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

ET

EN

CIE

S

LE

AR

NIN

G A

ND

DE

VE

LO

PM

EN

T

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

• Sue.hill@dh.gsi.gov.uk