ContentsExecutive summary031 Introduction052 What is widening participation?073 Widening participation – Why does it matter?093.1 Population demographics3.2 Diversity profile of the current NHS workforce in England3.3 Diversity profile of the students currently enrolled on NHSfunded (part or full time) healthcare education programmes3.4 Equality and diversity3.5 Work – Health and wellbeing3.6 Corporate social responsibility3.7 Social mobility3.8 Access to education3.9 Access to professions3.10 Widening participation initiatives3.11 Work experience0911154 Promoting widening participation– Our proposed strategic enablers and goals335 Strategic goal and actions: What do we need to do?346 Links with other strategic activity397 Making it happen - coordination, monitoring and communication398 Final comment40 Glossary41 Useful links42 References43 Appendix 1Appendix 2Appendix 3465052 221222323252729302

Executive summaryIntroductionHealth Education England (HEE) exists to improve the quality of care for patients by ensuring we have enoughstaff with the right skills, values and behaviours available for employment by providers. As part of our rolewe have leadership responsibility for promoting equality, diversity and enabling widening participation inrelation to the development of the current and future healthcare workforce.This strategy sets out how we will drive widening participation using our workforce and educationcommissioning leverage and strategic partnership working. This is with the intention of ensuring an approachwhere the NHS workforce is more representative of the communities it seeks to serve and where developmentand progression is based upon a person’s merit, ability and motivation and not their social background or theprivilege, extent and effectiveness of their social networks.Widening participation – Why does it matter?This strategy is needed and timely given that: the population of England is changing. Changes in population demographics will have implications for thedemand on healthcare services and the ability of the NHS to attract, train and sustain the development ofa workforce capable of responding to the changes that population growth will have. efforts to improve social mobility are a major theme of current UK policy. Despite recognition that therehas been some improvement in equality and measures of social mobility, deep-seated and systematicdifferences which can affect an individual’s potential and opportunities for enhancing social mobilityremain. equality, diversity and inclusion are core values for the NHS but it remains an ongoing challenge to ensurethat equality and diversity is actively integrated and managed as a key aspect of organisational andworkforce development. the diversity profile of the current workforce in England is not representative of the general populationthat it seeks to serve, nor is the diversity profile of those employed by the NHS representative across thekey staff groups. while students undertaking NHS funded healthcare programmes come from a range of diverse andsocio-economic backgrounds, there is further improvement to increase participation and progressionfrom under-represented groups for some healthcare education programmes and entry into healthcareprofessions. participation in education and work is associated with better health and wellbeing outcomes. Given thebenefits of employment and the impact of the NHS as a major local employer, the health sector has aspecific interest, as part of holistic preventative health and wellbeing strategies, in how it influences andcontributes to enabling employment and widening participation opportunities for the communities itserves. there have been significant efforts to develop and widen participation for access to the healthcareworkforce and/or to undertake healthcare education programmes. However more systematic planning andevaluation is needed to know what does and does not work in enabling effective widening participation. given that much of the development and investment in the healthcare workforce is enabled and achievedthrough higher education delivery, HEE has, through its commissioning function and relationshipswith education providers, a significant opportunity to be an effective collaborator with other nationalorganisations in implementing policies to improve access to education opportunities by under-representedgroups.33

Our strategic goalsThe key goals of this strategy are to: improve monitoring and reporting of widening participation activities:we will work with national stakeholders, education and health care providers to improve the monitoringand reporting of widening participation developments in relation to any education programmes/workforcedevelopments that HEE funds and supports. enhance further the visibility and targeting of Health Careers Information and Advice:Crucial to this is the need to present information, which clearly illustrates the breadth of career andprogression opportunities available within the NHS and wider health sector. increase, through research and evaluation, the understanding and evidence of what and what doesnot work in relation to widening participation developments in healthcare education and workforcedevelopment:the commissioning of research to investigate the specific needs of under-represented groups as they apply,commence and progress on healthcare education programmes including their programme outcomes. increase collaborative approaches in supporting widening participation initiatives, including outreachactivity:support NHS organisations and wider health sector employers in committing to more sustainedcollaborative models with education providers (higher education, colleges and schools) and others insupporting their widening participation initiatives including outreach work. stimulate and increase the capacity of healthcare organisations in being able to expand and support workor work related experience opportunities:enable wider, larger scale, sustained and coordinated access for potential participants, from allbackgrounds and circumstances, seeking a career and/or employment in the health sector to gain workexperience opportunities.This strategy reflects HEE’s active and significant commitment to widening participation. Through the initialactions proposed here, it sets out at national level how we might achieve a more coherent and coordinatedapproach to widening participation in the development of the future and current workforce.We accept that this is a broad strategy and we fully expect that it will evolve and focus further, as weunderstand better the profile, implications and barriers faced by those from under-representative groups inbeing able to access healthcare education opportunities and entry into the healthcare workforce.444

1IntroductionHealth Education England (HEE) exists to improve the quality of care for patients by ensuring wehave enough staff with the right skills, values and behaviours available for employment by providers(HEE 2014). As part of our role we have leadership responsibility for promoting equality, diversity andenabling widening participation in relation to the development of the current and future healthcareworkforce (Department of Health [DH] 2014, DH 2013). This responsibility is crucial for ensuring thatthe healthcare workforce represents the society that it seeks to serve in the delivery of healthcareservices.Any effective widening participation programme must provide access to education, employment anddevelopment opportunities for under-represented individuals (and groups) helping them to realise theirpersonal potential and, in doing so, reduce cultural, social and economic disadvantage. This is one of the keyreasons why this strategy is needed.Moreover, effective widening participation should provide an approach to workforce management anddevelopment where the value and contribution of a diverse workforce is actively managed, respected andthere is a robust promotion of a culture of equality, inclusion and opportunity. This is a central tenet of theNHS Constitution (2013) which is a key driver for the work that HEE supports.This strategy sets out how we will drive widening participation, using our system influence, workforce andeducation development, commissioning leverage and strategic partnership working. The successful use of ourlevers (Box 1) will help us deliver a talented and diverse workforce, where development and progression isbased upon a person’s merit, ability and motivation and not their social background or the privilege, extentand effectiveness of their social networks. If we get this right it should also have an impact in reducing healthinequalities, one of our key long term strategic aspirations (HEE 2014).PurposeImprove quality of care by ensuring our workforce hasthe right numbers, skills, values and behaviours forpatients today and tomorrow.1. Workforce planning- identifying the numbers, skills, values and behavioursto meet current and future patient need2. Attracting and recruiting the right people to theposts we have identified- using NHS Careers, value based recruitment, Oriel,return to practice and widening participation3. Commissioning excellent education and training- using our financial and contractual levers to ensurethat the next generation receive high quality trainingthat equips them to provide high quality care4. Lifelong investment in people- supporting our staff to be the best they canthroughout their careers, including the training anddevelopment of non-professional staffBox 1: Health Education England Purpose and Levers for Workforce Development (HEE 2014)55

1.1 Characteristics of the WorkforceHEE has set out in Framework 15 (HEE 2014) how we see the development of the workforce and thecharacteristics that will need to be developed if we are to meet the current and future needs of patients.These characteristics include, developing the skills which enable the workforce to encourage and supportpeople to manage their own health, promote behaviours aimed at securing co-productive models of care,and ensuring at all times, safe, high quality care regardless of setting. A key feature of these characteristicsis the anticipation that the healthcare worker is likely to be a member of a wider community of health thatsupports an individual patient.Central to the essence of future workforce characteristics is the need to attract and recruit people who havethe desired values, behaviour, and motivation to provide care. As the pen portraits for Ashraf, Chantelle andJoan illlustrate, and which are included in Framework 15 illustrate, we need to ensure the ability to attractmotivated people from a diverse range of backgrounds, seeking targeted ways to help them learn aboutpotential healthcare careers and overcoming some of the barriers that might otherwise prevent their ability toaccess available healthcare education or workforce opportunities.66

2What is widening participation?Dependent upon context, widening participation can mean different things and thus it is difficult topropose an overarching definition.For the NHS, widening participation is often applied within the context of seeking recruitment to entry leveljobs and supporting progression through the the healthcare support workforce and, for some, progressioninto pre-registration training. Within this context, under-represented groups are most likely to be disengagedyoung people, those without qualification, low skilled, part-time and temporary workers, those on lowincomes and/or working age benefits, older adults, those with literacy, numeracy or learning difficulties andsome minority ethnic groups (Tight 1998). In addition, widening participation is also related with equalityissues ensuring that those people from diverse backgrounds are encouraged and have equal access toopportunities for career development.Within the higher education community, widening participation refers to the participation of disadvantagedgroups in higher education, seeking to remove the barriers to accessing and succeeding in higher education,including financial barriers (Office for Fair Access [OFFA] 2013). The focus here is increasing the engagementof learners from specified socio-economic classes, those from state schools or from neighbourhoods with arecord of low participation in accessing higher education, given that significant and persistent differences inparticipation rates remain.As part of this strategy we will need to review and agree with our healthcare employers and healthcareeducation providers, a definition of widening participation which best reflects a shared meaning and helpsus understand how we measure and monitor widening participation. This will then help us recognise anygaps, understand the implications and priorities for action to bring about improvement. This will take sometime to define and agree.Therefore, at this point, it is better to reflect what wideningparticipation is about and seeking to achieve and at least usethis to inform our initial response which is: a commitment to equity. raising aspirations. increasing awareness of education and its benefits. enabling fair access to development opportunities foreducation, learning, training employment and furthercareer development. targeting the increase in education and employmentopportunities, particularly for under-represented groupsso that representation in education and the workforce isrepresentative of the broader population. promoting achievement. supporting progression.77

recognition that there may be/are inequalities that need to beaddressed for social good. active and focused planning.Widening participationdoes not therefore justhappen, it requires: commitment and partnership working between a range ofstakeholders at national, regional and local community level toaddress the issu

3.5 Work – Health and wellbeing 22 3.6 Corporate social responsibility 23 3.7 Social mobility 23 3.8 Access to education 25 3.9 Access to professions 27 3.10 Widening participation initiatives 29 3.11 Work experience 30 4 Promoting widening participation 33 – Our proposed strategic enablers and goals 5 Strategic goal and actions: What do we need to do? 34 6 Links with other strategic .