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Changing the course of IfATE: healthier higher and degree apprenticeships for regulated healthcare professionals

Finbar Lillis (Centre for Apprenticeships and Skills, Middlesex University, London, UK)
Angelo Varetto (Skills for Health, Bristol, UK)

Higher Education, Skills and Work-Based Learning

ISSN: 2042-3896

Article publication date: 22 July 2020

Issue publication date: 27 November 2020




The purpose of this paper is to show how and why government discoursal constraints have obstructed the development of viable degree apprenticeships for regulated healthcare professionals working in England and suggests some ways these constraints can now be managed and overcome.


The study uses an analysis of published literature, reviews of government and health professional body policies and regulations and semi-structured interviews recorded with those leading on the development of degree apprenticeships in healthcare-regulated professions.


Once created, a bureaucracy tends to look for ways to control discourse, to sustain itself and to extend its reach. In doing so, fault lines may be exposed which undermine the position of that bureaucracy, but it will continue to control discourses to maintain power over those it requires to act. There is no pedagogical need for End Point Assessment (EPA) to measure the competence of regulated healthcare professionals. The paper produces evidence to show how meeting health professional registration requirements is a sufficient metric for measuring successful degree apprenticeship outcomes.

Research limitations/implications

This paper examined current practices relating to the registered nurse and nursing associate degree apprenticeships only. The validity of EPA for measuring occupational competence should be further investigated.

Practical implications

The NHS and other public service organisations should use these findings to re-examine and challenge the requirements for EPA in degree apprenticeships for all regulated professions.


Understanding how “centering” bureaucracies control discourse in their interests can help those in their orbit find ways to challenge and alter the course of policy.



Lillis, F. and Varetto, A. (2020), "Changing the course of IfATE: healthier higher and degree apprenticeships for regulated healthcare professionals", Higher Education, Skills and Work-Based Learning, Vol. 10 No. 5, pp. 799-813.



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