Reflections on Inclusive Pathways into Health Services Research

Dr Nicola Fisher

Assistant Professor and Registered Nurse, Nottingham University Business School, University of Nottingham

As an assistant professor and registered nurse working in health services research, I am both traditional and non-traditional in my own research career. On the surface, with a degree, a couple of master's and a PhD, working in a health services research centre in a business school, I look like a traditional researcher. However, as a registered nurse, this is unusual. It is rare (though there are a few of us now), to come across a nurse, who has made it through to this level, though that should not be interpreted as a lack of ability in the profession. I did however have to come out of clinical work to pursue the research I am passionate about. I would like to see this change. The comments of ‘you are not a real nurse now’ are frustratingly frequent, and narrow minded. More often than I would like I have to defend nursing’s status as a degree entry profession, let alone championing higher education, and research careers. 

While challenges do exist for medical professionals to enter health services research, the challenges and barriers for nurses, midwives and allied health professionals are arguably more significant. Nurses alone make up the largest, safety-critical profession in healthcare, and have a wealth of knowledge and experience that can take the field of health services research forward. However, there are a lack of pathways, support and funding, limited even for clinical research, let alone integration with the more social science aspects of health services research. Those that make it through, are often the ones who push, and shout to be heard, or as I did, must come out of clinical work completely. My own PhD research highlighted that that this creates barriers to development including equity of access, such as hindering those from minority backgrounds.

A particular part of the HSRUK report that I am interested in seeing pursued is the recommendation to look at the development of alternative research pathways, considering integrating degree apprenticeships with advanced training options such as combining bachelor’s/master’s pathways or "top-up" qualifications. I consider that this will provide a much-needed avenue for non-medical healthcare professionals, such as nurses, to make a significant contribution to health services research, not yet fully realised by the current system. The formalisation of top up pathways, for example, will create opportunities, that are hopefully fairer and more inclusive. Ones that do not rely on who can shout the loudest to be heard and continually bang on the door to be allowed entry. I would like to see the glass ceiling of research careers for nurses not simply moved up, but removed, for the benefit of patients, staff and the system.

The views and opinions expressed here belong to Dr Fisher, and not that of Nottingham University Business School, the University of Nottingham, its affiliates or other employees.

Thara Raj

Director of Population Health and Inequalities, Warrington and Halton Teaching Hospitals NHS Foundation Trust

Breaking into Health Services Research (HSR) often demands postgraduate qualifications - a barrier that disproportionately excludes individuals experiencing multiple inequalities. Degree apprenticeships have emerged as a powerful counterweight to this exclusivity, offering structured, paid training pathways without tuition fees.

The HSR UK report (2025) highlights degree apprenticeships, like the Level 6 Applied Social Research pathway, as promising tools to diversify the HSR workforce. These programmes allow learners to earn while they study, making research careers more accessible. However, critical reflections from the HSR UK roundtable show that the potential of apprenticeships to enhance inclusion depends heavily on employers’ commitment to inclusive recruitment. Without systemic changes to hiring practices and university employment structures, such as flexibility around PhD requirements, apprenticeship graduates risk being confined to administrative roles, despite possessing relevant skills in research methods, ethics, and data analysis.

I was very lucky because in my first NHS job I was given match funding to do postgraduate studies. This developed my interest in Health Services Research and I have contributed to research projects over the years and ended up in interesting places. In 2002 I was part of a UK delegation to an EU conference on health services research and remember someone asking why I was at a conference for old men. Even though it was a tongue in cheek comment, it did make me think whether Health Services Research was the purview for a certain demographic of society. This isn’t the case and when I spoke at the HSR UK conference last year, I saw great diversity amongst speakers and delegates.

My continued HSR journey has been made possible by access to funding and mentorship from NIHR career development programmes offered through the North West Coast Applied Research Collaborative and the NHS Research and Development North West. Having these regional and local opportunities are an important part of creating inclusive pathways into HSR but we need more of them and they need to be promoted widely.

If inclusion is truly a goal, degree apprenticeships must not just open doors - they must lead somewhere. We need a range of routes to improve access into HSR. The recent UK government decision to end public funding for Level 7 (master’s-level) apprenticeships could be seen as counterproductive if they are not replaced with other supported and funded opportunities for people working in health and social care.

Strong advocacy is needed to position apprenticeships as legitimate research career pathways. As the sector evolves, we must redefine what “qualified” looks like in health research.

The views and opinions expressed here belong to Thara Raj, and not that of Warrington and Halton Teaching Hospitals NHS Foundation Trust, its affiliates or other employees.

Authors: Dr Nicola Fisher and Thara Raj

Dr Nicola Fisher is a Registered Nurse and Assistant Professor at Nottingham University Business School in the Centre for Healthcare Innovation, Leadership, and Learning (CHILL). She qualified as a registered nurse in 2015 and has worked clinically in the NHS and as a Nursing Officer in the British Army. Nicola also has a master's in Health Law from the University of Bristol, and a research master's in social science from the University of Nottingham. Nicola completed her PhD on the influence of political economy on nurses’ post-registration development in the English NHS at the University of Nottingham, funded by the Economic and Social Research Council. Her main research interests focus on the macro influences on health and healthcare, particularly the workforce and public health, including politics, economics, law, policy and governance mechanisms. External engagement and policy impact is a core focus of Nicola’s research profile, and she has experience of working in the UK Parliament with the Health and Social Care Committee, with the Office for Health Improvements and Disparities, submitting evidence to select committees, and undertaking research projects with Integrated Care Boards. Nicola has also developed and teaches 'policy engagement and impact for clinicians' with recent sessions for the Faculty of Public Health and the Midlands Clinical Senate Clinical Leadership Fellows. Nicola joined Nottingham University Business School in August 2024.

X(Twitter): @NicolaFisherRN. LinkedIn: Nicola Fisher

Email: [email protected]

Thara Raj is Director of Population Health and Inequalities at Warrington and Halton Teaching Hospitals NHS Foundation Trust. She is a visiting Professor at the University of Chester and an Honorary Fellow at Birmingham University’s Leadership Institute. Prior to coming to the hospital, Thara was Director of Public Health for Warrington Borough Council and has worked in public health roles for over 30 years at a local, regional and national level.

LinkedIn: Thara Raj

Email: [email protected]