InTuition taster: Hidden in plain sight

What springs to mind when you think of a teacher? For some, it will be someone who teaches in compulsory-age schooling. For others, it might be a college or university lecturer. Few – if any – will picture someone who works in the NHS. In fact, when people hear I work in the NHS, most will immediately ask if I am a nurse. I am not a nurse, or a doctor; I am a teacher. But teachers in the NHS are consistently overlooked in professional and academic circles as practitioners who can contribute to the discipline of education.

In February 2018 I started working in the NHS, and that is when my outlook changed. Until then, it never occurred to me just how many educators worked in the NHS or just how much teaching was carried out. The NHS employs approximately 1.3 million people (NHS Digital, 2022) and spends around £1.3 billion per year on education and workforce development (not including Health Education England, which has a separate annual budget of £4 billion (Gershlick et al, 2019)).

Within that 1.3 million are teachers, trainers and educators in many guises: learning and development; technology-enhanced learning and digital; teaching fellows; clinical educators; school nurses; and countless subject matter experts such as quality improvement, chaplains, information governance and more. Tallying up the actual number of educators within the NHS would be a near-impossible task because they are spread across every professional corner of the organisation and are often hiding in plain sight.

The NHS does not keep any data about staff with teaching responsibilities, so unless it is an explicit part of someone’s role, such as clinical educator or workforce development officer, it is difficult to quantify. With a workforce of 1.3 million, even if only 0.5 per cent of the workforce had an education element to their roles, that is still 6,500 people involved in educating the UK-wide workforce somehow.

The difficulty is that NHS educators occupy a kind of no-man’s-land somewhere in between academic and professional circles

Research gap

Despite this vast and diverse group, and the huge amount of education delivered within the NHS every year, precious little in the way of educational research is carried out. On completion of my MSc in 2019, I secured a funded place on the ETF’s Practitioner Research Programme looking at engagement with educator-specific continuing professional development among NHS educators. As far as I am aware, I am the first – and still the only – NHS educator to have ever applied for the programme. This fact was of some excitement to the programme faculty, who relished the little bit of diversity that I brought to the cohort.

However, this ‘little bit of diversity’ I bring creates challenges. I have a strong interest in research and see the potential for educational analysis everywhere in NHS. Mostly though, the NHS does not seem to know what to do with people like me, who want to do ‘pure’ educational research.

Understandably, the NHS is heavily focused on clinical and medical research; two of the NHS’s founding principles are that it aspires to the highest standards of excellence, and that the patient is at the heart of everything it does (Department of Health and Social Care, 2021). So clinical and medical research must take the spotlight, but there doesn’t seem to be any space at all for other types of research.

When I first started working on my PhD, I contacted some NHS research groups to ask if there was any support or guidance for a humble educational researcher. I was met with bemused faces and a lot of head-scratching while they tried to figure out who they could pass me on to next. Even the NHS research ethics approval system – IRAS (Integrated Research Application System) – has no mechanism built in to bypass clinical and medical questions, so a budding educational researcher must still answer questions relating to tissue sampling, drug administration and clinical trials.

The difficulty is that NHS educators occupy a kind of no-man’s-land somewhere in between academic and professional circles. Many do not fit into the stereotypical mould of academia, or have completed professional qualifications rather than academic ones, and so they have not had any exposure to academia and the opportunities available from it.

We ought to consider making space within professional and academic circles to begin nurturing communities of NHS ‘pracademics’

Additionally, because the role of educator is not emphasised within the NHS, they do not see themselves as being able to move in professional circles either. I joined the Society for Education and Training as soon as I started my PGCE and have reaped the benefits of membership for years now, yet many of my NHS colleagues do not see themselves as fitting the membership criteria. This leads to a severe under-representation of the NHS in professional and academic education circles, causing an identity crisis among its practitioners.

Identity crisis

When carrying out interviews for my research, I asked my interviewees how they conceptualise their own professional identity and what name they would give themselves. One responded “I wouldn’t say ‘teacher’, because for me teacher is like school. Because I think teachers... for all that’s what we do... my title has never had that in it.” Another responded “Self-identity within this particular role I’ve always found very strange... I consider myself as something more educator-adjacent.”

I have interviewed six NHS educators as part of my research, and all tell a similar story – that they find it difficult to conceptualise their own professional identity because they do not feel as if they ‘fit’ anywhere. That they do not see themselves as fitting anywhere means that these educators do not fully engage with the profession. Many have gone through some initial training as educators but continue to re-use and regurgitate that initial training year on year, never improving their practice or updating their knowledge for the benefit of their learners.

Trevanian’s novel Shibumi offers this sage advice on the matter: “You can gain experience, if you are careful to avoid empty redundancy. Do not fall into the error of the artisan who boasts of 20 years’ experience in craft while in fact he has had only one year of experience 20 times” (Trevanian, 1979). Without engaging properly in their profession, NHS educators are doomed to this fate, so we must create the conditions and spaces for them to properly engage and recognise their potential towards improving the NHS.

The sixth principle of the NHS constitution states that it is “committed to providing best value for taxpayers’ money”, yet its educators are not supported or encouraged to engage in activity that could help save money and provide evidence of value for money.

Taking action

Providing the places, spaces and support for NHS teaching staff to engage fully in their profession would support their development. It would also encourage them to apply a critical lens to the education and teaching practices they are involved with to become more adaptable and change-ready practitioners.

Crowley (2014) recognises this as a “crucial attribute of twenty-first century professionalism” but acknowledges that “there is a paucity [of] public sector organisations” that support and encourage the development of creativity and innovation.

NHS educators are not supported or encouraged to engage in activity that could help save money

I am certainly not suggesting that all NHS educators should embark on a PhD or aspire to be well-published academics. But we ought to consider making some space within professional and academic circles to begin nurturing communities of NHS ‘pracademics’ and supporting them as they tentatively dip their toes into the worlds of professional development and practitioner research.

The real question here is whether we can justify continuing to overlook this diverse and experienced group of educators who contribute to the learning and development of the 1.3 million staff who make our NHS what it is. After all, they are teachers too.

Carrie Walton FSET PGCE is a doctoral researcher with the University of Sunderland and specialist projects lead with the NHS focusing on remote and rural education. She is an avid collector of qualifications and a passionate devotee of lifelong learning and the pursuit of personal and professional development.

References and further reading

Crowley S (2014) Challenging Professional Learning. London: Routledge.

Department for Health and Social Care (2021) NHS Constitution for England. Available at www.gov.uk/government/publications/the-nhs-constitution-for-england

Gershlick B, Kraindler J, Idriss O and Charlesworth A (2019) Health and social care funding: Priorities for the new government. The Health Foundation. Available at www.health.org.uk/publications/long-reads/health-and-social-care-funding

NHS Digital (2022) NHS Workforce Statistics – March 2022 (including selected provisional statistics for April 2022). Available at https://digital.nhs.uk/data-and-information/publications/statistical/nhs-workforce-statistics/march-2022

Trevanian (1979). Shibumi. New York: Ballantine Books.