Research Study Report

Research study exploring the barriers and enablers for progression to Health and Social Care careers for disadvantaged/ underrepresented Health and Social Care students studying in Further Education Colleges

FOREWORD

I am delighted to have been invited to write the foreword to this report.

Building intentional partnerships between students, employers and further and higher education has the potential to transform the manner in which we train and educate our future health and social care workforce in London. For all of us there are multiple influences which shape our future career choices. The impact that early exposure to the wealth of employment opportunities in the health and social care sector cannot be underestimated.

This report describes the ways in which these career choices are perceived, understood, acknowledged and pursued by our further education and access students.

Bringing together the professional skills and expertise of health and social care professionals, alongside further education lecturers provides a contextualised and powerful dynamic to inform and prepare students for future employment in the ‘care’ sector.

This qualitative study advises how best to provide further education students with a rich and informed learning experience that is shaped by a two-way approach, honouring the knowledge and skill which employers and educators bring to the table from their professional and lived experience. This approach to learning has the potential to transform student’s experience of potential career opportunities in the health and social care sector. The report’s conclusion identifies findings which will shape future initiatives that seek to widen participation and to celebrate inclusion, diversity and emergent talent.

In particular the authors have emphasised the importance of health and social care providers ‘having early engagement with

further education to provide career information and pathways’, supported by ‘specific case studies to illustrate career progression opportunities for all health and social care students, but specifically for disadvantaged and underrepresented learners’.

All of this is dependent upon employers providing students with ‘ringfenced work experience opportunities’ which may be provided in the form of ‘real-life’ placements or through the medium of ‘virtual reality and simulation to deliver the required knowledge, skills and behaviours’ that are required of all aspiring health and social care professionals.

This report makes an important contribution to our understanding of the determinants and factors that either encourage or discourage further education students to progress to pursue meaningful and fulfilling careers in the care sector. The recommendations that are presented within the context of the report provide for the design of a purposeful strategy that should be adopted and implemented across the further, higher education and health and social care sectors. Such a strategy should nurture and encourage the deployment and progression of the multiple talents demonstrated by this wide range of culturally diverse students, who with the correct support could be facilitated to competently and proficiently assist in the transformation of our future local health and care workforce.

PROFESSOR

DAVID SINES CBE

Provost – Health and Social Care Buckinghamshire New University

OVERVIEW

This report describes a unique qualitative study, which is the output of collaboration between Further Education (FE), Higher Education (HE) and National Health Service (NHS) employers. This study is unique because of the triumvirate approach between these key stakeholders. The study shows there is a clear requirement for deeper collaborative working between FE colleges, Health and Social Care (HSC) employers and Higher Education Institution (HEI) to support the progression of FE students into HSC careers and HEI-related study, preventing them from falling between the organisational ‘gaps’. The study recommendations are pertinent to the FE, HE and healthcare sectors. These recommendations are based on prima facie evidence from FE HSC current and former students, employers and insights and knowledge obtained from the collaboration between FE, HE and employers.

CONTEXT

Traditionally, FE, HE and employers have few opportunities and/or incentives to come together. The FE/HE: Health and Social Care (HSC) Working Group, one of four London Mayoral workstreams, has provided such an opportunity.

The Working Group brought together representatives from FE, HE and NHS partners in West London to develop a collaborative, sub-regional approach to skills interventions relating to health and social care, responding to the impact of the pandemic on West London’s economy and communities. This aligns to the West London ‘Build and Recover’ plan and the London Recovery Board’s ‘Helping Londoners into Good Work’ mission.

The FE/HE HSC Working Group’s main objective is to support the HSC sector by addressing the skills gap, maximising opportunities for learning and providing support for learners to effectively progress onto meaningful courses and ultimately fulfilling careers in HSC. In initial discussions the group identified that the proportion of FE HSC students progressing into HE and/or employment was notably low and was not meeting the West London workforce demands. Amongst other strategic actions, the Working Group decided to investigate the relatively poor progression of disadvantaged/under-represented FE students into HSC careers. The group secured funding from the College Collaboration Fund (CCF) and Health Education England (HEE) to undertake an innovative qualitative research study to understand this phenomenon.

PROJECT LEADS

RESEARCH TEAM

Mike Anjoyeb, Buckinghamshire New University (Senior Lecturer)

Madeleine Jenkins, Buckinghamshire New University (Senior Lecturer)

Shabana Ali, Buckinghamshire New University (Senior Lecturer)

Euthan Newman, Buckinghamshire New University (Lecturer)

Nikki Percival, Buckinghamshire New University (Lecturer)

Heather Wilcox, Buckinghamshire New University (Lecturer)

ACKNOWLEDGEMENTS

This project was funded by the College Collaboration Fund (CCF) and Health Education England (HEE).

We would like to thank the Further Education Colleges who supported this project. We would additionally like to thank the students and alumni and NHS employers, for their valued contributions.

This is a research study to explore the barriers and enablers for progression to Health and Social Care careers for disadvantaged/underrepresented students studying in Further Education (FE) Colleges.

Professor Karen Buckwell-Nutt, Buckinghamshire New University Dr Karen Harrison-White, Brunel University London Suba Dickerson, Assistant Principal, Harrow College and Uxbridge College

Associate Professor Margaret Rioga, Buckinghamshire New University

RESEARCH STUDY

A qualitative research study was completed to explore the barriers for disadvantaged/underrepresented FE students progressing to HSC careers or through healthcare programmes in Higher Education. For the purposes of this research, disadvantaged or under-represented students represents students who are from: Black, Asian and Minority Ethnic Groups; LGBTQ+; first generation graduates; care leavers and lower social and economic backgrounds. (Other research key concepts can be found in Appendix 1). The main tenet of this study is to understand why there is a relatively low conversion rate from HSC courses in FE Colleges to HSC careers or Higher Education. Recommendations will be made to improve progression for this population of students.

LITERATURE REVIEW AND RATIONALE

The Royal College of Nursing, (2022) UK Staffing for Safe and Effective Care: State of the nation’s nursing labour market report found that the registered nurse vacancy rate rose from 4.9% in 2012/13 to 9.9% in 2020/21 with an increase in the number of nurses leaving the profession due to burnout, retirement and pressure of working with staff shortages. Therefore, in order for the Government to meet its target of 50,000 new registered nurses by 2025 (Building the NHS nursing workforce in England, 2022) there is a need to introduce a more proactive and dynamic approach to the recruitment and retention of healthcare workers. It is also recognised that whilst this data is predominately linked to nursing, HSC is wide and other allied health professionals are also included in this concern about low recruitment and high vacancy rates. The vacancy gaps for HSC careers are further increased by the introduction of the Health and Care Act (2022). This Act creates opportunities for new roles within HSC and supports a much-needed integrated approach to health and social care delivery across systems services. However, this may result in a dilution of applicants to specific disciplines, i.e. professions such as physiotherapy and nursing where there is a pervasive skill shortage.

Education is an important aspect of health, wellbeing and development across the life span, providing specialist knowledge and skills in particular professions (Leavey, Bunbury and Cresswell, 2021). Often Further Education is merely perceived as a mechanism for accessing first level vocational qualifications (Busher and James, 2020). However, this culture is now changing and FE is increasingly

recognised as essential in providing students with the qualifications to support employability particularly in vocational careers such as HSC (James Relly, 2020). FE colleges offer a full range of education opportunities, from level 1 to level 5 in Health and Social Care, providing the students with qualifications for them to pursue HSC careers and/ or HE study. The learners range from 16+ through to adults.

The pervasive healthcare skills gap requires consideration of barriers to progression through healthcare careers. Some known barriers for progression to HE for adult FE students include life events; employment; parental responsibilities; education achievements and socio-economic status (Barriers to Participation and Progression in Education, 2022). In a study by Quality Assurance Agency for Higher Education, (2016a), cited by Busher and James (2020), it was found that despite the interest and motivation to pursue further education, 31% of mature students (over 21 years of age) did not complete the course. The main cause of the incompletion rate was linked to the social and economic challenges experienced by this population of students. Mature students from disadvantaged socio-economic backgrounds viewed themselves as ‘lacking capacity to learn’, often grounded in their previous poor experiences of education. For lower socio-economic communities, the education experience was commonly inferior, compared to affluent communities, in terms of available resources and quality of teaching (Lifelong learning and levelling up: building blocks for good health, 2022).

HSC students are predominantly female and can experience emotional turmoil because they frequently manage conflicting priorities, including care giving and childcare (Pennacchia, Jones and Aldrige, 2018). Additionally, partners and ex-partners do not always recognise a new student identity, which may cause difficulties for students in finding the required time to dedicate to their studies (Pennacchia, Jones and Aldrige, 2018). The influence of family and friends is a significant factor for FE students, which can be both positive and negative (Barriers to Participation and Progression in Education, 2022). For some ethnic minority groups, certain careers are given a higher status, for example medicine, which can influence the motivation for FE student to continue on a HSC trajectory, particularly when they struggle to cope with the demands of the programme (Barriers to Participation and Progression in Education, 2022).

Pennacchia, Jones and Aldridge, (2018) found that factors such as: poor finances; reduced understanding of course requirements and opportunities available; poor health and negative previous education experiences had a negative impact, particularly on the younger students’ engagement with learning and progression on FE programmes. Barriers to employment for young adult carers, (2022) concluded that caring responsibilities were linked to low academic attainment, compromised employer perception of the young carers and general poor health and wellbeing. It is interesting to note that the barriers for entering FE study for young people and the barriers for employment are similar, which indicates a continuous cycle for disadvantaged students where they are constantly struggling with

the socio-economic challenges. However, Henderson et al., (2020) found that for some young people, the recognition that education will provide a pathway to securing employment and gaining financial independence was a significant motivating factor.

Buchanan and Warwick (2020) found that FE students with a diagnosed mental health condition experience either fear of relapse or actual relapse while undertaking HSC FE training. In this study, the triggers for the mental health symptoms/relapse were linked to the social and financial pressures of studying and coping, alongside managing the side effects associated with prescribed medication or symptoms of their mental health diagnosis (for example, concentration issues, hallucinations and paranoia). Academic support for students with disability, including mental health, was highlighted as an area which requires improvement to support and signpost students to suitable services (Pennacchia, Jones and Aldrige, 2018).

In reviewing the literature, it is evident that there is a mismatch between the HSC workforce needs and the supply of qualified applicants. FE colleges and HE provide an essential employment pipeline for HSC careers. It is essential that there is collaborative working between the FE, HE and employers in order to address the barriers for students and enable HSC career pathways. This study aims to address this issue by exploring the current enablers and barriers that disadvantaged/under-represented groups encounter when accessing HSC careers/HEI study.

METHODOLOGY

This is qualitative study incorporated focus groups and individual interviews. Qualitative research is the method of data collection based on non-numerical data, typically based on narratives, ethnography, case studies or grounded theory (Silverman, 2014). In order to fully explore the barriers and enablers for HSC careers and HEI study for disadvantaged/ under-represented FE students, it is important to consider the subjective experiences of the students. Qualitative methodology enables researchers to explore participants’ subjective experiences of the phenomenon under investigation. This methodology promotes researcher-participant interaction, which Polit and Beck (2017) suggest is the most effect methodology to develop a deeper understanding of human experiences as they appear to the individuals affected. Hence, data of qualitative studies are a unique, rich, valid and accurate representation of the views of study participants (Streubert, and Carpenter, 2011).

STUDY AIMS AND OBJECTIVES

To ascertain the barriers that disadvantaged/underrepresented HSC students in FE colleges encounter when accessing HSC careers/ HEI programmes.

To ascertain the enablers that support disadvantaged/ under-represented HSC students to pursue HSC careers/HEI programmes.

To explore with employers what they could do to mitigate barriers and enable HSC disadvantaged/ underrepresented FE students to access opportunities and pursue careers in HSC.

SAMPLING AND SAMPLE SIZE

The study utilised a criterion purposeful sampling approach to recruit disadvantaged or underrepresented HSC students. Purposeful sampling involves the conscious selection by the researcher of certain participants (Silverman, 2014). Full details of the Study setting and population are given in Appendix 2 with inclusion and exclusion criteria in Appendix 3.

RECRUITMENT

Initially all FE Colleges involved in the study gave consent at Principal level after receiving a Gatekeeper letter from the Project Leadership Team. Heads of School (in Health and Social Care) in each College were informed about the study. They subsequently informed students about the study. Those who expressed an interest were screened by the Colleges’ Health and Social Care team for participation eligibility.

SAMPLE SIZE

Focus

groups

41 student participants across four FE Colleges. One- one interviews

1 Alumni student

3 employers from acute North West (NW) London Hospital Trusts

This sample size is appropriate for a qualitative study (Silverman 2014). Traditionally qualitative research does not end at data saturation, but at a point when enough data is gained to provide rich data, enough to answer the research question and understand the phenomena under investigation (Polit and Beck 2017).

ETHICAL CONSIDERATIONS

As in normal practice in FE the relevant gatekeepers were approached; the Project Leadership Team responded to clarification questions raised by the relevant gatekeepers. The researchers ensured the participants had viewed and understood the information sheet, signed the consent form and received the debrief forms for both the focus groups and one-to-one interviews. The focus groups and interviews were preceded by explanations of the purpose of the study, including its benefits. Participants were informed of their right to discontinue participation in the research process at any time, with the reassurance it would not have a deleterious impact.

The Project Leadership Team considered potential power imbalances between participants/ researchers and concluded that to mitigate risk, the focus groups and one-to-one interviews should be held on college campuses. In addition, the research team were independent from the College; they were not members of the College staff. College staff were not present during the data collection to ensure objectivity. The Project Leadership Team were aware that the participants may be adversely impacted by the study. A debrief form was therefore given to all participants, signposting to relevant support. Whilst this mitigation was in place, no issues were reported.

DATA COLLECTION

Study site

The Project Leadership Team directed that the student interviews should occur on site at each of the College campuses to engender authentic interactions, which were observed by the researchers. The employer interviews were completed via MS Teams for accessibility reasons. It was anticipated that the use of MS Teams would not diminish the quality of the data, particularly given that these were a oneone interviews.

Focus Groups –FE Students

Five focus group discussions with an average of 6 – 9 participants per group were conducted with FE students who met the inclusion criteria. The focus groups were conducted using semi-structured interview questions, which consisted of a set of questions, including probes and prompts. The focus groups were facilitated by researchers from the research team. The researchers worked in pairs, with one person asking the questions and the other being the moderator, who recorded the behaviours of participants and any other issues considered to be important.

All focus groups were audio recorded in person, and lasted on average for 1 hour which allowed time for all participants to contribute.

Individual Interviews - Alumni Student and NHS Employers

Four semi-structured one-to-one interviews were conducted: one alumni interview and three individual employer interviews. The interviews were conducted using semi-structured interview questions, which consisted of a set of questions, including probes and prompts. The interviews were facilitated by researchers from the research team. All the interviews were audio recorded and lasted on average for 1 hour.

DATA ANALYSIS

Qualitative data

Thematic analysis (Clarke and Braun, 2017), used in this study, is a method of analysing data to highlight the patterns and themes in the data. This is the process of data analysis typically used for phenomenological studies. Thematic analysis demonstrates a description of codes and patterns, which enhances validity of the data because there is a clear pathway of how the themes have been formulated (Howitt, 2013). Thematic analysis can be used with a range of theoretical and epistemological frameworks (Creswell, 2009).

Findings From FE College Focus Groups and Alumni Interview

Similar themes were generated from the data across the focus group and alumni discussions. Thus, the study findings are presented in a single abbreviated table of themes. Excerpts from participants` narratives are used to support the identified themes. The abbreviation ‘FG’ (Focus Group) and terms ‘Employer’ or ‘Alumni’ are used at the end of each excerpt, in addition to a number, to identify the source.

Four main themes emerged from the analysis of the focus group discussions and individual alumni interview. Each of these main themes had at least one sub-theme

(see Table 1). The themes are discussed under the section ‘theme discussion’ in the order presented.

Table 1: themes and sub-themes Focus Groups

1. Motivation and influence for studying Health and Social care

1.1 Self-motivation, determination and innate feelings/qualities

1.2 External influences

1.3 Personal experiences that influence motivation

2. Academic expectations

2.1 Grade boundaries

2.2 The pressures and barriers associated with studying

2.3 Knowledge of higher education route, supports and other career options

3. Academic and personal support in FE colleges

3.1 Support from lecturers

3.2 Other support services

4. Perceptions of Health and Social care careers

4.1 Financial implications

4.2 Stressors, pressure and burnout

Themes Discussion Focus Groups and Alumni Interview

1. Motivation and influence for studying Health and Social care

The rationale for studying in further education varied across the participants. Whilst some factors were viewed as enablers, such as influence of family and friends, these factors were also viewed as barriers for some participants. The strongest motivation for participants pursuing HSC HE study was their personal motivation and having a clear goal to study HSC programmes when they enrolled on their FE programme. These participants confirmed that they had applied and received offers to join HSC programmes with a range of HEI providers. Other participants had enrolled on the programme without a clear goal; their motivation was often to pursue work opportunities as they shared their concerns about the cost of HE study, pressure of the work and salary comparison for HSC careers compared with other work opportunities.

1.1 Self-motivation, determination and innate feelings/qualities

The decision to pursue a HSC programme of study in a FE college was multifaceted. Some of the participants shared their goal of working in healthcare based on experiences of interacting with professionals in their personal lives or through undertaking caring responsibilities.

‘At first I wanted to be a social worker, from my own experiences growing up, because I had a social worker for about a year and eight months, and I had a whole load of other services involved. So, I was like, “Yes, let’s do this, become a social worker….’(FG1)

‘I’ve always been a young carer, since I was about 11 years old, because my mum had a stroke. And I really liked caring after that. So, I thought, “Well, I’m pretty good at this, so I can keep going at it.’ (Alumni 4)

Some of the participants shared their views that the HSC FE programme offered them opportunities to pursue their career and self-development.

‘ You get more choices in the career’ (FG1)

‘It was something that I’ve always wanted to do, because when you go to uni you are more independent’ (FG2)‘I wanted to build my confidence… really good to do things out of my comfort zone’ (FG3)

A common finding for the participants who wanted to pursue HE study was that they had clear goals. These participants knew the programme of study they wanted to pursue and had applied to HE.

‘I am planning to go to uni as well. I am thinking about either studying veterinary sciences or child nursing. But it depends, because I feel like it depends where I get offered. I already had an interview for veterinary sciences in Middlesex University, so I am just waiting for my offer.’ (FG1)

‘I’ve always wanted to be a midwife as well, since I was little. I did it at high school and then I realised that’s kind of like my dream job. So, when I came to college, I just really wanted to do health and social care.’ (FG4)

HSC is often viewed as a vocational profession, which is appealing to people who have an interest in supporting others and in some cases returning/ improving the care they received personally from services. Some of the participants explained how their lived experiences of healthcare services was the driving force for pursuing HSC study in HEIs.

‘I think it is just from my own experiences with services in health and social care. I know that there can sometimes be quite a lot of neglect, and I would want to help that,’ (FG2)

‘I think, if you’re the type of person who likes helping others a lot, then probably health and social care might be the career for you’ (FG4)

1.2 External influences

The influence of external factors was shared by many participants, and this was based on influence from family and friends, information shared by HEIs and College Tutors and influence of social media.

The influence of family and friends was a key factor discussed in the focus groups, with many participants sharing the impact of cultural and societal views about HEI study and HSC professions. The participants talked about enrolling on their FE course due to parental pressure and pursuing HEI study in fields that they were not necessarily interested in, but to appease their parents.

‘They [parents] basically tell the children to do a certain course or go to uni and the children do not want that’ (FG2)

Similarly, many participants discussed the pressure of being first generation aspirant graduates; pressure that is experienced intrinsically and from family.

‘Especially if you are the first one in your family to go to university as well, and you have that opportunity, it is a big pressure on you because it is like everyone is looking on you and it is like you are the one that needs to go university, and if you do not go to university then…’.(FG5)

The influence of friends was both an enabler and a barrier for progression to an HSC career/programme. There was a broad recognition that whilst friends could see positive attributes for a career in HSC, the individual could see that this was not a realistic goal for them.

‘Everyone is telling me I should be a youth worker, because I am quite good with the youth… It is quite personal in other

people’s lives, and I do not think I could deal with that.’ (FG2)

Although students were unaware of the opportunities from future employers, it is evident that employers recognised potential career progression for FE students, who had not progressed through traditional educational routes.

‘I might not go straight to university, but it is possible to do it in a slower, controlled way. There’s nothing wrong with that. You’re not a failure because you didn’t go straight to university out of sixth form’,.’ (Employer 2)

1.3 Personal experiences that influence motivation

The experience of studying in FE had a strong influence for many participants on their decision whether to pursue an HSC HEI programme of study. A significant number of students disclosed that their decision to continue with academic studies was influenced by their mental health.

‘I just cannot be in this classroom setting [due to anxiety] at certain moment’s in time’ (FG1)

The participants appreciated that studying in higher education would be expensive and many participants felt it was more important to be economically productive.‘

‘I have done my own research and I know for a fact it is not enough. I think you get £24,000 a year, or something like that. It is not a lot of money, especially for all the work you are doing.’ (FG2)

2.

Academic expectation of pursuing HEI study was the main barrier identified by participants, with many sharing the challenges of meeting the UCAS tariff points. The pressure of studying in the FE college environment and managing the workload was identified as stressful and difficult to manage; pursuing HEI study was therefore deemed unachievable for some students due to the higher academic level. There was mixed knowledge of HEI HSC programme pathways and the support and career options available.

2.1 Grade boundaries

The participants shared the challenges of meeting the grades required for HEI entry requirements. These were mainly based on students acquiring 112-136 UCAS points, which for the Access to HE Diploma in Nursing qualification was a minimum of 60 credits overall with 12 Merits and 30 Distinctions at Level 3 and 15 Credits at Level 2 at Pass. For some participants, this was felt to be unrealistic and difficult to attain. Some students highlighted that they did not understand the requirements from year 1, meaning they did achieve the required grades.

‘Maybe the grade requirements that some of them have made it a bit harder. Not everyone is an A* student’ (FG1)

‘The issue was not knowing when we were in that start of level 3 that we need distinction to get into uni.’ (FG2)

‘if you want to do midwifery and nursing they should tell you what you need to get there, because some of us did not get the grades that we needed last year, because we did not know that we actually needed these grades to get into university.’ (FG5)

There was also a view from the participants that the impact of covid-19 should be considered in the results for students who were qualifying this year.

“I do think unis this year should consider the pandemic and that the grades are predicted” (FG2)

2.2 The pressures and barriers associated with studying

The pressures and barriers of studying were associated with workload of academic study and assessments. The participants shared their experiences of studying full time, whilst also trying to manage their home and work commitments.

‘So, I am coming in 9:00-5:00, pretty much most days, doing my work placement Mondays and Tuesdays, so I am here every day, for the whole week. So, it is just stress and no break.’ (FG2)

‘…stress, a lot of hard work…I think the numbers we’ve got left in our class now show how many we started with to how many we’ve got left…’ (FG3)

However, some of the participants shared their determination to manage the workload through protecting time for study and accessing resources to support their learning.

‘You just give yourself that extra time to put aside to do coursework’ (FG3)

‘I’ve got four kids…you’ve got to plan it…’(FG3)

‘Probably like a schedule. So, since we are only in college for three days, and you have four days off, you can properly align your schedule.’ (FG4)

The financial cost of studying in a FE college and the need to complete the programme and secure a more permanent role with a fixed salary was a barrier to pursuing future HSC careers/programmes.

‘We used to get bursaries last year, and now it is £10 a week, and now they stopped it for me, I do not know why.’ (FG2)

‘the fees… the time… I have also got to think about starting working and getting money for myself instead of spending another three/four year studying’ (FG1)

Some participants discussed the curriculum delivery and identified the need for the curricula to be diverse and engaging for different learning styles.

‘Because sometimes, the course has a lot of work to do on the computer, and it can get very boring and stiffening. So, maybe that’s where some students may want to drop out,’ (FG4)

‘Even like little field trips to places, just so you can actually see it with your own eyes, to understand it more.’ (FG4)

A barrier for some students was the impact of their ill health, requiring them to withdraw from the programme.

‘when I left school, I did attend a health and social care course, but I got sick, so I had to drop out.’(Alumni 4)

Mental health symptoms were also a barrier for some students who found that their symptoms were exacerbated by the pressures of studying.

‘I feel like people don’t really talk about it in education, but if you’re not in the right headspace, then it can completely mess you up. In the sense that you could get stressed.’ (Alumni 4)

Previous educational experiences also had a negative impact on the participants’ ability to successfully learn in FE; some participants remained traumatised by the memories of childhood experiences.

‘I had really bad anxiety, my school didn’t help me, and I really struggled. I did pass things, but I didn’t pass things the way I knew I could’ (Alumni 4)

Some the participants shared that whilst they did want to engage in extra functional skills tuition, they were not always able to attend the classes due to their caring responsibilities.

‘Well I have to get my daughter from nursery after college, so then I cannot do that. The only thing I can do is they have this website called xxx, which I can go on, but then that is not really like human support.’ (FG5)

2.3 Knowledge of higher education route, supports and other career options

There was mixed understanding of the breadth of HEI HSC pathways available and the respective entry requirements. Many participants articulated that they required more information to inform their career / academic decisions.

‘I have chosen this route, adult nursing first, and then goes to anaesthesia nurse. So, I want to do adult nursing and then do that. But I do not know, because my grades’ (FG2)

‘I feel like people should always tell students, when applying for health and social care

You could do this, this, this and that,” rather than just saying, ‘you can work in hospital and be a nurse or a midwife.” So, there should be more opportunities with that.’ (FG5)

Many participants felt that work experience was helpful in supporting them to identify potential suitable HSC careers and requested more variety in the available opportunities. Many participants explained that if they could have more exposure to HSC careers it would enable them to make informed progression choices.

‘I think making it 50/50, like going outLike some people want to do nursing, so maybe going to a hospital, a nursery and stuff.’ (FG4)

Alternatively, many participants were also amenable to HSC professionals facilitating career talks for their cohorts.

‘Possibly have more visitors coming to the college. For example, probably ambulance services’ (FG4)

‘Instead of it always being writing and everything, I think it would be nice to see a different kind of perspective from other people. Not even a doctor or anything, someone that’s actually done health and social care’ (FG4)

3

Academic and pastoral support promotes progression and reduces attrition rates. The participants discussed their experiences of receiving academic and pastoral support from their course teams and shared the impact of this on their studies.

3.1 Support from lecturers

The first point of contact for most students is their lecturers and therefore it was not surprising that many participants shared the impact of their interactions with their lecturers. This was mainly positive with participants sharing how the lecturers went over and above to offer academic support for assessments and pastoral support for wellbeing concerns.

‘I feel like our teacher did support us, because they attend to us on Saturdays as well’ (FG1)

‘Some lecturers understood my position as a carer, knowing that if I had to go, I had to go’ (Alumni 1)

‘I really cannot be here this week; it is just so stressful. I will do any work at home, but I just cannot be in this setting at this moment in time. Then she is like, “Yes, just take a breather, chill out, and then come back when you are ready’ (FG2)

‘Some of us do maths, and they get extra lessons after school so they get the grade that they want, so that is extra support for them. And with English as well…’ (FG5)

There was a sense that the lecturers played a pivotal in motivating the participants to engage and persevere with their learning.

‘your lecturers motivate you and say, “You can do it. Try this way or try another strategy,” which will just help you.’ (FG4)

3.2 Other support services

In addition to the academic and pastoral support, the participants also shared the other support services available in FE colleges. This ranged from support with HEI applications to library services and disability services. Due to the diversity of learners within educational institutions it is important that a range of services are available to support course progression and reduce attrition rates.

‘If you feel like you need extra time, go to learning support’ (FG2)

‘There is the library that always offers resources for us’ (FG1)

‘The e-books, yes. All of our textbooks are all online. So, even if we’re in college, like iLearn or vocational, and we don’t have the textbook in our hand, we can still search it up’ (FG4)

4

The participants had mixed views about HSC careers; their views were influenced by many factors, including the salary, perceptions of family/friends, media influences and placement experiences.

4.1 Financial implications

One of the main barriers to pursuing HSC careers was the financial implications; participants viewed the salary as low in comparison to other careers.

‘‘I want to make sure that I have a steady income, the hours that I will be working, how much are the hours I will be working, is it worth the pay…’ (FG2)

4.2 Stressors, pressure, and burnout

Many participants had friends/family who worked in health and social care, and they shared their experiences. The participants had mixed responses: for some it was a point of inspiration and a motivator to pursue a HSC career/HEI study, whilst for others it acted as a barrier.

‘My friends in uni were telling me their experiences being a nurse, studying nursing. Then they were saying how they do a lot of placements, but it is long hours, they do not get paid and stuff like that’(FG1)’

The media influenced many participants’ considerations of a HSC career/programme. Negative reviews/incident reviews about healthcare impacted on their decisions.

‘Improvements in the NHS might be more encouraging. All you ever see is the negative stuff in the media about the NHS’ (FG3)

The influence of media was also recognised by Employer 2 as a barrier to recruitment.

‘They won’t be listening to the bad press that has been before: ……“Actually, how many people never take up a job from in a health and social care environment?” If we can change that dialogue and we can change that narrative around’ (Employer 2)

Clinical placements in HSC settings are a feature of the HSC FE programmes and these placements proved to be both an enabler and barrier. For some participants, the placements provided an opportunity for them to develop insight into the opportunities available and enhanced their motivation to continue with a HSC career. Whilst for others, the insight opportunities caused them to review their HSC career plan, based on traumatic experiences.

‘There are a lot of us in this class that do not want to do nursing anymore, because of the experience that we saw when we went to the hospital’ (FG5)

‘There is a sensitive side to it as well. I feel like they need to prepare us for the sensitive side. When I was seeing neonatal nurses and what they have to go through, the stress with having to deal with premature babies, it is a lot to deal with’ (FG5)

FINDINGS HEALTHCARE PROVIDER INTERVIEWS

Three main themes emerged from the analysis of the individual interview discussions with the healthcare providers. Each of these main themes had at least one sub-theme (see Table 2). The themes are discussed under the section ‘theme discussion’ in the order presented.

1.

1. Employment and Training Qualifications

Healthcare Trusts employ staff with a range of expertise and qualifications. In clinical environments the roles are diverse, ranging from entry level roles as healthcare support workers to more senior roles as ward managers, matrons and nurse consultants. The participants discussed the range of roles and the strategies introduced to increase recruitment and retention within the healthcare workforce.

1.1 HSC courses

The employer participants discussed the current schemes available to support recruitment of students on HSC programmes in FE colleges. These included T-Level qualifications and apprenticeships. T-level qualifications are 2-year courses, which are equivalent to 3 A Levels and are developed in partnership with employers and businesses. The aim of these programmes is to prepare the students for employment or further study in their chosen area. Apprenticeships provide on-the-job training, which is often supported by academic study for qualification in a particular profession. .

‘With T Levels becoming the new BTEC, I guess, we have been working quite closely with FE colleges around that, around functional skills and apprenticeships and, actually, then the BTEC healthcare programme’ (Employer 1)

1.2 Recruitment Strategies

The healthcare providers were investing in initiatives to support the recruitment of FE students by introducing several strategies, highlighting there is an available pipeline for employment to meet workforce requirement. These strategies included review of recruitment processes and outreach work with FE colleges.

‘There are more than enough students out there for us all to work together with. If all of them came in, we’d actually have a full workforce, every single one of us.’ (Employer 2)

‘we work with XXX College who run what they call a careers clinic which is aimed at people, unemployed adults, who want to get into employment as a healthcare support worker’ (Employer 1)

Participants that join the careers clinic are guaranteed an interview with the healthcare providers and within one cohort the provider was able to recruit 8 students.

‘I think, of the eleven people, we’ve made conditional offers to eight..’ ( Employer 1)

1.3 Recruitment and Retention

There was recognition the students on HSC programmes in FE colleges were an excellent potential source of employment for health care providers.

‘I think it’s an untapped talent pool and potential workforce’ (Employer 1)

However, relationships with the colleges needed to be fostered to maximise this potential. This point was reiterated by Employer 3:

‘it is rare that we recruit from the college themselves. So, what happens is normally they are already our staff and basically as part of their career progression we support our staff to undertake certain courses that relates to their job role in order for them, one to support in their job role and two to progress within their careers in the NHS’ (Employer 3)

However, there was an example of employability programme that operates within a College.

‘We’ve also worked very much with XXX college around the employability programme, so we’ve commenced an employability programme. That’s about how do we support those who are long-term employed into employment? We’ve just ran one cohort of that at the moment’ (Employer 2)

Students were mainly offered roles as healthcare support workers, but there was a drive to also offer them opportunities in their areas of interest.

‘The intention is to offer employment as support workers. I’m going to use that term really loosely because it could be in nursing, it could be in therapies, it could be in science’(Employer 1)

As part of their HSC programmes in FE colleges, students will complete clinical insight placements with local healthcare providers. It is during these placements that providers are able to identify the students who are keen to purse HSC careers and these students are offered opportunities.

‘Once they have completed their placements, we focus on those students who we know are already very keen.’ (Employer 1)

The healthcare providers also offered the FE college students opportunities to join the temporary staff through bank and/or agency work. This meant that when employment opportunities arose for permanent roles, these students could be made aware so they could apply.

‘we can track them much easier, talk to them about, “Well this vacancy is coming up, why don’t you apply, what support do you need?’ (Employer 1)

For the students that are successful and secure permanent employment with the Trust, they had the option of being offered apprenticeship programmes to progress their careers.

‘once they’re in as a support worker, we would use an apprenticeship journey’ (Employer 1)

‘So, xxx (Trust name), for example, we have utilised apprenticeships to widen the participation of people that we recruit into our trust. ‘

(Employer 3)

One of the other avenues for recruitment, which some participants discussed, was the requirement for FE providers to engage with private provider/business/ charity organisations who could potentially offer HSC placement and employment opportunities.

‘I think it would work very well if local colleges, for example, would speak to the local organisations, not only to hospitals.’ (Employer 3)

‘I think it would be good for colleges to actually promote themselves to say that we’re working with these organisations so if you study these sorts of courses with us then we could help you or we could introduce you to these organisations’ (Employer 3)

2.

Many healthcare employer participants explained that they have a vested interest in not only recruiting FE college students, but also retaining them within their workforce and supporting their career development. There was recognition that FE colleges could provide an employment pipeline for providers, and it was important to identify pathways for career progression to support the retention of staff. One of the providers had a Healthcare Support Worker Strategy, which informed the recruitment, career pathways and skills development for healthcare support workers. The development of such a strategy, at Trust level, raises the profile of healthcare support workers and provides a strategic commitment to growth and development of these roles.

2.1 Identification of career pathways

The employer participants recognised the importance of ensuring that line managers optimise career support by understanding the various roles, training opportunities and career pathways available.

‘It thinks about developing, not just the healthcare support worker but also, people who line manage them. So, introduce career coaching, career conversations, think about how…’ (Employer 1)

‘they are already our staff and basically as part of their career progression we support our staff to undertake certain courses that relates to their job role’ (Employer 3)

2.2 Enablers of career progression

The employer participants described how they had teams to support career progression for staff and students. These were mainly practice education teams who worked with staff and students providing training and other upskilling services. One of the employers additionally described the introduction of a buddy system for FE college students for when they are on placement/first employed, offering them a support system when working in clinical practice. The introduction of the buddy system provides training opportunities for the more experienced healthcare support workers, which adds to expertise and in turn supports their progression.

‘formalise development for support workers who buddy and coach other people, specifically those FE students who come in on placements’ (Employer 1)

The employer participants highlighted the importance of ensuring that FE students had the required information and support to enable them to make informed career pathway decisions.

‘in nursing it’s not always being on the bedside of the patient, like there are different kinds of nurses. There are research nurses. There are specialist nurses …… so they need to understand the variety of opportunities that could be available to them once they start on this particular course.’ (Employer 3)

Some of the employer participants described how they have adopted new approaches to recruitment panels by providing additional training to recruiting managers and promoting inclusive panels through required representation from an ethnic minority advocate. It was perceived this approach would support FE learners, from diverse backgrounds, to gain employment into HSC careers.

‘More training with, often, ward managers and senior nurses who are carrying out the interview, to make sure that they are being as inclusive as possible in their recruitment decisions…’ (Employer 1)

The employment participants recognised the need to enhance collaborative working with the FE college careers advisors, so that they could better guide the students on the entry qualifications and career pathways available within healthcare.

‘would like to see their career advisors be much closer to the employers and get to know what our requirements are’ (Employer 1)

Employer 3 suggested that FE students need to understand the apprenticeship offer. This offer provides students with funding because they are employed in healthcare support worker roles, whilst completing the programme. They highlighted that the guarantee of employment at the end of an apprenticeship programme could act as an enabler for FE students.

‘in every single stage of that career development pathway there is an attached course which is available through the apprenticeship route. So, that whatever is the required qualification of a particular role, it is available within the trust so that the staff will not need to pay for those courses’ (Employer 3)

2.3

One of the main barriers identified by the employer participants to progression was the lack of timely engagement with the HSC students by employers.

‘I think it’s about going into the colleges at a much earlier stage, when they’re just sitting down, thinking about the studies. It gives them a thought: “Actually, there is end in sight.” (Employer 2)

Two of the employer participants explained that a significant barrier to progression for disadvantaged/ underrepresented groups within healthcare is linked to the idea of a ‘glass ceiling’, where few ethnic employees progress to the more senior and executive roles within an organisation. The risk with this phenomenon is that ethnic FE college students may not pursue careers in HSC as they perceive they will be restricted to entry level jobs.

‘For nursing and midwifery, particularly, there seems to be, still, a bit of a glass ceiling. For people, Black, Asian, minority ethnic groups, it seems that they are stuck at a certain band. They will often get to charge nurse or sister and then won’t progress,’ (Employer 1)

‘I think it’s about knowing how to go about it. And it’s about having the doors opened for them and knowing how to access things,’ (Employer 3)

Employer participant 1 suggested that previous negative experiences of interview panels can also be a barrier to career progression, acting as deterrent for some people applying for new opportunities.

‘There’s no point applying because I’m not going to be successful.” because they’ve had so many knock-backs in the past. So, people become stuck based on their past’ (Employer 1)

Some employer participants suggested that placement pressures and limited capacity within clinical areas can also act as a barrier to career progression for FE students. Placement capacity pressures means there is often a hierarchy in how students are placed. HEI nursing/healthcare students often have placement agreements and placements allocated for their programme length, meaning few gaps are available for other students.

‘It has been really easy for those areas to deprioritise BTEC students because, “I’ve just got so many other students to worry about’ (Employer 1)

DISCUSSION

HSC students studying in FE colleges have an interest in pursuing HSC careers/further HEI study. Whilst this was a clear motivation for most of participants, some students pursued a HSC course due to family/ peer influence. Healthcare professions are vocations; in most cases people who pursue these careers do so because of their own lived experiences and/or interest in helping others (Liaw et al., 2017). Despite the enablers to support FE students to progress to HEI study/careers in HSC, the recruitment numbers remain low (Busher and James, 2020).

Continuing HEI education was a definite choice for some of the FE students in this study, but not all. Students with a clear goal of pursuing HE education, were often informed, had applied, and been offered places. Whereas, for the students who were uncertain, they had mixed views about HE study and healthcare careers based on the feedback from family/ friends or through media stories, which were not always a positive reflection of the profession. This group of students were often misinformed in relation to the HE entry requirements; frequently realising the tariff requirement in year 2, when it was too late.

There were frequent student concerns relating to the funding costs associated with HE study; many of the students were unaware of apprenticeship routes, which significantly reduce cost and guarantee employment. There was a general lack of student understanding on the range of career pathways available in HSC. Specifically for allied health, there was limited understanding of the various allied health roles and routes onto programmes, either by direct entry or through apprenticeships.

The students reported high incidences of poor mental health. Mental health symptoms were frequently exacerbated by the pressures associated with study and the requirement to balance conflicting responsibilities. Poor mental health acted as a significant barrier to course completion and career progression. Appropriate support mechanisms, such as ensuring reasonable adjustments for assessment and exams and providing students with identified tutors to offer pastoral support could help students to overcome the barriers and engage with their learning (Buchanan and Warwick, 2020). It is important for FE colleges to provide adequate academic and pastoral support for students to reduce attrition rates and promote progression to HSC careers/HE.

The healthcare providers in this study are keen to employ FE students as they viewed this population as a potential employment pipeline, meeting their widening participation workforce requirements. The completion of clinical insight placements provide an ideal vehicle for recruitment. The employers were working to introduce strategies to support recruitment and retention. The recruitment strategies involved supporting FE learners to join their bank staff and offering them permanent employment when they completed their FE programmes. Apprenticeships and broader opportunities available were shared with FE students whilst on placement or employed as healthcare support workers or as apprenticeship Nursing Associates.

It was acknowledged that limited placement capacity meant that not all students had the opportunity to experience clinical insight placements and thereby understand the available opportunities, which acted as significant barrier to career progression. Contributor, (2022) found that clinical insight placements were effective in supporting students to be more informed and committed to pursuing HSC careers. For these reasons it is critical that FE students have an equal opportunity to experience clinical insight placements. There was a strong indication that HSC employers needed to work in collaboration with FE colleges to inform the mapping of clinical insight placements and the sharing of career pathways, ensuring that FE students are fully informed of the available opportunities. This finding was supported by Institute, (2022) who found that it was important to promote collaborative working between key stakeholders and to provide FE learners with information on the options available to them.

FE students that did have the opportunity to experience clinical insight placements had limited opportunities for debrief, which resulted in some students changing their perceptions of healthcare and ultimate career decisions due to misinformation (relating to salary and career progression opportunities) and traumatic clinical experiences. There is a clear requirement for debrief opportunities for FE students whilst on clinical insight placements.

LIMITATIONS OF THE STUDY

This study was limited to colleges and HSC providers in the London region. It may be beneficial to extend this study to other regions, however it is likely that the findings are broadly representative. The study findings may be enriched through interviewing students who had completed HSC programmes but pursued other professions/ HE programmes.

Recommendations

FE Colleges

1. Training and support needs to be available for careers advisors to enable them to comprehensively advise students on HSC careers including: course choice; breadth of career options (including terms and conditions) and entry requirements. This training needs to be undertaken in collaboration with FE colleges, employers and HEIs.

2. As part of FE enrolment/induction, students must be given the opportunity to meet HSC providers/ HEI representatives to obtain information on available healthcare pathways. Following these sessions each student must be given an opportunity to map their career options so that they can be supported with the right information to inform their progression.

3. Students should be provided with relevant and high-quality HSC clinical insight placement opportunities. When placement capacity is unavailable, high quality replacement simulation opportunities must be provided for all learners.

4. HSC students should have a minimum entitlement to access care suite facilities. A review of care suite facilities must be undertaken by FE providers to ensure that the minimum entitlement is available to all learners to ensure equity.

HEIs

1. HEIs must form strategic partnerships with FE colleges and HSC providers to promote operational collaboration on curriculum design and progression pathways.

2. HEIs must have a strategic objective which is specially targeted at strengthening the liaison between FE colleges, HEIs and HSC providers to promote the recruitment and retention of disadvantaged and under-represented learners.

3. HEIs must strengthen their work with their outreach/widening participation teams to ensure that subject experts link with HSC students to provide information on HEI study, course options and pathways, the entry level requirements and associated funding arrangements.

5. FE colleges, in partnership with HSC providers, must ensure that adequate pastoral support is available for students on placements. Students must be offered opportunities for debriefing when they complete the placements.

6. Further training of FE staff must occur to support them in recognising mental health concerns for HSC students, utilising the available pastoral policies, for example mental health, student wellbeing and safeguarding. A review of the learner voice policies will further enable the strengthening of student feedback.

7. FE colleges must provide students with comprehensive information on the financial assistance available to them including those that have caring responsibilities or childcare requirements. This information must be delivered to students during the induction period.

8. FE colleges must work in collaboration with HEIs and employers to ensure a strategic oversight for placement capacity to offer T-Level students the requisite 45 day placement, for the Employer Set Project to be achievable.

4. HEIs must engage with and provide the following information to FE college career advisors: programme options; breadth of career options (including terms and conditions) and entry requirements.

5. HEIs, FE colleges and HSC providers must have strategic oversight of placement capacity across the sector to enable quality placement opportunities for all learners (eg. T-Levels, multiprofessional groups, HSC students).

6. HEIs should work in collaboration with FE colleges and HSC providers to inform and develop a simulation strategy, for example, including human factors.

HSC Providers

1. HSC providers must have early engagement with HSC FE students to provide career information and pathways available within HSC. Specific case studies must be given by employers to illustrate career progression opportunities for all HSC students, but specifically for disadvantaged and under-represented learners.

2. All HSC providers must consistently engage with FE Colleges to ensure they understand the requirements of HSC qualifications.

3. HSC providers must work in partnership with FE colleges and HEIs to ensure there is strategic oversight to maximise placement capacity. This may require specific ringfencing of work experience opportunities.

4. HSC providers should work in collaboration with FE colleges and HEIs to inform and develop a simulation strategy. This strategy will include the use of virtual reality and simulation to deliver the required knowledge, skills and behaviours within occupational Standards.

5. A diverse and inclusive HSC workforce must engage with HSC students to enable them to effectively role model and breakdown ‘glass ceiling’ perceptions, particularly with BAME communities, but also including other

Future research

disadvantaged groups.

6. HSC providers must engage with HSC students to promote a positive professional image to mitigate the influence of negative media reports.

7. All HSC providers must work with FE Colleges to develop clear career progression pathways for employment, for example from T level to employment opportunity (including apprenticeships).

8. HSC providers must train staff to understand how to engender a sense of learner belongingness, through careful work experience orientation, assignment of a mentor/ buddy and through debrief. To achieve this there needs to be a practice-based education infrastructure specifically to support these more vulnerable learners.

9. HSC providers must ensure that equality, diversity and inclusion related barriers to career progression are eradicated; this will enable a full representation of all communities at senior level. Students, for example, from BAME or disadvantaged backgrounds, will be inspired to undertake careers in HSC if they can see representative role models in senior positions.

It is recommended that future research should be conducted as a follow-up study with participants from FE colleges, HSC employers and HEIs to explore the impact of the recommendations outlined in this report.

CONCLUSION

In reviewing the findings of this study and evidence from the extant literature, it is apparent that students on HSC programmes provide an important employment pipeline for healthcare providers to close the current healthcare workforce gap. Although students have a clear motivation to enrol on HSC FE programmes, many do not subsequently follow HSC careers or further related HE study. Students from disadvantaged and under-represented groups are particularly vulnerable to deviating from their chosen career choice due to a number of pervasive and complex disadvantaging issues including: financial pressures; poor physical and mental health; conflicting caring responsibilities; lack of timely academic and career related information and support; peer and family pressures; negative media images and the perception that there are few representative role models in senior positions. Clinical insight placements are highlighted as supporting students to gain an important awareness into HSC and understanding of available career opportunities. However, limited placement capacity can lead to inequity in gaining this experience. This study makes several important recommendations to enhance progression opportunities into HSC careers, with a particular focus on those from disadvantaged and under-represented groups.

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DEFINITION OF KEY CONCEPTS

KEY CONCEPT DEFINITION

Clinical Insight Placements

FE college

HSC programme

These are learning opportunities for HSC learners to gain experience and an understanding of care settings. This is not a formally assessed clinical placement. They range from hours to weeks.

Further Education Colleges offer courses at every level from entry and pre-entry level courses that do not require GCSE grades at entry, through to higher level qualifications such as Higher National Certificate/Higher National Diploma and degree courses.

These are programmes of study which are designed to develop knowledge, skills and behaviours required for a professional qualification and career in health and social care. These careers include nursing, social work, general care work and allied health professions.

HSC career Health and social care careers are the employment pathways for professionals working within healthcare. These careers include nursing, social work, general care work and allied health professions.

Higher Education institution

This paper will include universities, which offer a range of qualifications that provide professional qualifications in fields such as: education; nursing and allied health; law, engineering; design and technology; healthcare and social sciences and dance and music. Universities mainly offer undergraduate and postgraduate education which focus on academic learning rather than vocational training.

STUDY SETTING AND POPULATION

FOCUS GROUPS

College

London College a 15

London College b 8

London College c 5

Access students

Access students

Access students

London College d 5 BTEC students

London College e 8 BTEC students

Total 41

Individual Interviews

London NHS Trust 1 1

London NHS Trust 2 1

London NHS Trust 3 1

Alumni Participant 1 Alumni Student Total 4

APPENDIX 3