Recruiting under 18s into the NHS

Chapters

A diverse group of young delegates at a conference.

Introduction

Employing young people in health and social care services provides them an opportunity to start a varied and fulfilling career and can also contribute to filling workforce supply gaps.

However, only 3.2 per cent of staff in the NHS are aged 25 and under, with this number decreasing slightly since 2016.

The number of new starters aged 20 or younger has increased over the years from 2 per cent to 9 per cent. This is partly due to the emergence of more support and new training routes into the NHS available to young people.

There are several misconceptions NHS organisations may have around employing people under the age of 18. The aim of this guide is to demonstrate the benefits of employing them in the health and social care sectors and highlight the work of other trusts in this area.

Entry routes for under 18s

Myth: Under 18s cannot work in clinical settings

Under 18s can enter careers within the health and social sector through several routes. Employers can host them through placements and work experience.

T levels

T Level programmes are level 3 qualifications and sit alongside A Levels and apprenticeships as options available to 16-19-year olds. Once a young person completes their education and industrial placement they can then apply for entry level vacancies, higher level apprenticeships or higher education.

Yeovil District Hospital NHS Trust piloted T level industry placements after years of hosting Business and Technology Education Council (BTEC) students. Students can help and support staff in the capacity of a student healthcare assistant once they complete their care certification and mandatory training prior to starting placement. This allows them to join as bank health care assistants creating a direct pipeline to the future workforce.
University Hospitals of Derby and Burton NHS Foundation Trust (UHDB) supports its local community by providing T Level placements and work experience placements for students. Through partnerships with Derby College, Burton and South Derbyshire College and South Staffordshire College, it supports students by providing hands-on work placements across both clinical and non-clinical areas such as, finance, wards, admin and clerical, business studies, laboratories, maternity, information technology and more.
UHDB’s work-based placements equip young people to step into the health sector where they gain insight and experience into their future careers. Students are put through a 20-week placement that runs during year one and year two of their T Level course. They are expected to spend one day a week in the hospital setting and the rest of the week studying at college.
Once students have completed their placements at UHDB and gain their T Level qualification, there may be potential for further career development within the trust. This is provided that the students display correct attitudes and behaviours, has been committed throughout their placement and have received positive feedback from their mentors. Since the scheme started in September 2022, UHDB have provided over 40 T Level work placements and over 150 placement to other work experience students.

Apprenticeships

Apprenticeships are a work-based training programme that incorporates skills development, technical knowledge and practical experience. They are available to anyone over the age of 16 and enable learners to demonstrate competencies while gaining a recognised qualification. Qualifications range from levels 2-7, this is the equivalent of GCSE level up to master’s degree level.

Note: The Care Certificate should be undertaken by employees within a clinical environment including those aged 16 and 17, however it cannot replace a learning programme to cover the requirement.

Read how Great Ormond Street Hospital (GOSH) expanded its apprentice programmes online presence to attract young people into NHS careers, offering over 10 entry level roles with no prior experience needed.
Read Coventry and Warwickshire Partnership NHS Trusts case study on how 240 young people were supported through a pre-employment programme focussing on apprenticeships.

Work experience

Pathways into future employment can also come from work experience.

The career and development team at East Lancashire Hospitals NHS Trust (ELHT) wanted to showcase to under 16s the numerous career options available within the trust using work experience placements. The team engaged with directors of departments and human resources managers to ask if they could take the project forward. The team went through the process of reviewing their existing policies and risk assessments to ensure they accommodate working arrangements of young people.
A local secondary school academy trust expressed its interest in the one-week work experience placement offered for its students. Through making the connection with the school, ELHT was also invited to attend school assemblies, workshops and career fairs to showcase the numerous roles available within the trust.

Pre employment programmes

Under 18s can be supported with finding work in the NHS through charities such as The Prince's Trust. The core offers of the programme include virtual or face-to-face pre-employment sessions which are tailored to fulfil the vacancy needs of each NHS organisation and give young people a real understanding of the sector. Each young person is supported by a mentor as they go through the programme and start employment, helping to retain them in the workforce.

Employers and mangers with responsibility for recruitment and retention activity in health and social care organisations can use the Recruit and retain young people toolkit for advice, tools and resources to help attract and recruit young people.

Employment conditions

Myth: Under 18s are prohibited from working more than eight hours a day.

Working time arrangements for under 18s must be reflective of the law that states workers aged between school leaving age and 17 must not work more than eight hours a day and 40 hours a week. They should receive a 30-minute break once they are working more than 4.5 hours or more per shift.

Young workers must be allowed to have at least 12 hours break between shifts and at least one 48-hours break each week. They cannot opt out of the working time limits. However, the host organisation can ask a young worker to work for longer in exceptional circumstances. They can only ask if:

there is no one 18 years or over available to do the work
it enables continuity of service during a very busy period
the young worker's education or training is not impacted by the work.

Similar rules apply for young workers being asked to work at night. Normally, they should not be asked to work between 10pm and 6am. In exceptional circumstances, the host organisation can ask if the following applies:

the conditions meet those listed above
the young person is supervised by an adult if necessary for their safety
the young person is given compensatory time to rest.

Ensure trust policies support hosting under 18s. They should clearly set out the organisations commitments to managing health and safety of young staff.

Health and safety

Myth: A separate risk assessment is needed for under 18s

NHS organisations have a statutory responsibility to assess the risks posed by using equipment or the environment a young person may be exposed to before they start work. This is to ensure they don’t carry out work that is of a hazardous nature due to their lack of knowledge, experience, and maturity.

If the organisation has not previously employed a young person, the original risk assessment should be reviewed to ensure control measures that are currently in place are sufficient or whether additional measures are needed. Use the Management of Health and Safety at Work Regulations 1999 to follow the requirements regarding risk assessing and employing young people. Parents or guardians should also be informed about the findings of the risk assessment and the control measures that are being taken..

Young people should always work under supervision of a trained member of staff who is competent in the task being carried out. Once the young person has been assessed as competent and confident to carry out the task required of them, they can begin to work out of direct supervision of an experienced colleague.

Young people employed by Cornwall Partnership NHS Foundation Trust work under supervision of colleagues to carry out basic healthcare assistant responsibilities. Once they complete the competency tests HCAs are required to do, they are allowed to work more autonomously.

Identity checks

Myth: ID cards are the minimum acceptable evidence for under 18s

Young people may not have a passport or driving licence, and some might not be able to afford the application for one. Therefore, to meet identity check standards, employers can request a passport sized photograph which is counter-signed on the back by a person of some standing in the community.

Young people can also show an identity card carrying the PASS accreditation logo (UK, including Channel Islands and Isle of Man), such as a UK Citizen ID card or a Connexions card (must be valid and in-date). They can apply online and there is a £15 fee for a non-urgent request and a £30 fee for an urgent request.

In terms of proof of address documentation for a young person please see our guidance in the identity checks standard. For candidates who are genuinely unable to provide the combination of documents suggested in the standard, employers may choose to accept other forms of documentary evidence at local discretion. The type of alternative documents they might wish to consider accepting will be dependent on the risks associated with the role and what the applicant can genuinely present them with, to give the necessary assurances.

Employment history and references checks

Myth: Under 18s are subject to the same employment history check

It may be a young person’s first exposure to work, so they are not expected to have any previous employment history that covers a three-year period.

Where limited references are available, the decision to appoint must be based on what the applicant can reasonably provide to support their application. This may be a personal or character reference to determine a young person’s reliability, skills and experiences. These types of references can be from acquaintances that are not related to the applicant, and who do not hold any financial arrangements with that individual. Personal acquaintances may include professors, academic advisors, or someone of some standing in the applicant’s community. See page 7 of the employment history and references checks standard.

Criminal record checks

Myth: a DBS check is required for all under 18s

The Protection of Freedoms Act 2012 legislates that disclosure and barring service (DBS) checks must only be conducted on individuals who are aged 16 or over. When offering work placements or experience to individuals under the age of 16, the host organisation should rely on other sources of evidence gained through its check process to assess a young person’s suitability.

Eligibility for a DBS check for those aged 16 and over will need to be based on the type of duties individuals will be undertaking while on placement and the level of access this will permit them to have with persons in receipt of health services. Quite often, work placements are only for very short periods of time, therefore the host organisation may decide that it would not be practical or proportionate to seek a DBS check. In such cases, the reasons for not carrying out a DBS check must be recorded and retained on file and appropriate safeguards put in place to manage that individual.

Individuals on work placements or experience should not be allowed to engage in a regulated activity. Observing clinical practise is not a regulated activity and therefore an enhanced with barred list check is not required. Legally, they must be supervised at all times and therefore a DBS check isn’t required.

The host organisation should consider whether the duties or contact with persons in receipt of health services would meet eligibility for other levels of DBS check (i.e., basic, standard, or enhanced without barred list).

What support can be offered to under 18s

Ensure there is ongoing support for the young person, it can be in the form of coaching, peer support, buddying or mentoring.
Place under 18s in an established team to give them an opportunity to learn from experienced staff members.
Pastoral care can be offered through the education provider, employment team or a named support in the department who can help with any daily concerns. Young people many need more one to one support throughout their time within your organisation.
Build in time for regular reflective practice, allowing the young person to discuss and receive feedback on their personal and work development.

Top tips

To gain buy in, demonstrate the advantages of employing young people. The case studies mentioned can be starting point of showing good employment practice.

The trust policies should reflect your willingness to host students between 16 and 18.

If the organisations risk assessments already fulfil the control measure for employing young people, it is not necessary to create one specifically for them.