Guidance for recruiting under-18s into the NHS

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

CREDIT: This is an edited version of an article that originally appeared on NHS Employers

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

Entry routes for under 18s

Under-18s can enter careers within the health and social sector through several routes; employers can host them through a number of placements and work experience:

• T levels: T Level programmes are level three qualifications and sit alongside A Levels and apprenticeships as options available to 16-19-year-olds. Once people have completed their education and industrial placement they can then apply for entry-level vacancies, higher-level apprenticeships or higher education.
• Apprenticeships: these 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. 
• Pre-employment programmes: under 18s can be supported in finding work in the NHS through charities such as The Prince’s Trust. The core offers of this 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.

Employment conditions 

Workers aged between school leaving age and 17 must not work more than eight hours a day and 40 hours a week and they should receive a 30-minute break once they are working more than 4.5 hours per shift. Young workers must be allowed to have at least 12 hours break between shifts and at least one 48-hour 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 but, 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.

Health and safety 

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 to ensure they don’t undertake tasks 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 that the control measures currently in place are sufficient, or whether additional measures are needed. Use the Management of Health and Safety at Work Regulations 1999 and follow the requirements regarding risk assessing and employing young people. Parents or guardians should be informed about the findings of this risk assessment and the control measures that are being taken.

Young people should always work under supervision of a competent and fully-trained member of staff. 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.

Identity checks 

Young people may not have a passport or driving licence, and some might not be able to afford the application for one. 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, such as a UK Citizen ID card or a Connexions card.

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 reference checks 

This 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 have any financial arrangements with that individual. Personal acquaintances may include teachers, academic advisors, or someone of some standing in the applicant’s community. 

Criminal record checks 

The Protection of Freedoms Act 2012 legislates that disclosure and barring service (DBS) checks must only be conducted on individuals 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, and 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 practice is not a regulated activity and, therefore, an enhanced barred list check is not required. Legally, they must be supervised at all times and, therefore, a DBS check isn’t required.

What support can be offered to under-18s?

• Ensure there is ongoing support for the young person; this 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 may 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.