HEE ‘Widening participation: It Matters’ ConsultationCouncil of Deans of Health Response

30th September 2014

The Council of Deans of Health

The Council of Deans of Health is the representative voice of all 85 UK university health faculties providing education and research for nursing, midwifery and the allied health professions. We aim to influence health and higher education policies that impact on the development of an expert healthcare professional workforce across the UK and build partnerships that help demonstrate and support the contribution of our members to research.

For further details on this consultation response:

Leah Edwards, , 0207 419 5493

Stakeholder Response Form

Given the issues and analysis presented, overall do you agree with the strategic goals identified?

Yes / No / Partially

We agree in principle with the strategic goals identified. However we have concerns about the potential of the strategy to deliver meaningful results given the lack of a clear definition of widening participation and the breadth of the aims, covering widening access to education and employment, equality and diversity and social mobility

Part B: Relevance of Proposed Strategic Goals and Initial Actions

Strategic Goal 1

Improve monitoring and reporting of widening participation activities
We will work with national stakeholders, education and health care providers to improve the monitoring and reporting of widening participation developments in relation to any education programmes/workforce developments that HEE funds and supports

Is this goal appropriate and relevant?

Yes / No / Partially

Do you agree with the proposed initial actions to achieve this goal?

Yes / No / Partially

We welcome the drive to build a national picture of widening participation developments, particularly the integration of widening participation as a key theme in HEE guidance and commissioning. In order for this to be consistent and effective, a clear definition of widening participation needs to be agreed. Equally, the analysis presented in the strategy does not adequately capture the complexity of underrepresented groups, and there is a danger that the current approach will lead to a conflation of socio-economic background with other under-represented characteristics. This is particularly evident in the use of the term ‘disadvantage/d’. It is vital that monitoring and reporting are sufficiently nuanced, and allow for analysis of where underrepresented groups or characteristics cross over.

Strategic Goal 2

Enhance further the visibility and targeting of Health Careers Information, Advice and GuidanceImprove and better target Careers, Information, Advice and Guidance (CIAG). Crucial to this is the need to present information which clearly illustrates the breadth of career and progression opportunities available within the NHS and wider health sector.

Is this goal appropriate and relevant?


Yes / No / Partially

Do you agree with the proposed initial actions to achieve this goal?

Yes / No / Partially

We support the focus on the breadth of the career opportunities within the NHS and expect that this will cover routes from support worker to registered professional, as well as pathways to research, academic and leadership roles. Key to promoting a range of career options to individuals from diverse backgrounds is the development of clear and consistent career pathways.

The strategy identifies mature students as a priority group for further research. Given that the average age of a new nursing registrant is 29, accessible and supportive CIAG needs to have reach outside of educational settings. However it is unclear who will have responsibility for developing this.

Strategic Goal 3

Increase, through research and evaluation, the understanding and evidence of what works in relation to widening participation developments in healthcare education and workforce developmentThis will require the commissioning of specific research to investigate the specific needs of underrepresented groups as they apply, commence and progress on healthcare education programmes including their programme outcomes

Is this goal appropriate and relevant?

Yes / No / Partially

Do you agree with the proposed initial actions to achieve this goal?

Yes / No / Partially

We welcome the opportunity to develop a research programme into priority WP areas and the use of a framework to guide analysis of NHS WP developments.

Strategic Goal 4

Increase collaborative approaches in supporting Outreach ActivitySupport NHS organisations and wider health sector employers in committing to more sustained collaborative models with education providers (higher education, colleges and schools) and others in supporting their widening participation and outreach work

Is this goal appropriate and relevant?

Yes / No / Partially

Do you agree with the proposed initial actions to achieve this goal?

Yes / No / Partially

We are concerned over the priority given to outreach over other widening participation mechanisms and activities that can provide more sustained and consistent support to accessing higher education but also to staying the course. Outreach is an important part of the work HEIs are already doing to widen participation, but other, longer term activities are equally important in order to back this up.

Whilst we welcome the impetus for collaboration between NHS organisations, health sector employers and education providers in widening participation work, we urge caution towards prescribing particular activities. Careers in healthcare are many and varied; activities need to be tailored in order to sufficiently support students from underrepresented groups within each course/career to access both healthcare higher education and on-going support.

Strategic Goal 5

Stimulate and increase the capacity of healthcare organisations in being able to expand and support work or work related experience opportunitiesEnable wider, larger scale and sustained coordinated access for potential participants, from all backgrounds and circumstances, seeking a career and/or employment in the health sector to gain work experience opportunities.

Is this goal appropriate and relevant?

Yes / No / Partially

Do you agree with the proposed initial actions to do to achieve this goal?

Yes / No / Partially

Whilst the practice commitment to promote work experience within the NHS to underrepresented groups is welcomed, it is likely that demand will continue to outstrip availability. It is therefore important that a range of experiences, in the NHS and beyond, are recognised and promoted. Information about accessing work experience in the private healthcare sector, the charity sector and in the local community should be included in the toolkit.

This flexibility is particularly important for prospective students who may have caring responsibilities, disabilities or are from a low social-economic area and who might struggle to balance formal work experience with other commitments such as study, paid work or child care. Barriers to accessing work experience may not be immediately obvious, so flexibility both in the structure of work experience but also in the interpretation of what constitutes care experience are vital to ensuring prospective students are able to accumulate pre-degree care experience.

Part C: The Practise - Work Experience and the Ambassador Commitment

With reference to the Practise - Work Experience Commitment presented in Appendix 1, please can you indicate how relevant you think this commitment will be in helping organisations to target their work experience opportunities as a means of supporting widening participation activities?

Very relevant, Relevant, Unsure, Not Relevant, No relevance at all

Is there anything missing from the commitment statement that would be helpful to include to ensure that organisations feel able to support the Work Experience Commitment?

Given the under-representation of people who have declared a disability within the NHS workforce (2.4% compared to 17% of the national population - p.13), we suggest that those with a disability could also be targeted and prioritised within the Practice Commitment.

With reference to the Ambassador Commitment presented in Appendix 2, please can you indicate how relevant you think this commitment will be in helping organisations to support the development of Ambassadors as a means of supporting widening participation activities?

Very relevant, Relevant, Unsure, Not Relevant, No relevance at all

Is there anything missing from the commitment statement that would be helpful to include to ensure that organisations feel able to support the Ambassador Commitment?

We support the Health Ambassador commitment in principle but have concerns about the long term sustainability of the commitment. Equally, it is unclear to us whether universities would be expected to adopt the commitment and what this would look like. Universities often have career advice and widening participation teams alongside registered professionals engaged in teaching and research; a strategy which connects them in partnership with Health Ambassadors from clinical practice would enable a joined up approach, providing a strong foundation to the pledge.

Additional Comments

Breadth of strategy

We have concerns about the breadth of the issues identified in the strategy and the potential to conflate the aims of widening participation, equality and diversity, social mobility and corporate social responsibility. It is unclear whether the strategy is intended to cover activities supporting underrepresented groups to access and complete education as well as to enter and progress within the NHS workforce. Whilst we recognise that activities to support both may have shared outcomes, we urge caution in assuming a causal link between education outcomes and workforce outcomes. Currently, only 40% of registered nurses work within the NHS and there is work to be done to understand the profile of those who do not finish their course, enter related professions outside the NHS or unrelated careers.

Supporting progression

The strategy document recognises that: ‘widening participation needs to encompass the whole student lifecycle from recruitment, progression, achievement and movement into appropriate employment’ p.25. However, there is little evidence of a commitment to on-going support within the strategic goals. The focus on outreach activities, pre-degree care experience and health ambassadors is welcome, but must be matched by activities that support nursing, midwifery and AHP students from diverse backgrounds to progress through education, into the workforce and beyond – to become registered professionals, advanced practitioners, team leaders, senior managers, researchers, academics and educators.

Use of language

We are concerned with the use of the terms disadvantage, disadvantaged groups and disadvantaged backgrounds. It is important that the language of widening participation does not alienate the people it intends to support. It is equally important that sufficiently nuanced language and descriptions are provided so as to recognise the often multiple reasons why an individual may struggle to access or progress within education or a particular role as a result of their particular background. The use of the term ‘disadvantaged’ to describe under-represented groups can unintentionally reduce a multiplicity of under-represented characteristics to low socio-economic status.

Promoting a breadth of roles within the NHS

Diversity patterns differ across courses and professions and whilst we would warn against any catch all solution, promoting the breadth of healthcare roles should form a foundation for any widening participation work. Equally, it is vital that aspirations around healthcare careers are raised to support entry into leadership, research and educator roles.