Getting better by degrees

A degree has become common currency for NHS clinical and managerial staff: over the last few years many professions have moved to an all degree entry.

But as the NHS changes rapidly, the advantages of staff furthering their studies are becoming obvious to organisations and individuals.

Many are looking to masters level and other postgraduate qualifications to enhance their skills - whether it be in understanding research and carrying this into practice, deepening their understanding of a patient’s involvement in his or her own care, or reflecting the shift towards integrated care.

• The challenge of self-management

Keeping up with change

Sue Covill, director of employment services at NHS Employers, says: “We need a workforce that is able to deliver care in a changing environment - I would see postgraduate courses as one means of delivering that.”

Professor Victoria Joffe, associate dean of postgraduate studies at City University London, says that the Health and Social Care Act has made these issues central to service provision - but many healthcare professionals will have trained in a different environment where they were not so prominent.

The involvement of service users or clients, for example, “needs to be taught and talked about. We know it is a good idea but it is a huge jump to do this in a meaningful way”.

Another area she highlights is around professional practice and accountability - something which many organisations are having to reconsider in the light of the Francis report. It is not just the accountability of the individual, she points out, but helping them to speak out in a professional manner when witnessing unacceptable care or behaviour.

‘Masters courses are not about spending a year in an ivory tower. They are linked to the workplace and draw on students’ experience and challenges’

“There is a real focus on professionalism in our MSc courses,” she says.

“We are asking people to do a lot more on a lot less - that is just the reality. How do you manage that; manage yourself and your time in a way that allows you to be effective?”

Increasingly, masters courses are not about spending an entire year in an ivory tower: they are more closely linked to the workplace and are often part-time, with some assignments which will draw on the students’ experience or challenges at work.

There is also increased flexibility over how long a student has to complete the course - some part-time courses at City University London can be completed in two years, or five. There is some use of online learning and students can opt for a module by module approach.

Direct improvements

Talking to students and employers is crucial in devising both pathways and content of courses. Professor Joffe says City University London redesigned its masters courses after an in-depth consultation with service providers, past and current students - as well as those who had asked for information about courses but then decided not to go ahead with them.

This has led to a portfolio of courses - including MScs in advanced practice in health and social care - with 11 routes tailored for various professionals such as nurses, speech and language therapists, optometrists and radiographers.

One option is focused around long term conditions and long term care, reflecting the challenges health services and professionals face in caring for the increasing number of patients with one or more LTCs. There is also a National Institute for Health Research-funded masters in clinical research, which helps people progress into an academic clinical career.

“A key concept in all of these is inter-dependency and inter-professional working,” she says.

All students have two core modules - research methods and critical appraisal - which help them to understand research and how it applies to their practice.

“We need to show how we know we are effective - it is not good enough to say we know it works, we need to know how it works.”

‘For some staff, the course can allow their career to develop in new directions’

But why should hard-pressed NHS organisations invest this money in staff? Ms Covill says benefits in terms of improved patient care will be important.

“I would want them to come back and demonstrably show the learning they have acquired,” she says.

For Professor Joffe part of the rationale is that it is actually investment in a team rather than an individual: it is crucial that the student goes back into the workplace and shares their new knowledge and skills to change team practice as well as their own.

For some staff, the course can allow their career to develop in new directions - taking on more advanced clinical work is one option but some students may want to take on more research responsibilities.

Others may want to change their practice and that of their colleagues, using the skills they acquire in critical appraisal to lead this. Some may be looking for a more managerial role or to take on public health responsibilities (there’s a masters in public health on offer).

“We ask them what they need to change and what they feel is important,” she says.

Staff morale

Investing in staff’s further development can also make them feel more valued and be good for their morale and commitment to the organisation.

There can also be some financial support available: the National Institute for Health Research, for example, is funding 12 students to do a masters in clinical research at City University London, both paying their fees and covering their salaries while they study. Students on some courses can also apply for Dean’s scholarships, which reduce the costs.

However, many students will be funded by their employer and a brave few will self-fund.

East London Foundation Trust supports six to eight staff members a year to get a masters qualification through City University London.

‘Research work staff do while undertaking their masters can translate into improvements in patient care’

Jonathan Warren, director of nursing and quality at the mental health and community services trust, views it as an investment.

“What I’m interested in as a director of nursing is having an excellent, inquisitive nursing workforce,” he says, pointing to the need for healthcare professionals to employ evidence-based interventions.

Sometimes the research work the staff do while undertaking their masters can translate directly into improvements in patient care - one occupational therapist researched the value of sensory rooms in some psychiatric settings, and this has led to the trust using them. A senior nurse did research around families in crisis and this has changed the approach the trust has with families and carers.

And the staff who undergo masters training provide a cohort of clinicians who can take on leadership roles and bring expertise to their teams and the organisation, he says. “It encourages others to think critically about how they approach care of patients. It stops the cycle of ‘we do it this way because we have done it this way’.”