edgehill.ac.uk Widening access to health care professions – enablers that matters - a review of interventions and strategies for the future’ ‘Rethinking Widening Access: How do we improve student outcomes across the lifecycle?’ Neon Conference 10 th of June 2016 Dr Vicky Duckworth and Professor Liz Thomas

Overview This research was commissioned by Health Education England (HEE) to inform their emerging widening participation (WP strategy).

Premise Widening participation in health education is vitally important to both the NHS and to society as a whole. A more representative workforce enables the NHS to work towards greater equality, diversity and social mobility and to provide health services that better meet the needs of the communities it serves, both as a provider of health care and as a major employer (HEE 2014). Health Education England (2014) Widening Participation It Matters! Our strategy and initial action plan. NHS/Health Education England.

Objectives The objectives included: Investigate the experiences of students – identifying the enabling and challenging factors Explore the different types of strategies being employed by higher education providers

Methodology A mixed methods approach Students studying NHS-funded healthcare programme and recent graduates

Research participants

Lens and context

Ways of being - Habitus Our respondents were usually aware of their underrepresented status and spoke of feeling ‘different,’ sometimes contrasting themselves with what they thought of as a ‘typical’ students

Recognising difference in the field of Health Age and maturity I really struggled when I first came back to university. I was only a year over into the mature student category, but I definitely saw a distance between myself and the year ones. Maybe I was a bit snobby as well about, ‘I’m old and they’re so young. They probably can’t understand me.

Voices just have university as your life, you’ve got a whole other life that runs alongside it.

Voices I have to still work to survive, so that’s made it even more difficult. I can’t do at least a third of study time outside of class because I have to work… I think giving up work would improve my chances. I have to think about what I’m going to do on that front. I think just working harder, just working more hours. I mean to work eight hours on Saturdays and Sundays but I end up doing six.

Enablers: Imagination capital Future selves whilst within the context of study our respondents spoke of notions of ‘othering’ (i.e. feelings of separateness, a lack of belonging, differentiation, etc.), this does not seem to have had a detrimental knock- on effect regarding perceptions of their futures selves.

Imagination to overcome diversity There aren’t a lot of other people who are from a similar background. It hasn’t been a problem but it’s definitely a perceived barrier. Then just other responsibilities that other people don’t have. The caring responsibilities. My parents aren’t in the best financial health. When you see all these big amounts about debt and the cost of university, it is very off-putting, especially if you don’t really understand what benefit you’re going to get at the end of it.

The reality of Socio-economic status What does it mean to fit in? Finance Class capital generational history

Enablers – social capital Family and friends Academic staff placement supervisor

Enablers – Economic capital Prior to deciding to enter higher education money was a key issue that potential students thought about. I had six, if I can remember them all. One is financial, how can I afford this, I’ve given up full time work and I’m going to go to earning £450 and a student loan of £800 every four months.

Transitions in the field Financial concerns were particularly significant for students both giving up full-time employment, and with other responsibilities, such as a family to support and with responsibility for housing (rent and mortgages).

Economic capital though bursaries matters Finance was clearly an important element in these students’ decisions to participate in higher education, but equally, the bursary support also contributed to their decisions to pursue an NHS-funded programme of study, and made the prospect of studying seem more achievable. One student explained that she could not contemplate healthcare degrees that did not provide NHS-bursaries

Saying goodbye to the Bursary The overwhelming view is that this will make studying a healthcare course in higher education more difficult for the majority of students, with potentially detrimental implications for healthcare professions, both in terms of absolute numbers and the diversity of the workforce.

Impact Without the bursary, I wouldn’t have been able to do it. Without the bursary, a lot of people wouldn’t be able to. People are scared of grants, and it’s another reason why people don’t go and do courses, because they are scared of the debt they’ll have at the end. They don’t understand how and when it gets paid back

Impact think the biggest barrier was the financial aspect, and if it wasn’t for the bursary, then I wouldn’t be on the course. It’s very worrying that the bursary is no longer going to be there, because I don’t think any mature students will be able to do it as easily…and now, the financial help’s going to be taken away, I think it’ll be a lot harder for people like me to do it, and a lot easier for people like me to drop out.

Impact I’ve spoken to lots of mature students in my group, and they wouldn’t have done it if they had had to pay tuition fees, it wouldn’t have been viable

Passion is not enough The students who participate in NHS-funded HE programmes demonstrate a strong commitment They care and feel pride in what they are training to do The bursary provides essential financial support and demonstrates a commitment from the government that makes the health professionals feel valued

Key question The importance of financial issues seems to be greater for students who study NHS-funded HE programmes that the undergraduate student population more generally. This raises concerns in the context of the proposed changes to student financial obligations and support.

Recommendations The NHS must take steps to maintain the diversity of the student population in subject areas and with respect to personal characteristics where it has already been successful, there needs to be attention paid to ensure equality of outcomes for students from non-traditional and under-represented groups; and steps need to widen participation and success in subject areas and with respect to student characteristics that are still under-represented.