The overall objective is to identify similarities and differences between the four countries. VET in health and work care is under pressure and reform (similarity), but the reforms are different: strengthening the interaction between educational institutions and working life (Finland), filling the gap between the dual system and the health and work care (Germany), financial cutbacks and a decline in work learning places (Netherlands), and trends towards inter-professional learning (United Kingdom).

The Finnish VET system, and thus health and care education (HCE), is public, mainly school-based and government led. HCE includes trainings such as Practical Nurse, Dental Technology and Laboratory and Pharmaceutics. Compared to other countries, VET is more popular than general upper secondary education (FNAE, 2016). The VET system is currently under reform, which focuses on strengthening interaction between educational institutions and working life. One big challenge is also government’s budget cuts and prevention of exclusion and discrimination (Kyrö, 2014, p. 253). According National Board of Education the future needs in HCE are divided in two: general and specific competences such as elderly care. Furthermore, globalization and internalization, co-operation between schools and working life are areas, in which innovations and new solutions are needed. 

Opposing the growing importance of health and care work, there are historically formed vocational structures in Germany, which are characterized by a lack of professionalization and standardization. Compared to the training for technical occupations in the Dual System these apprenticeships enjoy a lower social prestige, offer lower wages and much less career opportunities. Due to a current expansion of these professions, a heightened reform pressure arises. This discrepancy between a growing importance and an insufficient professionalization can also be found in teacher education and training for special subject areas of personal service occupations. VET in the health and care work sector can be actually charaterised by an accelerating professionalization, whereby administrative regulatory changes, training curricula and the structure and competency requirements addressing the teacher training for social and healthcare professions will be dealt with.

In the Netherlands health and care education (HCE) is part of both the public VET system and professional Higher Education. It is mainly school-based, but with a strong work based component. Traditionally HCE was mainly in company. HCE is since 1996 integral part of the VET system. Participation in social and health care courses in growing, as is the demand on the labour market. HCE is in ongoing reform with cutbacks in funding for medical and social care.  One consequence of cut backs  is a decline in work learning places. Hospitals and care institutions prefer nowadays to teach students in school based courses, rather than apprenticeships. A relatively (2009) new phenomenon are ‘learning departments’ (leerafdelingen).This seems a promising solution for recurring problems concerning both availability of learning places and the separation of theory and practice. On the learning department students are coached by a teacher from school and by a workplace coach.

United Kingdom: Work-based learning (WBL) is responding to demands from regulators, educators, clinicians and students for conceptual and methodological tools that develop learning in professional healthcare contexts (Evans et al 2010, Cook 2012). In established trends towards inter-professional learning, medical practitioners now work with those whose occupational role includes diagnosis, therapy, prevention, health promotion, rehabilitation and management of care, including nurses, midwives, physiotherapists, speech therapists, health visitors and radiographers. Research points to the significance of learning embedded in the communicative practices of workgroups (Kress, 2010; Cook et al 2012; Allan et al 2016). The use of contexualised simulations (Kneebone  2016) creates opportunities to move outside a clinical ‘insider’ frame to communicate with practitioners and patients in innovative ways.

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