Training and Retention of Medical Laboratory Scientific Officers

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The Recruitment, Training and Retention of

Medical Laboratory Scientific Officers

Working together for a healthy, caring Scotland

Scottish Medical and Scientific Advisory Committee


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Introduction

1. Clinical laboratory medicine is a specialty in its own right and an integral part of

clinical practice. Its essential role is to provide and interpret investigations for the diagnosis,

management, early detection and prevention of disease, through specimen analysis and the

clinical interpretation of its result. It forms a vital component of the clinical care of patients,(for example, on-going monitoring of treatment), and is used as a resource in both the

undergraduate and postgraduate training of medical students and in support of the training of

nurses in infection control. Test results and autopsy reports provide valuable information for

medical audit. Results provided by the laboratory are often a prerequisite for clinical

research and development.

2. Laboratory services are consultant-led and employ medical staff, clinical scientists,

medical laboratory scientific officers (MLSOs), medical laboratory assistants, medical

technical officers, cytology screeners, phlebotomists and an infrastructure of ancillary staff

and administrative and clerical staff. The work, which is mainly carried out in the laboratory,

may also be undertaken in near-patient settings such as wards and out-patient clinics,

particularly one-stop clinics. The proportion of time spent in these locations will vary

according to the particular discipline concerned and to local arrangements for service

delivery.

3. Approximately 1,600 MLSOs are employed in NHSScotland. This category of staff

makes up the largest group of personnel within the clinical laboratory service who carry out

the investigations which are crucial to modern medical care. Without them, the diagnosis of

disease, the evaluation of the effectiveness of treatment, and research into the causes and

cures of disease would not be possible. As with other health care professionals, many of the

tasks which were originally only carried out by medical staff, are now the responsibility of

the MLSO working under the direction of the consultant in charge of the laboratory.

4. Each year, some 50 million tests are performed by the clinical laboratory service in

Scotland. The expectations of patients and NHS professionals, coupled with the rapid

exponential growth in advances in health care, conspire to create a cycle where demand may

often exceed resource.

5. MLSOs are recruited from graduates holding an Honours degree approved by the

Council for Professions Supplementary to Medicine, (CPSM) and accredited by the Institute

of Biomedical Science, (IBMS). After a minimum training period of one year, undertaken in

a laboratory approved by the CPSM for training purposes, they can apply to the Medical

Laboratory Technician Board of the CPSM to be placed on the State Register. Currently, as

well as the academic and training requirements of the CPSM, candidates have to sit and passan oral examination before becoming state registered.

6. MLSOs may go on to study for a postgraduate degree in order to further progress

within their profession. The Institute for Biomedical Science, (IBMS), is the professional

body for MLSOs in all fields of work, including that of medical laboratory scientific officers

in the National Health Service and related services in the United Kingdom and Ireland. Its

aims are to promote and develop biomedical science and its practitioners, and to establish,

improve and maintain professional standards.


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7. MLSOs are also employed in the Scottish National Blood Transfusion Service,

government, university and forensic laboratories, the Medical Research Council, (MRC), the

pharmaceutical industry, and with Her Majestys Forces.

8. The profession has never enjoyed a high public profile. Frequently, the significanceof their vital work is lost or, at best, simply taken for granted because the laboratory is

hidden away from the public gaze and, in most disciplines, there is little direct patient

contact. The Group therefore make no apology for including a brief summary of the vital

work of each of the laboratory disciplines in Appendix II.

Background

9. This report has been commissioned against the backdrop of the Review of Acute

Services1 and increased recognition of the difficulties encountered in the recruitment, training

and retention of Medical Laboratory Scientific Officers (MLSOs). The Groups remit is

explicit in identifying the need to look at some of the broader issues of changes in laboratory

practice taking into account such issues as skill-mix, automation, extended hours of work,

near-patient testing, fast-tracking and links with primary care.

10. The laboratory services are demand-driven and the workload has been rising as a

direct result of increased clinical activity and the scope of pathology generally. Increasing

emphasis on primary care, earlier hospital discharge and more day care means that the

laboratory service has to respond to new demands from general practitioners who require

assistance with the investigation and management of patients in the community.

Method of Working

11. The Group, which met on four occasions between June 1999 and May 2000, soughtevidence in the form of a postal questionnaire from all Head Medical Laboratory Scientific

Officers / Laboratory Managers in the NHS in Scotland. Nearly a hundred written comments

were received with the returned questionnaires. Direct quotations from some of these

comments have been placed in italics at the head of each chapter to convey the extent of the

problem and the strength of feeling which exists within the profession. The results of the

survey (see Appendix III) formed the evidence base on which the Group formulated its

recommendations. The Group is grateful to the Institute of Biomedical Science, (IBMS), for

collating the responses.

12. During the lifetime of the Working Group, the IBMS conducted a parallel survey2,

(see Appendix IV), relating mainly to Trusts in England and Wales (but including eight largeScottish Trusts), with broadly similar results.

13. The composition and membership of the Group is shown in Appendix I

Structure of Report

14. The report sets out the background to the review, identifies the issues involved and

puts forward a range of solutions. For ease of reference, separate chapters concentrate on the

three main areas under review, namely the recruitment, training and retention of Medical

Laboratory Scientific Officers, even though it is recognised that these three areas are


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interlinked. No attempt is made to differentiate between the laboratory disciplines except

where the context clearly demands it. A summary of the main recommendations appears in

Chapter V.


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II. RECRUITMENT

Nobody seems to know what an MLSO is, or what he or she does

It is becoming increasingly difficult, if not nigh impossible, to recruit qualified MLSOs

Recruitment is difficult due to an extremely low starting salary

We have lost several highly trained and long serving biomedical scientists in recent

months, all of them going to jobs outside the NHS

Introduction

15. The focus of this report relates primarily to MLSOs and the relatively new grade of

Medical Laboratory Assistant (MLA). Recruiting MLSOs to work in NHS laboratories is

becoming increasingly difficult. These difficulties were first identified in theReview of Acute

Services1and have since been identified by Porter (1998)3

and Johnston and Milne (1999)4.

The use of MTO grades, MLAs and the permanent locum are now established employment

strategies as shown by a recent survey, conducted by the IBMS2, which has confirmed the

extent of the problem throughout the UK. Our own survey, conducted as an integral part of

the work of this Group, revealed broadly similar findings (see Appendix III).

Current Issues

16. Two main factors dominate the problem of recruitment at all levels of non-medical

laboratory staff. These are:

low pay competition from industry in the Science and Technology sector.

Possible Solutions

Pay and Conditions of Service

17. According to a recent report from the Association of Graduate Recruiters (AGR)Warwick

5, graduates in science and engineering, starting their careers in research and

development and other technical roles, are earning median salaries of 17,250, and those with

qualifications in information technology and computer science are earning a median of

17,500.

18. By contrast, MLSOs have a training grade with a pay scale ranging from 9,726 to

10,782. This reflects the fact that the starting salary for trainees has been boosted by over

20% in this years pay round in recognition of the fact that low pay has been a factor in on-

going recruitment difficulties. On attaining State Registration (normally within one year),

MLSO 1s move on to a salary scale ranging from 13,066 to 17,195.


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19. There is further scope for Trusts to advance the salary of an MLSO1 up to 19,343 if

the post carries additional responsibility or if it requires specialist skills which do not justify a

higher grade. Nonetheless, the majority of trainee and qualified MLSOs consider themselves

to be poorly paid relative to other similarly qualified staff in the NHS, other parts of the

public sector and the private sector.

20. The review has identified some practice and potential developments that may go some

way to ameliorating this position. While appointments should normally be made to the

minimum of the appropriate Whitley Council scale for the grade, employers do have

discretion to appoint to any point on the scale, having regard to local conditions, skills,

experience and qualifications. There is evidence that some employers have been using this

flexibility to offer above the minimum rate of pay in an effort to attract good quality

candidates. At best, however, such an approach only addresses issues short term.

21. In the longer term, current UK negotiations on NHS pay modernisation may offer the

prospect of some improvement. The development of an NHS-wide job evaluation system

should identify whether MLSO posts are of equal value to other similarly qualified posts in

the NHS. Issues of equal pay for equal value should therefore be addressed. A further part of

the pay modernisation negotiations will cover the possibility of extending the remit of the

Nursing, Midwives, Health Visitors and Professions Allied to Medicine Pay Review Body

(NPRB). If MLSOs are one of the staff groups which achieve NPRB status this will have a

positive impact on recruitment and retention.

Key Issues:

22. Present rules dictate that MLSOs must possess a degree in biomedical sciences

accredited by the IBMS and approved by the CPSM, the body which is responsible for State-

registration of MLSO staff. A view has been expressed that current CPSM regulations forregistration are too restrictive. Many science graduates who possess a degree that is notin

Biomedical Science are required, depending upon the degree content, to attend a top-up day

release course at an approved university before they are eligible for State registration. Over

the years this has contributed to an inability to recruit staff. The Group therefore believes

that 4 year Honours degree courses in Scotland, provided they meet all the statutory

requirements, should be tailored more to the needs of a clinical laboratory service. At

present, these courses are offered by The Robert Gordon University, Aberdeen; Napier

University, Edinburgh; Glasgow Caledonian University and the University of Paisley.

23. The fact that MLSOs increasingly belong to a graduate-only profession is in itself a

clear recognition of the high level of qualifications and skills required to carry out laboratoryscientific work and the acquisition of such qualifications and skills should be encouraged.

Graduate entry requires medical laboratory based training at an appropriate level to fulfil the

requirements of state registration and to ensure that the skills acquired are fully relevant in

the context of the modern NHS laboratory.

24. In addition, applicants with Highers in science subjects should be given the

opportunity to progress to graduate level and state registration. To facilitate this matter,

dialogue with those Universities offering courses in biomedical science needs to be opened as

a matter of urgency. The re-introduction of part-time courses needs to be explored along with


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the introduction of a link year as part of the 4-year Honours course where students gain the

necessary practical laboratory experience.

25. The Group advocates the need for supernumerary posts for trainee MLSOs in Scotland

to link in with the rural / urban training initiative, (see paragraph 41). A model to be followed

is the NMET Levy System currently being established in England and Wales.

Competition from the Science and Technology Sector:

26. The NHS is unable to compete for applicants on an equal footing with outside

industry. This problem is likely to increase since commercial science is already an expanding

industry in Scotland.

27. In order to attract highly qualified and trained staff it is important that the Nursing

Directorate and the Directorate of Human Resources of the Scottish Executive, Universities,

employment organisations and professional bodies work together to encourage recruitment

and develop career pathways for staff entering laboratory medicine.

Recommendations

Although pay and conditions of service lie outwith the remit of this Working Group, the

Group welcomes the fact that these issues are being examined in other fora, e.g. theNational Pay Review Body, Agenda for Change Pay Modernisation. The Group

believes that the inclusion of MLSOs in the National Pay Review Body would have a

positive impact on recruitment and retention.

4 year Honours degree courses in Scotland, provided they meet all the statutory

requirements, should be tailored more to the needs of a clinical laboratory service.

(Paragraph 22).

Applicants with Highers in science subjects should be given the opportunity to progress

academically to graduate level. (Paragraph 24).

The re-introduction of part-time courses needs to be explored along with the

introduction of a link year as part of the 4-year Honours course where students gain the

necessary practical laboratory experience. (Paragraph 24).

The Nursing Directorate and the Directorate of Human Resources of the Scottish

Executive, Universities, employment organisations and professional bodies should work

together to encourage recruitment and develop career pathways for staff entering

laboratory medicine. (Paragraph 27).


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III. TRAINING

Graduate staff feel aggrieved that we cannot accept their Honours degrees without their

attendance at a further top-up course when they realise that the top-up course has little

relevance to their everyday work

Due to increased workloads, qualified MLSOs have very little time to fulfil training

needs

Our location away from the major training centres means that staff require much more

time off to follow Continued Professional Development. This problem needs to be tackled

urgently

Due to our geographical position, trainees effectively incur a 16 hour day taking into

account the 155 mile round trip to attend classes

Introduction

28. At present, different approaches are adopted for the training of MLSOs and MLAs

according to local practice. In addition, there are approaches such as the mandatory use of

log books for all who are in training for State registration and compliance with IBMS

guidance. The IBMS / DoH training manual for MLAs is currently widely used.

29. MLSOs are required to be State registered and are thereby subject to the rules and

governances of the CPSM as administered by the Medical Laboratory Technicians Board.

There are four post-registration grades and MLSOs normally require further postgraduate

qualifications and training to progress through the grading structure. MLSO in-servicetraining is geared towards ensuring that the registrant gains sufficient practical ability to

undertake the duties of the particular discipline. Students generally specialise in one of the

main disciplines prior to State Registration. Increasingly, a multi-disciplinary approach to

training is being encouraged and the CPSM log books recognise this with the recently revised

log books. It is the view of the CPSM that registrants should undergo an appropriate course

of training for all the disciplines that they are expected to practice in.

30. At present, there are only 82 MLSO trainees in Scotland which equates to just 4% of

the total MLSO workforce.

31. Entry into the MLA grade does not require any school leaving qualifications or indeedany educational qualifications. These staff undergo training programmes to provide them

with the practical skills needed to support the routine work of a pathology laboratory. The

training programmes do not, however, lead to any qualifications. They always work under

the supervision of qualified staff.

Current Issues

32. Key issues affecting the training of MLSOs include:


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the difficulties of training staff in-house when having to operate a 24-hour service andshift systems

differences between the university education systems in England and Scotland the lack of a formal training programme and career progression structure for MLAs the provision of education and training for staff who are based in remote and rural

areas, and

no recognition of commitment / resources required to organise training.Possible Solutions

Review of the Core Curriculum:

33. The CPSM and the IBMS should jointly undertake a review with the universities of

the core curricula of degree courses to ensure that they reflect modern laboratory practice.

Role extension of MLSOs is likely to involve a change in the direction of training to a more

widely based concept both in the acute and primary care settings in some of the laboratory

disciplines. Many MLSOs already undertake tasks such as film reporting, near-patient clinics

for anti-coagulant and diabetic control, peripheral blood stem cell harvesting, histology tissue

cut-up, etc. In addition, current trends in laboratory work patterns, including converging

technology, have enhanced the capacity for multi-tasking of technical and scientific staff in

appropriate circumstances. In most disciplines of clinical laboratory medicine, MLSOs are

responsible for validation, quality control and reporting of the laboratory results. Work

pressures on pathologists are also extending the professional role of the MLSO. For example,

the Royal College of Pathologists and the IBMS have recently agreed the development of anAdvanced Practitioners Grade within Cytopathology with a wider range of responsibility and

reporting powers. Advances in information technology continue to have a significant impact

on the ability of laboratory staff to extend cover to remote and rural areas. It is important that

the roles and interface of scientific staff receive critical attention within all disciplines.

34. There is a need to make a clear distinction between requirements for basic education

and those forfurther training. Under the category of further training, appropriate programmes

should be designed to accommodate the requirements of multi-tasking in the core section of

larger laboratories, (which may provide services on a regional basis), and / or a laboratory in

a remote and rural location and these should be appropriately funded.

University / NHS Interface:

35. The Group recommends that the IBMS and CPSM should foster closer links with

Universities in Scotland. In particular, different styles of teaching modules, e.g. distance and

open learning, should be explored. Relevant universities should critically examine, in

conjunction with IBMS and CPSM, the course content of biomedical science degrees for its

suitability for careers in laboratory medicine. At present there is only a limited number of

universities offering suitable courses for part-time education. These are Napier University;

Glasgow Caledonian University and the University of Paisley. This has implications both in

terms of finance and time for departments in remote and rural areas.


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Training Opportunities:

36. In addition to proficiency in technical skills, MLSOs in many disciplines are required

to be proficient in scientific, interpretative, diagnostic and monitoring skills. The IBMS and

the CPSM promotes the view that MLSOs should be educated in the clinical aspects of theirdisciplines. It also requires them to be proficient post-diagnosis so that they can aid in the

monitoring of treatment and thereby make a crucial contribution to the clinical management

of such patients. Opportunities should be taken to allow MLSO training to take place at the

clinical interface. Examples from the acute and primary care sectors could include training

for work in lipid and diabetic clinics, anti-coagulant clinics, allergy skin-testing clinics and

community health centres. The Royal College of Pathologists and IBMS are currently

considering a number of joint initiatives in this area. MLSOs could also be used as much

more of a resource in the context of the education of medical and nursing staff. Such

activities would help MLSOs to raise their profile, foster a sense of team working and utilise

staff to their full potential.

37. Managers will be aware of, and should adhere to, the recommendations set out in theStrategy for Education, Training and Lifelong Learning11 and the opportunity that this

affords all NHS staff to develop their skills and to deliver a high quality service.

38. The key aims of this Strategy are to modernise the NHSScotland by promoting:

Fitness for purpose: to ensure that all NHS staff are equipped with the skills,knowledge and attitudes to deliver the services patients and their families expect.

Improved access and opportunity: to ensure that all NHS staff in Scotland aresupported and encouraged to develop and maintain their skills.

A flexible workforce: that is capable of responding efficiently to change in clinicalpractice and new methods of service deliveries.

Effective team working: encouraging methods of working and learning which promotean integrated approach to patient care.

Recruitment and retention: career progression and job satisfaction which fulfils theneeds and aspirations of all NHS staff in Scotland regardless of their social, academic

or ethnic backgrounds.

Staff development as an investment in quality: by raising awareness among NHSBoards, managers and service planners of the value of education, training and lifelonglearning in delivering quality services.

39. The Strategy means that staff throughout NHSScotland will be encouraged to take

greater responsibility for their own learning. In return they can expect:

Support from their employer in helping them to keep up-to-date and acquire newskills, including access to appropriate learning resources and to induction training.


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The opportunity to sit down with their managers / senior professional colleagues atregular intervals, to discuss their development needs and identify learning

opportunities.

Help in preparing personal development plans and / or learning portfolios whichsupport their career development using as a model the IBMS PDP plan.

Local decisions about investment in education and training activities, including accessto funding, based on a recent assessment of learning needs and the service

development objectives of the NHS.

To take part in team-based learning as well as development activities. To have their skills and competencies recognised as part of the continuous process of

lifelong learning.

40. To ensure that NHSScotland has staff with the necessary skills and knowledge, the

Working Group recommends that MLSOs, in conjunction with Trusts and with the

collaboration of MSF and IBMS, be involved in the preparation of workforce needs

assessments so that they reflect the change in need for a fully staffed and appropriately

skilled laboratory service. These workforce needs assessments are required to accompany all

service change proposals put to NHS Boards. The Group also recommends that MLSOs

should ensure that local approaches to Continuing Professional Development, as part of the

development of local learning plans, should be channelled through their professional body,

the IBMS, with support from their MSF representative.

41. All NHS employers were asked by December 2000 to ensure that all their staff have

personal development plans, backed up by the opportunity to discuss their learning needs at

regular intervals.

Training of MLA Staff:

42. At present there is no programme for the formal training of MLAs or a recognised

career structure where achievement is rewarded. A formal training scheme should be

introduced which could lead to recognised qualifications. A career structure which

recognises the different roles undertaken by MLA staff should be considered.

Training for Staff in Remote and Rural Areas:

43. At present, there is no programme of distance learning available in Scotland. Thenearest course is available from the Virtual School of Biomedical Science, University of

Ulster. The development of a Scottish-based distance learning course would help to train

laboratory staff in remote and rural areas without the need to travel long distances and take

time off work.

44. The need to support laboratory services in geographically different sites is relevant to

a significant number of acute Trusts across Scotland. The support needs to encompass issues

wider than that of basic training per se to include, for example, multi-tasking, accreditation

and information technology. Opportunities for secondment should be made more widely

available to allow a free-exchange of staff from a remote and rural area to central Scotland


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and vice versa. If necessary, financial incentives should be put in place to allow this to

happen effectively.

45. A training network, focused on the training needs of MLSOs would help to knit

together all the different strands of the service from every part of Scotland. It would also act

as a forum to ensure that all staff achieve Continuing Professional Competencies which, it isunderstood will become mandatory under the proposals of the Health Care Professional

Council, (HCPC), and can demonstrate continuing professional development. This might be

achieved through the use of supernumerary MLSO training posts or by means of

networking training between a rural district general hospital and a teaching hospital which

is a CPSM approved training centre with cross-secondment between laboratories. This could

either take place within a health board or across health boards. The Remote and Rural Areas

Resource Initiative, (RARARI), would seem to be the appropriate body to facilitate the

development of this network.

Recommendations

The IBMS and the CPSM should foster closer links with relevant Universities in

Scotland and jointly undertake a review of the core curricula of degree courses to

ensure continuing relevance. In addition, different styles of teaching modules, e.g.

distance and open learning, should be explored. (Paragraphs 33 and 35).

More opportunities should be taken to allow MLSO training to take place at the clinical

interface. Such activities would help MLSOs to raise their profile, foster a sense of team

working and utilise staff to their full potential. (Paragraph 36).

Managers will be aware of, and should adhere to, the recommendations set out in the

Strategy for Education, Training and Lifelong Learning and the opportunity that thisaffords to all NHS staff to develop their skills and to deliver a high quality service.

(Paragraph 37)

All MLSOs, in conjunction with Trusts, should be involved in the preparation of

workforce needs assessments through MSF and the IBMS- so that they reflect the

change in need for a fully staffed and appropriately skilled laboratory service. MLSOs

should ensure that local approaches to Continuing Professional Development, as part of

the development of local learning plans, should be channelled through their professional

body. (Paragraphs 40 and 41).

A formal training scheme for MLAs should be introduced leading to an improvedcareer structure.(Paragraph 42).

A training network focused on the training needs of MLSOs, would help to knit

together all the different strands of the service from every part of Scotland and should

be facilitated by RARARI. (Paragraph 45).


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IV. RETENTION

There is little to offer staff with no prospects of promotion and an escalating workload

Introduction

46. Staff retention is a major problem. This was highlighted in our survey and also in the

survey conducted by the IBMS2. Furthermore, the IBMS Annual Report for 1998

12singled

out the continued decline in the number of MLSO4 grades, (the most senior grade), as a

source of particular concern.

Current Issues

47. A number of factors affect staff retention. These include:

inadequate remuneration little opportunity for career progression a sense of not being a part of the hospital team / absence of direct patient contact in

some laboratory disciplines

low morale escalating workloads [see Appendix III] competition from outside industry offering career progression and improved prospects

for remuneration, and

requirements for a 24-hour service.48. The situation is also exacerbated by the ageing profile of the laboratory workforce. In

Scotland, 80% of MLSOs are more than 35 years of age and 37% are more than 45 years of

age, (see Appendix III).

Possible Solutions

New Technology:

49. Over the past thirty years, the development of automated analysers has had a profound

effect on medical laboratories. In Clinical Chemistry, several instruments now have the

capacity to offer a menu of over 100 general chemistry tests. In Immunology,

immunoassays, which previously were only available after days of analytical processing, can

now be analysed within hours. Full blood counts and coagulation results are available rapidly

and automated analysers are now also available for a range of immunological, virological and

antibiotic assays. More recent developments mean that it is now possible to carry out assays

from different laboratory disciplines on the same analytical platform, (e.g. clinical chemistry,


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immunoassay and haematology analysers can be bolted together, with a single shared sample

processor) as part of a modular approach.

50. The benefits of automation may not always be apparent to laboratory staff, some of

whom even view these developments as a threat to their professional skills. However, if the

bulk of the routine analysis can be completed easily with minimum intervention from highlytrained MLSO staff, time will be freed up for the more challenging tasks of audit, teaching

and training, research and development, quality management and improved communications

with other health care professionals, all of which enhance job satisfaction.

Enhanced Job Satisfaction:

51. In the light of technological development and changing patterns of service delivery,

there needs to be a radical re-think about job design, the structure of the grading system and

the need to match the expectations of graduates with realistic and rewarding responsibilities.

52. There is no doubt that cross-disciplinary working (i.e. multi-tasking), which

makes greater use of core skills to span specialty boundaries, is on the increase. Attempts

should be made to enhance job satisfaction through role extension, for example, into the field

of diagnosis / reporting of results, provided this is underpinned by appropriate training and

approved by the medical head of the laboratory. Flexible working, short-term placements

and facilitation of movement between academic and service sectors should also be explored

more actively than at present. These proposals should go some way to resolve present

problems resulting from rigidly defined professional boundaries and ill-defined career

pathways which make movement between different grades difficult.

Career Progression:

53. The present grading structure impedes career progression. It is also outmoded andserves no useful purpose in the context of a modern laboratory. The structure of departments

means that there is usually only one MLSO4 in any given laboratory and a limited number of

MLSO3 posts. The paucity of MLSO 2, 3 and 4 posts, (see Appendix III), means that

opportunities to secure promotion are few and far between. Furthermore, MLA grades, with

neither a structure nor a formal training scheme, have not been particularly successful in

terms of retention.

54. The ability to progress through grades is an attractive one to most employees, with

the promise of reward. The Group therefore propose that an integrated career structure with

multiple entry points should be introduced for all MLAs and MLSOs. The structure would

have entry points from school leavers to graduates with a commitment to lifelong learningand continuing professional education. Progress through the structure would be dependent

upon qualifications, ability and aptitude.

55. Certain jobs and skills are common to all disciplines and these should form the basic

training for all medical laboratory workers (MLSOs and MLAs). This includes pre-analytical

work, health and safety, record keeping, reagent preparation and clinical waste disposal.

Techniques common to most disciplines, such as the use and maintenance of equipment,

including loading automated analysers, should form the next stage of training. Further stages

will include specialisation and training leading to State registration and beyond for

postgraduate staff.


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56. The potential for lateral movement into other areas of NHSScotland, should be

encouraged.

Raising the Profile:

57. It is an unfortunate fact that there is a general lack of awareness amongst both NHS

employers and the public about the contribution made by laboratory staff to health care

delivery13

. Laboratory staff are perceived by many members of senior NHS management to

be remote from the rest of the hospital, resistant to change and unwilling to become involved

in management issues. On the other hand, laboratory staff themselves often sense resistance

on the part of clinicians and managers to let them become more involved in issues of

common concern. The Group recommends that all Trusts should encourage the professional

representation of laboratory staff by laboratory staff at Clinical Directorate level within the

organisation. The person appointed should be accorded equal status with other lead

professional heads. It is known that such an arrangement has already been tried and tested in

at least one Trust in Scotland to good effect.

58. There is a need for MLSOs to develop links beyond the confines of the laboratory.

To some extent, this is already happening in some of the laboratory disciplines because of

increased opportunities for MLSOs to undertake near-patient testing on the ward or in the

clinic and to meet the needs of general practitioners working in the community. In addition

to this, technological developments such as small analysers for use outwith the hospital

laboratory, are likely to result in more interaction between laboratory staff and the users of

the service. Control of infection and the public health aspects of laboratory work are prime

areas which call for laboratory staff to be interactive with other colleagues in the Service.

Staff should build on these opportunities to raise their profile among the general public and

other health care professionals.

Regulation of a 24-hour Service:

59. A 24-hour service is now more or less mandatory in every hospital laboratory but the

type and level of service varies according to the laboratory setting and the subsequent

demands that are placed upon the laboratory. The Working Group believes that the voluntary

aspect currently attached to this service no longer conforms with the demands of the modern

NHS and is increasingly anomalous. The Group believes it is crucial that each laboratory has

a sufficient pool of staff to operate a 24 hour service, recognising that not all staff will be

willing to participate in the on-call rota at any given time.

Recommendations

Attempts should be made to enhance job satisfaction through role extension, for

example, into the field of diagnosis / reporting of results, provided this is underpinned

by appropriate training. Flexible working, short-term placements and facilitation of

movement between academic and service sectors should also be explored more actively

than at present. (Paragraph 52).

An integrated career structure with multiple entry points should be introduced for all

MLAs and MLSOs. The structure would have entry points from school leavers to


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graduates with a commitment to lifelong learning and continuing professional

education. (Paragraph 54).

The potential for lateral movement into other areas of NHSScotland should be

encouraged. (Paragraph 56).

All Trusts should encourage the professional representation of all laboratory staff by

laboratory staff at Clinical Directorate level within the organisation. The person

appointed should be accorded equal status with other lead professional heads.

(Paragraph 57).


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V. SUMMARY OF MAIN RECOMMENDATIONS

Recruitment:

1. Although pay and conditions of service lie outwith the remit of this Working Group,

the Group welcome the fact that these issues are being examined in other fora, e.g. the

National Pay Review Body, Agenda for Change Pay Modernisation. The Group

believes that the inclusion of MLSOs in the National Pay Review Body would have a

positive impact on recruitment and retention. (Paragraph 21).

2. 4 year Honours degree courses in Scotland, provided they meet all the statutory

requirements, should be tailored more to the needs of a clinical laboratory service.

(Paragraph 22).

3. Applicants with Highers in science subjects should be given the opportunity to

progress academically to graduate level. (Paragraph 24).

4. The re-introduction of part-time courses needs to be explored along with the

introduction of a link year as part of the 4-year Honours course where students gain the

necessary practical laboratory experience. (Paragraph 24).

5. The Nursing Directorate and the Directorate of Human Resources of the Scottish

Executive, Universities, employment organisations and professional bodies should work

together to encourage recruitment and develop career pathways for staff entering

laboratory medicine. (Paragraph 27).

Training:

6. The IBMS and CPSM should foster closer links with relevant Universities in Scotland

and jointly undertake a review of the core curricula of degree courses to ensure

continuing relevance. In addition, different styles of teaching modules, e.g. distance and

open learning, should be explored. (Paragraphs 33 and 35).

7. More opportunities should be taken to allow MLSO training to take place at the

clinical interface. Such activities would help MLSOs to raise their profile, foster a sense

of team working and utilise staff to their full potential. (Paragraph 36)

8. Managers will be aware of, and should adhere to, the recommendations set out in the

Strategy for Education, Training and Lifelong Learning and the opportunity that thisaffords to all NHS staff to develop their skills and to deliver a high quality service.

(Paragraph 37).

9. All MLSOs, in conjunction with Trusts and with the collaboration of MSF and IBMS,

should be involved in the preparation of workforce needs assessments so that they

reflect the change in need for a fully staffed and appropriately skilled laboratory

service. MLSOs should ensure that local approaches to Continuing Professional

Development, as part of the development of local learning plans, should be channelled

through their professional body. (Paragraphs 40 and 41).


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10. A formal training scheme for MLAs should be introduced leading to an improved

career structure. (Paragraph 42).

11. A training network, focused on the training needs of MLSOs, would help to knit

together all the different strands of the service from every part of Scotland and should

be facilitated by RARARI. (Paragraph 45).

Retention:

12. Attempts should be made to enhance job satisfaction through role extension, for

example, into the field of diagnosis / reporting of results, provided this is underpinned

by appropriate training. Flexible working, short-term placements and facilitation of

movement between academic and service sectors should also be explored more actively

than at present. (Paragraph 52).

13. An integrated career structure with multiple entry points should be introduced for

all MLAs and MLSOs. The structure would have entry points from school leavers to

graduates with a commitment to lifelong learning and continuing professional

education. (Paragraph 54).

14. The potential for lateral movement into other areas of the NHS should be

encouraged. (Paragraph 56).

15. All Trusts should encourage the professional representation of all laboratory staff

by laboratory staff at Clinical Directorate level within the organisation. The person

appointed should be accorded equal status with other lead professional heads.

(Paragraph 57).


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References

1. The Scottish Office Department of Health. Acute Services Review Report. Edinburgh:

The Stationery Office, 1998.

2. Institute of Biomedical Science / The Gillett Consultancy. A Survey of Recruitment andRetention amongst Biomedical Scientists employed in the National Health Service. IBMS,

London. 2000.

3. Porter A R. MSF Heads of Pathology Departments 1998 Survey. Biomedical Scientist

1998; 42: 707.

4. Johnston P W, Milne G D. A survey of factors affecting the recruitment and retention of

Medical Laboratory Scientific Officers in Pathology.Health Bulletin 1999; 57(6): 393-398.

5. Institute of Employment Studies. Graduate Salaries and Vacancies 1999 Survey.

Association of Graduate Recruiters, Warwick 1999.

6. Staffing crisis hits testing of patient samples. The Herald24 January 2000.

7. Laboratory cut-backs [Opinion Leader] The Herald26 January 2000.

8. Browne A, McSmith A. Cuts force secretaries to diagnose cancer tests. The Observer.

23 January 2000.

9. Laboratory staff lobby Wesminster.Medical Laboratory World. May 1999.

10. Ward S. Down the tubes.Health Service Journal 25 May 2000: 22-23.

11. Scottish Executive Health Department. Learning Together: A Strategy for Education,

Training and Lifelong Learning for the National Health Service in Scotland. Tactica

Solutions, Edinburgh. 1999.

12. Institute of Biomedical Science. Annual Report: 1998. IBMS, London. 1999.

13. Connolly C, Huckerby D. Test match.Health Service Journal 25 May 2000: 24-25.


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APPENDIX I

MEMBERSHIP OF THE WORKING GROUP

Chairman:

Mr T Cavanagh Laboratory Manager /Senior Chief MLSOWestern Infirmary, Glasgow.

Members:

Ms M Allardyce Senior Chief MLSO (Haematology)

Aberdeen Royal Infirmary.

Dr E G Buckley Executive Director

Scottish Council for Postgraduate Medical

and Dental Education.

Dr R A Burnett Consultant Pathologist

Western Infirmary, Glasgow.

Mr J Deans MLSO 4 (Haematology)

Falkirk & District Royal Infirmary

Mr R Fleet Pathology Laboratory Manager

Borders General Hospital

Mr M Fuller Regional Officer, MSF.

Mr E Galloway MLSO 3 (Immunology)Western Infirmary, Glasgow.

Mr S Greep Trust Chief Executive

Ayrshire & Arran Acute Hospitals

NHS Trust.

Mr R A McCartney Head MLSO (Regional Virus Laboratory)

Gartnavel General Hospital, Glasgow.

Mr G D Milne MLSO 4 (Pathology)

Aberdeen Royal Infirmary.

Dr D C Old Reader in Medical Microbiology

Ninewells Hospital, Dundee.

Mr J K Rae Head MLSO / Pathology Services Manager

University of Edinburgh Medical School

Mr J T Scott Laboratory Manager

Edinburgh and S E Scotland

Blood Transfusion Service.


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Mr R Singer Business Manager / Laboratory Manager

Ninewells Hospital, Dundee.

Mr D Swan Senior Chief MLSO (Clinical Microbiology)

Western Infirmary, Glasgow.

Officers:

Dr A Keel DCMO (Management Executive)

Scottish Executive Health Department.

Mr J N Leadbeater Health Care Policy Division

Scottish Executive Health Department.


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APPENDIX II

SUMMARY OF THE MAIN LABORATORY DISCIPLINES

Clinical Chemistry

Clinical Chemistry (also called Clinical Biochemistry or Chemical Pathology) is the study of

the chemical constituents of the human body in health and disease. Most tests are carried out

on blood or urine but other body fluids, cells and tissues may also be analysed. It is

increasingly concerned with major screening programmes of neonates and adults. The

discipline is primarily a hospital-based service but offers a significant service to general

practitioners.

Staff perform a wide range of tests including routine automated tests, metabolic function tests

and endocrine tests in order to determine the diagnosis of metabolic disease and to monitor

drug therapy. They may also be required to investigate drug overdoses. The discipline is a

highly automated one which has a large volume of work and a wide range of laboratory

investigations.

Blood Transfusion

The Scottish National Blood Transfusion Service (SNBTS) is a division of the Common

Services Agency of NHS Scotland and is organised and co-ordinated on a national basis. It is

responsible for the collection of voluntary blood donations and for the preparation and

provision of an adequate supply of safe blood components and blood products.

Staff perform tests to determine blood grouping and antibody identification in order to

provide compatible blood and blood products. This service is essential in the acute hospital

context where modern medical techniques and treatments rely heavily upon the support ofsuch products being available. Staff also undertake specialised testing for the resolution of

grouping and matching problems, the preparation of diagnostic grouping reagents, the

provision of rare blood and tissue-matched blood products and the preparation of blood

components and plasma fractions in order to supply the needs of acute hospital Trusts.

Haematology

Haematology is the study of blood and blood forming tissues. Haematology laboratories

provide an investigative, diagnostic and clinical service for the care of patients with anaemia,

haematological malignancy, haemaglobinopathies and coagulation abnormalities. Laboratorystaff perform a wide range of tests on blood and bone marrow aimed at diagnosing and

managing haematological conditions ranging from leukaemia to control of anti-coagulant

therapy.

Cellular Pathology

Cellular pathology encompasses two related but different elements: Histopathology and

Cytology.


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Histopathology

Histopathology is concerned with the diagnosis and management of disease through the

examination of tissue which has been obtained through surgical removal, biopsy or autopsy.

Staff prepare tissue removed during surgery or at post mortem using techniques such asmicrotomy, routine and specialised staining procedures and frozen sections so that they can

be examined under the microscope. Nowadays, increasing use is made of

Immunocytochemistry and Molecular Biology techniques as an aid to diagnosis.

Cytology

Cytology is the microscopic study of free cell specimens. It is usually, though not always,

closely linked to Histopathology, and refers to the examination of exfoliated or aspirated

cells. It plays a crucial role in the national breast and cervical screening programmes.

Screening of cervical smears and non-gynaecological cellular material forms a large part of

the workload. Fine needle aspiration of abnormal tissue (e.g. breast lumps) is increasingly

being used for rapid diagnosis. Laboratory staff are involved in preparatory techniques in

cytology and also in studying the cells under investigation to detect abnormalities.

Autopsy

Post mortem examinations are performed by staff in histopathology departments and are

undertaken either on behalf of clinicians or at the request of the Procurator Fiscal. Accurate

information on cause of death is a pre-requisite for health service planning and the autopsy

provides one of the most direct means of clinical audit and is an accurate measure of quality

of care.

Medical Microbiology

Staff in medical microbiology laboratories in the NHS are primarily concerned with

providing a service to clinicians to aid in the diagnosis and treatment of microbial diseases

such as meningitis, respiratory tract, enteric and wound infections. They also provide a

public health function by assisting in the control of epidemic and sporadic disease.

Tests are carried out to isolate and identify disease-causing micro-organisms, fungi, protozoa

and parasites. Serum is tested for antibodies to infective agents and for microbial antigens.

Specimens commonly examined are blood, urine, faeces, sputum and swabs from various

body sites.

Virology

Virology, together with bacteriology and mycology, is concerned with the study of all aspects

of disease caused by infectious agents.

Staff in virology laboratories are primarily concerned with the detection and identification of

viruses such as herpes, influenza and the human immunodeficiency virus (HIV). Tests

include the culture of viruses in living cells, testing of blood samples for antibodies to viruses

and the use of specialised techniques for the detection of viral particles in human tissue.

These laboratories also have a heavy routine commitment to population screening for


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immunity to hepatitis and rubella and to monitoring the efficacy of vaccines. Molecular

biology techniques are widely applied.

Immunology

Immunology is concerned with the study of the diseases of the immune system.

Staff in immunology laboratories specialise in the investigation of abnormalities and

disturbances of the immune system associated with, for example, bacterial and viral

infections, parasitic infestation, allergy, malignant and autoimmune diseases and

immunological deficiencies. Changes are analysed in antibodies and other proteins and

leukocytes are identified in conditions such as leukaemia and AIDS. Investigations take

place in order to assess responses to vaccination or treatment and, in transplant recipients, to

measure the function of their immune system.

Histocompatibility / Tissue Typing

Histocompatibility / Tissue Typing laboratories provide HLA (tissue) typing services pre

solid organ or bone marrow transplantation. Such laboratory tests are a prerequisite to

determining whether a potential donor is compatible with the recipient in order to avoid

major problems of rejection. Certain tissue types are also associated with specific diseases

and histopathology laboratories undertake the tests necessary to determine such links.


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APPENDIX III

SUMMARY OF SCOTTISH SURVEY ON RECRUITMENT, TRAINING AND

RETENTION OF MEDICAL LABORATORY SCIENTIFIC OFFICERS

The Survey

Questionnaires were sent to all Head MLSOs and Laboratory Managers in Scotland. Replies

were received from 120 out of 143 possible respondents, representing a response rate of 84%.

It was not possible to identify or follow up the outstanding questionnaires since respondents

had been assured a guarantee of anonymity. Nearly a hundred written comments were

received with the returned questionnaires. The questionnaire was conducted during the

period 1-30 September 1999.

Over the past 2 years, staff vacancies accounted for 25% of the total MLSO complement(50.5 w.t.e.) for Cellular Pathology; 21% (014.73 w.t.e.) for Haematology; 17% (12

w.t.e.) for Virology; 15.5% (71.73 w.t.e.) for Biochemistry and 13% (54.83 w.t.e.) for

Microbiology.

Over the past 2 years, the average time to fill vacancies amounted to 45 weeks for 2 postsin Immunology; 9 weeks for 9 posts in Blood Transfusion and 8 weeks for 104.73 w.t.e.

posts in Haematology.

Currently 25% of MLSOs in Scotland are graduates and 8% possess a higher degree.With the move to all-graduate recruitment, these percentages are set to increase

dramatically over the next few years.

The accompanying graphs illustrate the results of the survey.


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APPENDIX IV

SUMMARY OF IBMS SURVEY ON RECRUITMENT AND RETENTION OF

BIOMEDICAL SCIENTISTS EMPLOYED IN THE NATIONAL HEALTH SERVICE

The Survey

Questionnaires were sent to 1,163 NHS Trust Pathology Managers and Senior Medical

laboratory Scientific Officers to ascertain recruitment and retention status in NHS Pathology

laboratories in the UK. The survey was conducted between Christmas 1999 and 21 January

2000.

Perceptual data was received from 68% of Trusts in England and Wales, with full statistical

data from 39%. Data were also received from 8 trusts in Scotland and Northern Ireland, 8

PHLS laboratories and 12 private hospitals.

The Workforce

88% of all Trust laboratories were understaffed 62% of all Trusts had unfilled vacancies 66 % of all Trusts considered their MLSO establishment was inadequate There is a calculated 1,255 shortfall in MLSO numbers in NHS Trusts in England and

Wales, of which 1,052 are MLSO 1 vacancies

Over 20 % of laboratories report the following impacts of these staff shortages (on freeexpression):

-training stopped or suffered

-staff under stress

-falling service delivery

-failings developing in Quality Assurance and Quality Control systems

-Difficulties in maintaining on-call services

50% of MLSOs have a degree, 25% having a BSc in Biomedical Science.Recruitment

89% of Trusts sought to recruit MLSOs in 1999, 54% failed to fill all vacancies and 18%failed to appoint any new MLSO staff

68% of Trusts sought to appoint Trainee MLSOs in 1999. 61% felt fields of applicantswere adequate (9.19 candidates per post)

61% of Trusts sought to appoint MLSO1s in 1999. 93% felt fields were inadequate (2.95candidates per post) and 50% failed to appoint altogether. Where appointments were

made these often took protracted periods of time and multiple advertisements


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98% of respondents thought that recruitment problems were getting worse Histology / cytology was the most problematical discipline to recruit to, with 40% of

respondents reporting particular difficulties for Histologist recruitment

97% of respondents spontaneously cited pay levels as a key recruitment problem

25% cited poor public image and a similar 25% cited lack of career prospects as problems Training and development issues, and a lack of comparability with other NHS graduate

groups were also seen as hindering recruitment.

Retention

Over three quarters of laboratories reported highest staff turnover rates for the MLSO1grade

60% reported highest turnover rates for staff between 20 and 30 years The mean MLSO1 turnover rate was 16.47% in 1999 Reasons for leaving. gleaned from exit interviews were given as:

-low pay (61%)

-stressful working conditions (19%)

-low morale / lack of career status (18%)

-career change (10%)

Only 21% of resignations were attributed to routine career progressions (promotion,retirement or moving away)

A mean of 56% of leavers were reported as leaving the NHS altogether, while one-fifth ofTrusts reported that ALL their leavers left the Health Service

40% of Trusts reported offering enhancements to salary terms in order to attract andretain staff, though this was significantly more common in London and least common in

Scotland.

Working Practices

76% of all Trusts use inappropriate staff groups to cover Biomedical Scientist duties.Most commonly used substitute staff are Trainee MLSOs (71%), MLAs (59%) and non-

State-Registered locum cover (21%)

Approximately half the Trusts responding believed that Biomedical Scientist recruitmentand retention problems were not recognised by their Human Resources Director. Fewer

still (40%) thought their problems were recognised by the Trust Chief Executive and only

10% believed that their Health Authority saw BMS recruitment and retention as a

problem


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Regional Education Consortia provided 23% of Trusts with funds for education, 20%with funds for training, 11% with funds for continuing professional development and 4%

with funds for personal development planning

By far the most significant issue emerging from a free expression invitation to commenton the current state of BMS recruitment and retention was that of low pay (53%). Low

morale (14%), wrong career structure (12%) and lack of training provision (10%) also

featured prominently.

Reproduced with kind permission from the Institute of Biomedical Science.

Documents

Training and Retention of Medical Laboratory Scientific Officers