1. www.hee.nhs.uk Welcome ! “Promoting ethnic diversity in paramedic education and the profession” Harminder Bains Education Transformation Manager – Health Education East Midlands

2. www.hee.nhs.uk Housekeeping Here to help

3. www.hee.nhs.uk The journey so far… Young Carer Recent experience Different sector similar challenges Paramedic Lead for HEEM

4. www.hee.nhs.uk A bit about today Expert Individuals

5. www.hee.nhs.uk Three ask 1.Share 2.Recommend 3.Accountable

6. www.hee.nhs.uk Staying Connected #ParamedicDiversity @EastMidsLETB @HEEM_EduComms

7. www.hee.nhs.uk Thank- you

8. www.hee.nhs.uk Strategic Overview - Paramedic Evidence based Education Project (PEEP) David Farrelly Local Director Health Education East Midlands 29 th July 2015

9. 9 Paramedic Evidence Based Education Report Commissioned by DH’s National Allied Health Professional Advisory Board - funded by the College of Paramedics, reporting in October 2013 and passed over to HEE in autumn 2013 Provides an evidence base to progress the strategic direction of the standardisation of education and training Various education and funding models in place across the UK - PEEP seeks to address these issues Delivery lies with Health Education England (HEE), the College of Paramedics and the Association of Ambulance Service Chief Executives HEE asked College of Paramedics to co-chair an oversight national steering committee including devolved nations invited to be active participants to deliver UK solution

10. 10 PEEP Report In 2013 the PEEP report identified that The paramedic profession as the only Allied Health Profession: o With no single education level entry route to registration with HCPC o No clearly nationally defined or aligned career structure leaving inconsistency in titles, scope of practice and purpose –Advanced prescribing necessitates both to be agreed and in place before the non- medical prescribing board will consider a business case from the profession –The outcomes of Keogh’s urgent and emergency care review – have a direct influence on the future work force plan as well as the role paramedics will play in providing services to the public, through the urgent care commissioning framework

11. 11 Steering Group - Key Recommendations There should be a nationally agreed approach to the commissioning and funding of paramedic education Models of pre-registration education and training should align with other non medical professions and lead to an all graduate profession The standards of proficiency and Standards of Education and Training are both HCPC documents and were reviewed by them and updated in 2014. The College of Paramedics Curricula Guidance and Competency Framework were submitted for independent Educational reviewing to confirm the standards of education at BSc (Hons) HE level 6 Evaluate education and development opportunities for the existing workforce and embed a whole systems approach to enhance the learning environment for the student paramedic There should be an enhancement of clinical skills and clinical decision making developed through the College of Paramedics curricula

12. 12 Project Structure Education & Training Steering Group Ways of Working /Scope of Practice PEEP Report RecommendationSub Group Leading Education Models Clinical Models Urgent Care Steering Group Workforce Planning 1.0 Standardised approach to education and training Scope of Practice and Ways of Working 1. Nationally agreed approach to commissioning and funding Finance 1.2 Access to bursary fundingFinance Finance Commissioning 2.0 Pre-registration education development model leading to an all graduate profession Scope of Practice and Ways of Working 3.0 Models of pre-registration education and training Scope of Practice and Ways of Working Clinical Standards 3.1 Knowledge and skills enhancementScope of Practice and Ways of Working Communication and Engaged 3.2 ContentScope of Practice and Ways of Working 3.3 Clinical Decision MakingScope of Practice and Ways of Working 4.0 Partnership ModelWorkforce Planning 5.0 Paramedic leadership for EnglandScope of Practice and Ways of Working 6.0 Standardised approach to identificationCommunications

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14. 14 Where are we now? A managed phased transition to a 3 year BSc (Hons) programme for all direct entry students, achieved by the 2019 intake. Continued growth in demand, as measured by total calls to switchboard in AmbSYS data, consistent with the average for the last three years. Continued progress to achieving a 40% ‘See & Treat’ share of activity, supported entirely by Paramedics, including 15% at a post-registration qualified level, by 2021 at the latest. Changes to the education pathways arising from the PEEP project, i.e. a move to a standard 3 year BSc (Hons) Paramedic Science degree programme; Underlying demand pressures in the face of changing urgent care systems at a local level; An increase in ‘see and treat’ responses that reduced conveyance to hospital, supported by an enhanced skill mix.

15. 15 Work in progress Development of a transition implementation plan, to include: Education and development opportunities for the existing workforce An engagement programme with all stakeholders to be delivered from a national platform to have the necessary influence, supported by local delivery plans The development of the infrastructure to deliver the education and training model with service HEE to pilot pre-degree paramedic programme in four geographies with a particular aim in widening participation/BME inclusion agendas. Development and delivery of education assurance framework: The assurance framework has been developed by HEE in partnership with the Education Modelling sub group and National Ambulance Service HR Directors Group.

16. 16 Managing Transition Education Development Employment Issues Workforce Planning

17. 17 College Developments Agreed Scope of Practice at point of registration Revised Paramedic Curriculum Guidance Developed competency framework Developed Paramedic Post Registration - Career Framework Developing the Post-Graduate Curriculum for Specialist and Advanced Paramedics Reviewing the QAA Paramedic Science Benchmark Statement in Partnership with the QAA.

18. 18 Next Steps and Opportunities Financial viability to be fully assessed and a suitable commissioning model to be determined Workforce plan to be confirmed and the education delivery model to be approved Communications strategy to be developed New Implementation Steering group and transition plan to be supported Growth in Paramedic Workforce, working in new settings and in new networks in the Primary Care Commission report and the new urgent care vanguards Pre degree and access opportunities to develop the BME workforce in all areas Final report to be submitted HEE in September - use the proposed commissioning numbers and pre degree pilots as an opportunity for addressing underrepresentation of BME groups Outputs from today will inform our narrative preferred approach with sponsorship from HEE

19. www.hee.nhs.uk The role of leadership - Jagtar Singh “We are the change we have been waiting for”

20. www.hee.nhs.uk Paul Deemer – NHS Employers

21. www.hee.nhs.uk Tea break

22. www.hee.nhs.uk What the research suggest ? West Midlands Ambulance Service Equality Challenge Unit

23. Promoting ethnic diversity in paramedic education and the profession Barbara Kozlowska, Head of Organisational Development Maria Watson, Senior HR Manager

24. Activity to date: June 2013: WMAS CEO established HEI Deans group HEI Consortium University of Worcester led on research Positive Imagery Positive Action Engaging with Young People Co-mentoring Pilot Next steps

25. Activity to date: June 2013: WMAS CEO established HEI Deans group

26. Activity to date: June 2013: WMAS CEO established HEI Deans group HEI Consortium

27. Activity to date: June 2013: WMAS CEO established HEI Deans group HEI Consortium University of Worcester led on research

28. West Midlands Ambulance Service NHS Foundation Trust Organisational Development: Driving positive change through consulting and influencing Purpose: To gain an understanding of how BME groups respond to information about paramedic courses, their experience of the enrolment processes and their experience of paramedic training. What barriers to paramedic education exist for BME groups? - a joint research project between WMAS and the University of Worcester

29. West Midlands Ambulance Service NHS Foundation Trust Organisational Development: Driving positive change through consulting and influencing Methodology: Questionnaires were distributed to BME and non- BME qualified paramedics and student paramedics within the West Midlands. Telephone interviews were conducted with qualified paramedics and student paramedics from BME groups. What barriers to paramedic education exist for BME groups? - a joint research project between WMAS and the University of Worcester

30. West Midlands Ambulance Service NHS Foundation Trust Organisational Development: Driving positive change through consulting and influencing Findings: Questionnaire results revealed significant differences between BME and non-BME groups for the accessibility and understanding of information on paramedic education Results produced no significant differences in the way that specific sources of information influenced career choice for BME or non-BME respondents (e.g. internet, newspapers, television, etc.) No significant difference between BME and non-BME respondents for factors relating to; prior knowledge of the profession, experiences of recruitment processes, recommending the profession to others, influence from family/friends, and sharing information on the profession with others. Interviews suggest a lack of information in preparation for paramedic courses and on the job training, causing unrealistic expectations. A lack of diversity in the student population, incidences of racial offence (unconscious or conscious), and also a lack of visibility of BME staff in the ambulance service as well as in the wider community were identified. What barriers to paramedic education exist for BME groups? - a joint research project between WMAS and the University of Worcester

31. West Midlands Ambulance Service NHS Foundation Trust Organisational Development: Driving positive change through consulting and influencing Practical implications: The results produced from this evaluation may contribute towards a series of recommendations in order to better inform practice to increase the diversity of students entering into paramedic science and in order to avoid issues such as student attrition. What barriers to paramedic education exist for BME groups? - a joint research project between WMAS and the University of Worcester

32. Activity to date: June 2013: WMAS CEO established HEI Deans group HEI Consortium University of Worcester led on research Positive Imagery

33. Activity to date: June 2013: WMAS CEO established HEI Deans group HEI Consortium University of Worcester led on research Positive Imagery Positive Action

34. West Midlands Ambulance Service Positive Action

35. The Beginning Audit data analysis Positive Action Paper Board Buy in and vision Recruitment analysis Changing the image Community engagement Raising the profile Audit data analysis Positive Action Paper Board Buy in and vision Recruitment analysis Changing the image Community engagement Raising the profile

36. Positive Action Imagery Leaflets Flyers Advertisements Positive Action Statement Social media Careers brochure Leaflets Flyers Advertisements Positive Action Statement Social media Careers brochure

37. Community Engagement Diversity Tour Board & Directors Community Events Recruitment events Diversity Tour Board & Directors Community Events Recruitment events

38. Access Course

39. Activity to date: June 2013: WMAS CEO established HEI Deans group HEI Consortium University of Worcester led on research Positive Imagery Positive Action Engaging with Young People

40. Activity to date: June 2013: WMAS CEO established HEI Deans group HEI Consortium University of Worcester led on research Positive Imagery Positive Action Engaging with Young People Co-mentoring Pilot

41. Activity to date: June 2013: WMAS CEO established HEI Deans group HEI Consortium University of Worcester led on research Positive Imagery Positive Action Engaging with Young People Co-mentoring Pilot Next steps

43. More questions: What does retention look like? How do we help with understanding the role, personal characteristics required and progression routes available? What progression opportunities do people want? Do universities offer courses that support progression? How is the profession marketed?

44. Examining BME underrepresentation in paramedic programmes in the East Midlands 29 July 2015 Szilvia Altorjai and Jennifer Panting ECU

45. Outline =About ECU =The research project =Case for greater ethnic diversity in the paramedic profession and education =What the data suggests =Recommendations =Next step – stage 2 =Questions

46. Equality Challenge Unit ECU works to further and support equality and diversity for staff and students in higher education and seeks to ensure that staff and students are not unfairly excluded, marginalised or disadvantaged because of age, disability, gender identity, marital or civil partnership status, pregnancy or maternity status, race, religion or belief, sex, sexual orientation, or through any combination of these characteristics or other unfair treatment.

47. Equality Challenge Unit Programme of projects, activities and services =Research projects =Guidance and best practice publications statistical reports =Conferences and training events =Advice line for universities =Gender and race charter marks (Athena SWAN Charter) =Bespoke services and consultancy www.ecu.ac.uk

48. The research Questions: Why do you think there BME underrepresentation in paramedic courses in the East Midlands? What can be done to encourage students from a BME background to apply for and accept places on these courses? Stage 1: Data analysis and literature review Stage 2: Primary data collection

49. Scope and case for greater diversity in the paramedic profession and education =Paramedics’ increasing workload (CfWI, 2012) =Increasing population and diversity (ONS, 2012b) =Paramedics care for and treat an increasingly diverse population =More diverse student body  more confident workforce in meeting the demand for care (Saha et al., 2008; Whitla et al., 2003)

50. Ethnic minority population in the East Midlands Figure 1. Ethnic minority population aged 16-64 by counties in the East Midlands, 2014 Source: ONS Crown Copyright Reserved [from Nomis on 19 July 2015]

51. Ethnic composition of students in the UK Table 1. UK domiciled students studying subjects allied to medicine and paramedical science in the UK by ethnic group, 2013/14 Source: HESA Student records 2013/14. Note: 4 digit JACS subject 3.0: (B900) Others in subjects allied to medicine; (B950) Paramedical science. Note: only UK-domicile student included, those whose ethnicity is not known are excluded from the calculation. Ethnicity Percent of ethnicities (within others in subjects allied to medicine) Percent of ethnicities (within paramedical science) White73.2%96.6% Black9.7%0.4% Asian13.2%1.2% Other (including mixed)3.9%1.8% Total100.0%

52. Ethnic composition of paramedic completers in the East Midlands Ethnicity Percent Chinese <1% Mixed-White and Asian <1% Mixed-White and Black African <1% Mixed-White and Black Caribbean 2.2 Other Asian background <1% Other Mixed background 1.3 Other White background <1% White 22.5 White-British 71.9 Grand Total100.0 Source: Paramedic completers data – Health Education East Midlands. Note: Those whose ethnicity is not known are excluded from the calculation. Table 2. Ethnicity composition of paramedic completers in the East Midlands, 2008-2014

53. BME underrepresentation in paramedic science Source: Census 2011. Paramedic completers data – Health Education East Midlands. Method: Modood (1993). Table 3. Comparison of ethnicity composition of paramedic completers (2008-2014) and 0- 24 year olds in the East Midlands (2011) by ethnicity. % of paramedic completers in the East Midlands (2008- 2014) % of 0-24 year olds in the East Midlands (2011) Level of representation in comparison to population size (%) White93.481.215.1% Other White background0.93.2-72.0% Mixed and other Mixed background4.84.117.7% Asian and other Asian background0.88.5-90.5% Black/African/Caribbean/Black British0.02.4-100.0% Other ethnic group0.00.7-100.0% BME total5.615.6-64.1%

54. Literature review: factors that influence university and subject choice of learners 1 Meeting the entry requirements (Ball et al., 2002b) Perception of the university and the course (Greenhalgh et al., 2004) Information, advise and guidance (IAG) received (Greenhalgh et al., 2004; NUS, 2011) Perception of ethnic diversity - “Will I fit in?” (Ball et al., 2002a and 2002b; Reay et al. 2001)

55. Literature review: factors that influence university and subject choice of learners 2 Structural barriers Geographical proximity of course delivery – localism and travel costs (Reay et al. 2001, Ball et al 2002b; NUS, 2011) Combining full-time education with existing paid employment (Reay et al. 2001) Inclusive learning and teaching environment Learning and teaching experience – Stereotype threat and unconscious bias impact teacher-student interaction, pupils’ educational attainment and future career opportunities (Gilborn et al., 2012; Woolf et al., 2008) Students satisfaction with clinical learning, course, university and supporting services available (UNISTAT, 2015; NUS, 2011)

56. Recommendations 1 Pre-application stage Identify areas where discrimination could occur (ECU, 2012): ‒Access to information  streamline and widen access to information about the course and the profession ‒Entry requirements  collect data, analyse, and monitor applications ‒Admissions process  collect data, analyse, monitor and evaluate processes =Establish mechanisms to ensure admission process is consistent and non-discriminatory (ECU, 2012) =Effective communication to internal and external audiences (ECU, 2012) =Regular reviews to assess and advance effectiveness of policy and practice (ECU, 2012)

57. Recommendations 2 Teaching and learning experience =Identify areas where teaching and learning experience can be improved ‒Course content ‒Course delivery ‒Lecturer training and experience ‒Unconscious bias

58. Recommendation 3 Collaborative efforts =Regional model with voluntary sector  to gain practical experience of being a paramedic =Education community link-workers (Thomas, 2001; Cohen et al., 2002)  personalised support to course applicants while channelling their needs to the course providers =Shared practice and joined up approach of existing initiatives

59. Stage 2: Data collection Focus groups/interviews among current and prospective students and practitioners to 1) Examine prospective students’ access to IAG and knowledge of paramedic science 2) Explore decision-making of prospective students 3) Examine the admissions process from a student and practitioner perspective 4) Identify good practice in admissions, course content and delivery

60. Questions 1)Who do you think should be involved in the process of developing the action plan to improve BME representation? 2)What challenges might your institution encounter when developing an action plan to promote BME participation?

61. References Ball SJ, Davies J, David M, Reay D, 2002b: ‘Classification’ and ‘judgement’: social class and the ‘cognitive structures’ of choice of higher education. British Journal of Sociology of Education. 23:51-72. Ball SJ, Reay D, and David M, 2002a: ‘Ethnic choosing’: minority ethnic students, social class and higher education choice. Race Ethnicity Education. 5:333-57 Centre for Workforce Intelligence (CfWI), 2012: Paramedics: Workforce risks and opportunities - education commissioning risks summary from 2012. Cohen JJ, Gabriel BA, Terrell C, 2002: The case for diversity in the healthcare workforce. Health Affairs 21(5) ECU, 2012: Equitable admission for underrepresented groups. Equality Challenge Unit, November 2012. Gillborn D, Rollock N, Vincent C, Ball S, 2012: ‘You got a pass, so what more do you want?’: race, class and gender intersections in the educational experiences of the Black middle class. Race Ethnicity and Education. Vol. 15, No. 1, January 2012, 121-139. Greenhalgh T, Seyan K, Boynton P, 2004: “Not a university type”: focus groups study of social class, ethnic, and sex differences in school pupils’ perceptions about medical school. British Medical Journal. 2004;328: 1541. National Union of Students, 2011: Race for equality – A report on the experiences of Black students in further and higher education. ONS, 2012b: Ethnicity and National Identity in England and Wales 2011.

62. References Reay D, Davies J, David M, Ball SJ, 2001: Choices of Degrees or Degrees of Choices? Class, ‘Race’ and the Higher Education Choice Process. Sociology. Vol. 35., No. 4, pp. 855-874. Saha S, Guiton G, Wimmers PF, Wilkerson L, 2008: Student Body Racial and Ethnic Composition and Diversity-Related Outcomes in US Medical Schools. American Medical Association. 300(10). Thomas L, 2001: Widening participation in post-compulsory education. Emerald Group Publishing Limited. UNISTATS, 2015: Course data comparison – the official website for comparing UK higher education course data http://unistat.direct.gov.uk Whitla DK, Orfield G, Silen W, Teperow C, Howard C, Reede J, 2003: Educational benefits of diversity in medical school: a survey of students. Academic Medicine, 78(5). Woolf K, Cave J, Greenhalgh T, Dacre J, 2008: Ethnic stereotypes and the underachievement of UK medical students from ethnic minorities: qualitative study. BMJ Research.

63. Contact 7th Floor Queens House 55/56 Lincoln's Inn Fields London WC2A 3LJ Tel: 0207 438 1010 Fax: 0207 438 1011 info@ecu.a.cuk www.ecu.ac.uk

64. www.hee.nhs.uk Workshop sessions 1. Universities approach to E&D – Here 2. Service Organisations approach to E&D – Ashby Room 3. Workforce Race Equality Standard - Quorn Room

65. Universities approach to Equality and Diversity Paramedic Practice 29 th July 2015

66. Introductions Vicki Severs - Senior Schools and Colleges Engagement Officer Ann Ball - Admissions Tutor, Paramedic Practice Andy Kirke - Paramedic Practice Current Paramedic Practice students

67. An overview of Paramedic Practice at Sheffield Hallam University 2 year course Diploma in Higher Education Course fees paid Entry requirements: 280 UCAS points, experience prior to application, driving licence by interview stage Who are we looking for? 100% Student Satisfaction overall in 2014 NSS High employability rates - high demand for paramedics High rates of further training, promotion and CPD in the profession

68. An overview of Paramedic Practice at Sheffield Hallam University Places: 49 places 2014/15 Applications: 768 applications - More than 15 applications per place Applicants: 7.4% BME, 85.4% White, 7.2% Unknown % Conversion Application to Enrolment: o BME: 5.3% o White: 6.7% o Unknown: 3.6%

69. Student voice at Sheffield Hallam University Introducing……. Daniel Chow Herpreet BainsJohn Reeves

70. Proposed Action Plan Stage 1: Research, investigation and preparation  Data analysis and embedding of standardised reporting  Equality Impact Assessment of pre-application and enrolment processes  Staff engagement and training  Recruitment of Student Ambassadors and Role Models  Further discussions with EMAS re. work experience opportunities Stage 2: Activity  Marketing messages: Equality Impact Assessment; joint campaign with Northampton  Recruitment Activity: Use of role models, review of Open Day date setting process  Schools and Colleges Engagement: staff training, Health & Social Care Roadshow, work with target schools and colleges, Staff Conferences  Community Engagement: 'Careers in Health Professions', joint led community engagement event  Communications and staff awareness: key messages for all staff To increase the numbers of BME students on Paramedic Practice

71. Feedback What can we learn from your experiences? Are we considering the best approach? What opportunities are we missing?

72. Equity and diversity in paramedic Science

73. FDSc 2 year pre registration programme Course fees paid. UCAS 280 or experiential knowledge considered UK full licence and C1 practical booked by course start 100% student satisfaction 2014 NSS 100% employment rates 2016 3 year BSc 320 UCAS or experiential knowledge considered Overview of provision The University of Northampton

74. : Enrolment Data: FULL-TIME UNDERGRADUATE Course Stage TOTAL<21>=21FM Asian or Asian British Black or Black British ChineseMixedOtherWhite Not Known YesNo Not Known HomeEUOther Not Known FdSc Paramedic Science 12510151312 1 24 223 25 24711362522 2 423641 47 At 1 st June 2015 24 white and 1 BME student (stage 1) and 42 white, 2 BME and 3 unknown at stage 2. For 2013/14 there were 44 white, 2 BME and 3 unknown at stage 1 and 24 white and 2 BME at stage 2. For 2012/13 there were 24 white and 3 BME at stage 1 and 19 white and 1 BME at stage 2.

75. Application Data is lost if candidate is offered alternative course on first sift in admissions This year 10 BME students were part of the 230 interviewed. Last 3 years between 4- 12% BME per cohort. Paramedic Science

76. Proposed activities for 2016 – using the Whole Lifecycle Model Pre-entry Access Outreach and Capability: Open day activities to include – Use of technicians and paramedics from Black and Asian backgrounds. ( paid for their time) Developing DVD / U Tube video for use at 2016 Open Days / School and College outreach events. Marketing flyers to reflect a multi-cultural staff and student group. Delivering talks at community based events – e.g. Northampton / Leicester / – Black and Asian events. Working with schools and colleges to promote the profession – outreach workshops at FE and Sixth Form Colleges. Working with local schools / Ambulance trusts to develop / shadowing work experience – Summer work experience 1 week workshop Web and flyers – dropped to Local Community groups – Black and Asian Community Centres. Use of Face book page for paramedic science – with features on BME paramedics. Transition into HE: Offer interview to (up to 5 applicants per year) from BME groups who have the potential to succeed but lack the full entry tariff points for entry – using a UON Compact Agreement with an FE College – (possibly Leicester ) Paramedic Science

77. A Compact programme – for Paramedic Higher education: for 13 – 16yrs olds attending school and 16-18 yr olds attending college. Working with BME students from a wide range of backgrounds to enable them to enter university and successfully gain employment in emergency care. We believe everyone should have an equal access to study in higher education and that it is important to equip students with the knowledge, skills and experience to help them succeed. The Compact programme will be designed to support students through activities, advice and impartial guidance, from secondary school age through to graduation and employment. We will offer a small bursary to Compact students who take part in the programme at the University – School of Health and upon successful completion of the programme – a chance to apply for Paramedic Science Education.bursary Paramedic Science

78. What would it include? Paramedic Science taster lectures and workshops summer and Saturday schools opportunities to shadow our students one-to-one support with writing personal statements help in preparing for interviews.

79. Thank you for listening

80. www.hee.nhs.uk Q & A

81. www.hee.nhs.uk Next steps Linking this work with national work Forming an “steering group” Midlands and East approach Completing the research April 2016 “doing” Evaluation Pre Paramedic pilot

82. www.hee.nhs.uk Three ask 1.Share 2.Recommend 3.Accountable

83. www.hee.nhs.uk Thank you!