The National School of Healthcare Science (NSHCS) is currently undergoing an independent review, with findings expected to be released in Spring 2025. This review aims to shape the future of healthcare science education and training across over 40 specialties in the NHS, including clinical immunology.
The NSHCS have invited responses from the clinical community, patients and the public on specific consultation items. The British Society for Immunology Clinical Immunology Professional Network (BSI-CIPN) has actively participated in this important process by submitting the responses below. This contribution reflects the network's commitment to enhancing education and training in clinical immunology and ensuring that healthcare science training meets the evolving needs of the NHS.
For any questions on the consultation and our response, please contact cipn@immunology.org.
Please provide background information on your organisation and the expertise of your organisation.
The British Society for Immunology Clinical Immunology Professional Network (BSI-CIPN) is an integrated and impactful professional network for individuals working within clinical immunology. The BSI-CIPN’s membership includes over 170 professionals in the clinical immunology space including clinical immunologists, healthcare scientists, allergists, pharmacists and immunology specialist nurses. The Network is used to share best practice and guidelines and to foster collaboration, ultimately improving care for patients.
Clinical immunology (which in many areas also includes specialist allergy services) is a small but growing pathology sub-specialty and is gaining more visibility as we come to understand more about the role the immune system plays in a vast range of conditions. Rising patient demand, and the growing pipeline of immune therapies used to treat an increasing number of conditions across many clinical specialties from oncology to gastroenterology, warrant an increased national drive and focus to support this vital area of clinical practice.
Healthcare scientists, including clinical and biomedical scientists, are core to immunology as a speciality, with consultant clinical scientists leading a number of immunology laboratory services across the country. The NSHCS STP and HSST programmes comprise the main route into NHS healthcare scientist roles for many of our current and future members, and we recognise the important contribution the NSHCS makes to the education and training of healthcare scientists across the country.
Please share your views about what the NSHCS does well to meet their current responsibilities.
The NSHCS is responsible for ensuring that the delivery of healthcare science training and education is delivered to the highest standards. The NSHCS is doing well to ensure training sites are accredited and meeting agreed standards. The NSHCS acts appropriately to revoke accreditation in situations where this is not happening. However, regarding immunology training specifically, for the accreditation of sites which do not specialise in immunology, with Consultant Clinical scientists in post, these sites may need to provide further evidence to support accreditation and delivery of high standard of training. The NSHCS provides a high level of support for both trainees on programmes, and for training supervisors with frameworks in place to overcome issues as they arise. The NSHCS collaborates with the relevant bodies to ensure the curriculum is appropriate, relevant and meets the standards set out by the HCPC.
The use of the electronic portfolios has evolved significantly since the conception of the training programmes in 2010/2011. The current portfolio works well and is user-friendly for both trainees and assessors. Recruitment processes are appropriate and well managed, however, for small specialities such as immunology, the limited number of specialist laboratories can be a challenge in terms of workforce progression planning, provision of high quality training, and ensuring trainees will be able to gain a suitable post (at the appropriate level) on completion of training.
This call for written evidence addresses the role of the NSHCS, the future education and training needs of the healthcare science workforce, its alignment with NHS workforce requirements and the recently announced three strategic shifts guiding the NHS’s future direction, outlined below.
- From Hospital to Community: Prioritising services outside of hospitals, such as primary and community care, to support people before they need hospital treatment
- From Analogue to Digital: Embracing digital transformation to improve efficiency, patient care, and access to services
- From Treatment to Prevention: Focusing on public health strategies that prevent illness and keep people healthy in the first place
Your vision for how the healthcare science (HCS) workforce may need to adapt and change to meet the requirements of the NHS three strategic shifts.
As our healthcare system shifts towards early intervention and care closer to home, it should be expected that healthcare scientists have some role in community care too, with NHS England, the NSHSC, The Association for Laboratory Medicine, The Royal College of Pathologists and others playing a part in developing the thinking on the future of healthcare science services, and the role that these services can play in the community setting within immunology.
With a shift from hospital care to care in the community, further expansion in point of care (POC) testing will likely be on the horizon, and the healthcare science workforce will need to be adequately staffed and resourced to meet these demands, through established multidisciplinary teams. Furthermore, the provision of POC testing will require significant work in terms of service development. The delivery of POC testing fits within the remit of healthcare scientists, however it is not currently recognised as a specialist discipline with the PTP, STP or HSST programmes. It is likely that POC will encompass a wide range of testing including immunology, biochemistry, haematology and microbiology; preparing future healthcare scientists to deliver this service will require support and investment from the NSHCS.
Furthermore, demand for allergy diagnostics and care has been rising significantly in recent years, and with a continually growing pipeline of immune therapies to treat a range of conditions resulting in increasing levels of secondary immunodeficiency within the population, it is likely that the healthcare science workforce will need to grow to meet this demand in this specific area, and to advise on and direct appropriate use of testing. It may be that the role of the healthcare scientist needs to expand to support other healthcare professionals in a community setting, where appropriate.
Your vision for how the NSHCS in partnership with stakeholders can provide high quality education and training to meet future NHS service needs and the NHS three strategic shifts.
Immunology is a discipline that has relevance across all clinical specialties, and as such immunology healthcare scientists work with a wide range of partners and stakeholders at both the national and local level – for which the NSHCS should have awareness of in order to best support trainee healthcare scientists through their career pathways.
For the NSHCS, one of the most important groups of stakeholders are the NHS trusts they partner with to provide the training programmes. To meet future service needs, the trusts delivering the training must be able to meet the training needs of the healthcare scientists placed with them – and it is the responsibility of the NSHCS to ensure trainees are being placed in appropriate sites for their needs. Within immunology, we have had a situation in recent years in which immunology healthcare science trainees have been placed in trusts which have no specialist immunology service, and so therefore it is not possible for them to access the training and support they need. This is also an issue regarding equity, as immunology trainees who are placed in a trust which does have immunology expertise are at an advantage.
As mentioned in the previous question, although the delivery of POC testing fits within the remit of healthcare scientists, it is not currently recognised as a specialist discipline with the PTP, STP or HSST programmes. It is likely that POC will encompass a wide range of testing including immunology, biochemistry, haematology and microbiology; working in partnership with appropriate stakeholders, the NSHCS should support future healthcare scientists to deliver this service through the delivery of formal training programmes and career development pathways in this area.
What changes (if any) to the current ways of working of the NSHCS you would recommend to achieve your vision.
We are conscious that NHSE is currently refreshing its Long Term Workforce plan, and the NSHCS should be linking in, if it is not already, to that work to align its training programmes with the projected workforce needs of the future. This includes developing thinking about where clinical scientists may be needed to support community diagnostics and clinics, as the focus shifts toward preventative and community care.
The NSHCS could develop its use of workforce modelling to inform its training programmes – this could constitute an evidence-based way of working which would help ensure the right number of trainees are completing training pathways with a view to entering into posts within the NHS that meet current and projected patient demand. As immunology is a relatively small, specialist area, there are limited numbers of specialist laboratories that can deliver training which can be challenging for national workforce planning, particularly for sites that do not currently have clinical scientists, and therefore may not recognise the value provided to the service. Despite there still being a high demand for clinical scientists and healthcare scientists with expanded roles to relieve current pressures within clinical immunology, the current ways of working aren’t always meeting these needs. Increasing consultation with professional bodies and those in the profession delivering training should be explored to address this.
The NSHCS also could do more to ensure that trainees are able to progress into funded posts within the NHS. We have seen a situation in recent years in which there are not enough funded posts within trusts across the country to allow NSHSC qualifying healthcare scientists to progress into senior positions. This is unfortunate as this has meant the NHS is losing talented candidates to other sectors. The lack of senior posts available may also reflect the lack of workforce planning at a national level, particularly for immunology and other smaller pathology sub-specialties. The NSHCS should therefore explore shifting its focus to the impact of the training programme on ultimately supporting patient care through a stronger healthcare scientist workforce within the NHS, rather than simply the numbers of trainees it is sending through the programme.
How the NSHCS should approach the education and training of small, specialist HCS specialities to provide a sustainable workforce.
The NSHCS should work closely with the bodies that represent these smaller specialities to ensure that the training programmes are meeting the needs of the smaller specialties, as a generic one-size-fits-all approach employed for the larger specialities may not be suitable for them.
Immunology is widely recognised, including by the Royal College of Pathologists, as one of the most fragile pathology sub-specialties with regards to workforce. It is therefore absolutely crucial that trainees intending to work within the specialty are supported in their training. There has been an unfortunate situation in recent years in which immunology healthcare scientist trainees have been placed in hospitals in which there is no specialist service, as previously mentioned – and for optimum outcomes for these trainees, their host trust and supervisors must have expertise in the specialty.
As mentioned previously, the small number of training sites available to deliver high quality training is small, therefore the pool of assessors for preparing and delivering exit assessments is very limited. The School should recognise there may be an increased volume of work required from professionals in smaller specialisms in order for trainees to formally exit the programme. Consideration of how to manage this going forward should be sought, potentially providing formal recognition such as financial compensation.
How the NSHCS should work with Higher and Further Education partners including the geographical availability of academic provision across the UK.
For immunology, the University of Manchester delivers the training, and is the sole Higher Education provider for the specialty. Therefore, the funding for trainees to access the training should reflect that there is no choice, geographically, for where trainees can go. This is challenging in terms of equity for trainees, as some trainees consequently need to use their funding for travel and accommodation if they live a long distance from North West England, while those who are based a short distance from Manchester are likely to have more funding available for continuing professional development.
Therefore, the NSHCS should review the planning and budgeting process for the single HE provider model and ensure that funding is a) sufficient and b) takes account of geographical disparities to ensure that trainees are not unfairly disadvantaged in access to other continuing professional development activities. There should also be ongoing work around long-term planning to ensure the sustainability of future courses for each specialty, particularly for those with a sole provider model.
How the NSHCS should work with the devolved administrations of the UK and what changes (if any) are needed for the future.
The NSHCS should ensure, as far as possible, that there is alignment in terms of the training and education standards for healthcare scientists between the devolved nations. We are conscious that workforce challenges are felt UK-wide, and so there should be a focus on enabling the healthcare science workforce to take up posts that may be needed throughout the UK nations.
Please give up to a maximum of 5 suggestions that your organisation think would improve the NSHCS and/or the education and training programmes they provide for the HCS workforce.
- Ensure immunology healthcare science trainees have access to the specialist training and support that they need and are not placed in trusts that cannot offer this due to a lack of specialist immunology services and/or lack of partnerships with larger sites that can provide the areas which are not locally available. Burden on small number of large specialist sites must be considered.
- Develop forward-looking long-term planning for the organisation to ensure that it keeps training programmes relevant and can expand where needed in light of shifts away from hospital care and toward earlier diagnosis and prevention. This includes tying in with broader NHS long-term workforce planning and making the case for the healthcare science workforce needed in the future based on projected patient demand, as well as developing more of a strategic focus on the onward roles of graduates of the NSHCS programmes, as opposed to the numbers going through the programmes.
- Ensure that immunology trainees are able to use their full funding in an equitable way, and are not disadvantaged due to the training infrastructure involving a sole Higher Education Partner based in the North West of the country.
- Review the direct entry STP recruitment and application process for the NSHCS, as it has not been updated for some time. The application questions have remained the same for some years, and therefore it may be helpful to consider additional experience and behaviour focused application questions going forward with more opportunity for candidates to demonstrate relevant transferable skills - as it has previously been difficult to stratify potentially stronger candidates based on the current scoring system. Equality, diversity, and inclusion should also be considered in question formulation and scoring criteria to ensure no candidates are put at a disadvantage due to protected characteristics.
- Review processes for professionals working in small specialisms who are delivering training and assessment as part of national training programmes, given the limited pool of appropriate professionals available nationally. Consideration of how to manage this going forward should be sought, potentially providing formal recognition such as financial compensation for lead assessors, case-based assessment writers, and those providing additional support for smaller training sites.
Is there anything else you would like to tell us about the role of the NSHCS, the education and training needs of the current and/or future HCS workforce, workforce planning and alignment to NHS workforce requirements? Please share your comments below.
Closer working with national bodies and specialist training sites is required to ensure each of the programmes remains fit for purpose, particularly as ways of working continue to evolve. Healthcare scientists are an essential, often under-recognised part of the NHS workforce; therefore it is crucial that the training continues to evolve to meet the changing demands of the NHS. The updates to the NHS long term workforce plan alongside the appropriate training and support provided to healthcare scientists will ensure the development of a profession that is fit for the future.