52 2011
IMAGING & ONCOLOGY
The challenge for HEIs is to maintain alignment with the current scope of practice for entry to the profession, whilst anticipating future requirements; to provide effective, relevant CPD opportunities for radiographers that meet the needs of a diverse and fluid market; to contribute, where possible, to training the assistant level workforce, again in line with local requirements. So, quite a few variables there then!
What are the factors that impact on their ability to deliver on these elements?
PRE-REGISTRATION, ENTRY LEVEL PROVISION Radiographer education at the entry level could be seen as the more stable component of the equation, at least currently. The challenge exercising many HEIs is how to minimise student attrition from programmes at a time when, in England at least, strategic health authorities are penalising them for failing to deliver higher completion rates16
. Periodic programme review requires them to look five years into the future
when the first graduates from a reviewed programme will enter the workforce. Will graduates be fit for practice in the environment that exists then? It is clear that many HEIs are taking great care to develop curricula that are forward looking and anticipatory, but a balance must be achieved. Too much, too soon risks a misalignment with existing needs. Too speculative and the misalignment may be further down the line. So, do these factors encourage conservatism in the design of curricula?
An example of this was the adoption over 10 years ago by some HEIs of the theory component of the College of Radiographer’s intravenous (IV) administration programme in the anticipation that IV administration would become an entry level skill, but has it? Despite the fact that IV administration is now effectively a mainstream activity for radiographers, it remains essentially a post-registration skill. Knowing the style and rate of change remains a speculative process.
POST-QUALIFYING In the post-registration/postgraduate arena, the situation is currently more dynamic. The demands of developing the workforce to meet a rapidly changing environment has required HEIs to operate in ways not previously associated with that sector, more responsive, more flexible, more cost effective. The clinical sector requires targeted, specific programmes that are accessible, tailored to their needs, and aligned with KSF or Skills for Health standards. They will pay for what meets service needs and that does not necessarily mean traditional postgraduate programmes.
Anecdotal evidence indicates that in many areas the number of students signing up for full postgraduate awards has dropped in recent years as students seek focussed programmes that will deliver a specific skills package in line with their CPD requirements. This requires a culture shift for many HEIs as they come to terms with a major change in the shape of post-registration delivery and their ability to respond must also take account of the fact that the market size for many programmes is not sufficiently large to ensure
consistent viability. This, and the reduced emphasis on academic credits, has created an opportunity for independent providers who may meet a need not fulfilled by larger scale HEIs. The law of economy of scale does not necessarily apply in this situation.
ASSISTANT WORKFORCE In many respects, this component of the workforce has been hardest for the HE sector to comprehend. Although standards for practice are defined, particularly through the College of Radiographers’ Learning and Development Framework17
, educational arrangements
are inconsistent, with no specific identified ‘qualification’ for entry to this group. Training arrangements range from in-house training schemes to NVQ programmes, BTECs, Foundation degrees, and a few things in between. Implementation of this tier of the workforce has been influenced by, amongst other things, financial pressures, radiographer availability, and strategic imperatives of clinical managers, meaning that it has been patchy in geographical terms and across modalities and disciplines. For example, assistants are well embedded in the mammographic screening workforce, though less than might be expected in radiotherapy, with some oncology managers questioning the need for assistant practitioners in their service. This has caused some difficulty for HEIs in identifying demand and sustaining programmes for assistants. It is also fair to say that many HEIs are unfamiliar with the business of delivering programmes beneath the undergraduate academic level.
It may be argued then that in this transitional period for development of the assistant workforce, there has tended to be a vicious circle of varying supply and demand. Nevertheless, it is quite clear that there is an evident political will to consolidate and build the band 4 workforce18
and therefore the need to provide appropriate
opportunities, both for initial training and subsequent development, cannot be ignored. This is potentially a major growth area for radiography education, so who delivers it? The HE sector which has the knowledge and expertise in radiography, or the Further Education sector, which has the ability to deliver effective and well supported programmes that meet the very specific needs of learners at this academic level?
THE FUTURE? LP Hartley said ‘the past is another country, they do things differently there’ and, in this case, it may literally be true. The rate of recent change has been significant and gives some sense of what is to come. Looking ahead, the medium term prospect for radiography education is one of shifting emphasis. In general terms, policy direction suggests expansion of the band 4 workforce in a more directive manner than in the past18
; possible contraction in
undergraduate radiographer training, at least in diagnostic (already some evidence of this at the time of writing); increased interest in supporting post-qualifying training at all levels to facilitate skill mix developments and the restructuring of some services. What this means for the HE sector probably has two main facets.
Firstly, developing or expanding provision in ‘pre-graduate’ and post-qualification areas requires a degree of re-prioritisation and potential re-skilling. Whilst it is true
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