agree with the proposal for Healthcare Science Assistants (HCSA) to have the opportunity to gain formal awards and qualifications? (Yes No)

Yes: This is essential if there is to be career progression from this stage to PTP and ultimately STP.
Please comment

9) To support the Practitioner Training Programme (PTP), should there be greater provision of Higher Education/ Further Education academic programmes with NHS-funded workforce placements aligned to the outcomes of the Practitioner Training Programme? (Yes No)

Workforce training in combination with HE/FE courses is an effective method of training HCSP but funding required for additional trainers to fulfil this role. There should be recognition that there is a shortage of skilled HCS’s with the necessary skills; diverting staff from clinical roles will impact on service delivery.
Consider modern work-based apprenticeships for HCSP training: early exposure to work environment and being useful at an earlier stage. Employed by NHS, with secondment to University courses on part-time or block-release.

10) How can Further Education contribute to the learning and development of Healthcare Science Assistant (HCSA) and Healthcare Scientist Practitioner (HCSP)?

National certificates and diplomas gives complementary theoretical and motivational training to practical workforce placements. FE delivered FdSc/BSc programmes validated through a university allows access to HE courses at reduced cost.

11) In the Practitioner Training Programme (PTP) should trainees undertake workplace based training in one discipline (focussed PTP e.g. only in biochemistry) or in related disciplines (broad-based PTP, e.g. in biochemistry and haematology)?

Focussed but flexible

Life Sciences (Focused PTP Broad-based PTP)

Physiological Sciences (Focused PTP Broad-based PTP)

Physical Sciences and Engineering (Focused PTP Broad-based PTP)

Any comments

12) Do you agree with the broad indicative themes laid out for the Scientist Training Programme (STP)? (Yes No)

Please comment

Yes: For the disciplines of imaging, physiological measurement and retinopathy screening the STP would provide a structured higher level training programme which at this time doesn’t exist, there is question over the relevance of audiology and neurophysiology within the rotation. An ophthalmology, medicine and genetics rotation would be more relevant

Reducing clinical scientist training from 4 to 3 years is a retrograde step. In Visual electrophysiology skills are required from ophthalmology, neuroscience and in many cases clinical engineering. This combination does not appear possible in the MSC document

Important for trainees to be able to reduce the length of their training where previous relevant training can be demonstrated, e.g. relevant PhD.

13) Do you agree with the proposals for Higher Specialist Healthcare Scientist Training (HSST) programmes? (Yes No)

Please comment

Yes

14) Are there existing programmes that could be used for Accredited Specialist Expertise? (Yes No)

Please comment

Not aware of any.

Implementation Issues
15) How important are the following areas for the development of the existing workforce, where

1 = Vitally Important, 2 = Important, 3 = Not Very Important and 4 = Least Important:

Leadership skills (1 2 3 4)

Management skills (1 2 3 4)

Further Specialist Scientist Expertise (1 2 3 4)

Higher Specialist Healthcare Scientist Training (HSST) (1 2 3 4)

Other (please specify)

1 for all of the above

Responder’s Comments
Do you have any further comments?

The consultation document provides an essential framework for education and training for Ophthalmic & Vision Science where in some instances, none exists. Currently there are many ways of entering the profession creating variable skill levels and as a consequence, the career pathway is inconsistent and there is no national parity. Career progression can be restricted. The professional disciplines consist of highly skilled healthcare scientists at all levels, who have currently been let down by the lack of career structure and professional development, particularly at the lower levels. Ophthalmology has advanced dramatically over recent years, with increasing emphasis on diagnostic imaging, disease screening, physiological measurement and clinical investigation. These changes require a robust scientific workforce, which at this time does not exist in sufficient numbers.

Clinical resources within ophthalmology in the UK are stretched to the limit, in many trusts; outpatient numbers for ophthalmology exceed the combined workload of all other clinical disciplines. If ophthalmologists are to meet these increasing levels of service demand then disease screening, investigation and treatment monitoring must be devolved to healthcare scientists. Supporting training in these circumstances will need to be resourced, both financially and in terms of staffing.

Of concern is workforce planning as to how supernumerary trainees within the PTP and STP will be supported and where the specialist expertise and trainers will be drawn from, to facilitate training. Currently this role would have to be carried out by senior staff working within the ophthalmic HCS, which, if taken out of the workplace to assist in training, would have a detrimental effect on service provision.

Recruiting specialists from outside the NHS is a concern. Even if we can manage without them, we run the risk of developing a homogeneous workforce, which may limit our ability to think ‘outside the box’.

There is no mention of transitional arrangements or how will staff be mapped across to the MSC career pathway.

Would existing clinical scientists be eligible to apply for consultant posts without undergoing HSST, that is to say, which would automatically be accepted onto the Higher Specialist Register? What, if any, are the grandfathering arrangements for all points on the MSC Career pathway?

Modernising Scientific Careers seeks to improve standards of patient care and at the same time provide uniformity of education, training and career progression to the scientific professions. Ultimately this will raise the profile of healthcare scientists and giving them a voice equivalent to their medical and nursing colleagues. Ophthalmology and Vision Science supports these goals and wishes to work towards an effective and structured career pathway for the workforce. MSC offers a framework for training and development that in some instances has not been available or is at an embryonic stage and therefore needs support. However, in creating a new career structure we should not loose sight of our successes, clinical scientist training within ophthalmology, creates registered practitioners of the very highest standard, any new training programme must emulate or exceed these standards and not diminish them.

Consideration must be given to Clinical Photographers who at this time are involved in ophthalmic photography at a basic level. Currently qualification mechanisms for clinical photographers are inadequate for Ophthalmic & Vision Science; curriculum of existing training programmes would require significant revision to be fit for purpose.

Thank you for your comments, which will be considered by the Modernising Scientific Careers Team and will inform the future development of the Modernising scientific Careers programme.