Sector Skills Insights:
Health and Social Care
Introduction
The UK Commission is working to transform the UK’s approach to investing in skills
to help secure jobs and growth. Key to our ambition is the need to encourage greater
employer ownership of skills, working to secure long term sustainable partnerships.
This slide pack and accompanying evidence report present the case for more employers
in this sector to invest in the skills of their people. It does so by presenting real-life,
skill-based business solutions that have been used by leading employers to tackle the
performance challenges they face and by drawing on examples of the investments being
made by the UK Commission through its investment funds.
There are several determinants of employers’ skills needs and training behaviour including
firm size, strategy and location but it is by sector which the strongest variations appear.
Hence this work focuses on the Health & Social Care sector. Slide packs and reports are
also available for a number of other sectors from: http://www.ukces.org.uk/ourwork/sectorskills-insights. Each of the sectors are important to the economy in terms of employment,
productivity or their future potential.
For information about this slide pack and accompanying report please contact:
Rebecca Jones, rebecca.jones@ukces.org.uk
Source information can be found in the notes section of each slide
Storyboard
What key skills
challenges are
being faced in
Health and Social
Care?
The importance
of Health and
Social Care
sector today
Imagine where
the sector could
be tomorrow
Performance
challenge (1)
doing more with
less
Performance
challenge (2)
attracting talented
individuals
Performance
challenge (3)
key skills
shortages
Performance
challenge (4)
management
capability
Tackling these
performance
challenges:
Growth through
skills
Benefits
to organisations
What services do the Health and
Social care sector offer?
Residential
care
Hospital
activities and
nursing homes
Child day
care
GP
practices
Dental
practices
Specialist
practices
Social
work
activities
What key skills challenges are
being faced overall?
Doing more with less
The NHS in particular is facing major restructuring including significant reductions in management and
administrative costs and further efficiency savings are planned across all UK nations.
Reduction in public spending is likely to result in significant cost pressures for the Health and Social care
sector.
Research has demonstrated that management skills are correlated with financial performance and better
patient outcomes.
Attracting and retaining the necessary talent
An ageing population, and an ageing workforce produce a combination of increasing demand for services
coupled with high rates of retirement of existing employees.
Almost 1.7
million job openings are expected across health and social care by 2020 (both new
demand and the replacement of retiring staff). This includes 881,000 job openings for managers,
professionals and associate professionals (160, 000 new job openings).
Some parts of the social care sub-sector have high
staff turnover and vacancy rates.
Reducing skills gaps among the existing workforce
A lack of proficiency has been reported in the areas of strategic management, team-working and
communication skills. Skills gaps can typically make it harder for organisations to meet quality standards,
increase the workload of other staff and create additional operational costs.
At the same time, new technology is expected to have wide ranging impact across the sector with assistive
technologies shifting the delivery of care towards the home and local providers. Technology will increase
demand for high level skills, with potentially negative consequences for the skills gaps in the sector.
Health and social care matter:
where the sector is today
•
•
•
•
The health and social care sector is fundamental to the success of the economy as a major employer
employing almost 4 million people.
Data suggests approximately 1/3 of health and social care employees work within small organisations
(under 25 employees) and 1/3 work in large organisations (500 or more employees).
The importance of health and social care lies in its contribution to all other aspects of the economy: a
healthy population is more productive, and more economically active.
The health workforce is much better qualified than average. Almost a third work in professional
occupations compared with a fifth in the labour market as a whole.
• Growth in output in the sector is projected to increase by 2.4% a
year to 2020. When taking qualitative measures into account,
productivity has increased over the last decade
•
Employment in health is dominated by the NHS (over 75%),
whereas 47% of employment in adult social care is in the private
sector
•
There is strong female participation in the sector (79%) and high
rates of part-time working (40%), compared to an all-economy
average of 47% and 28% respectively.
•
The influence of health & social care extends beyond the sector: it
provides a large market for UK life sciences industry and other
industrial supply chains.
•
However, the health and social care sectors have relatively low
rates of innovation and investment compared to other sectors. 6
• Exporting innovative ideas and expertise, provides business opportunities for UK-based companies.
Health and social care:
imagine where we want to be tomorrow
• The sector offers world-leading standards of
care and public health supporting the wellbeing and economic activity of the population,
so supporting the performance of other sectors
• World-class managers drive continuous
improvement and maximise the contribution of
employees to deliver service excellence
• Services are delivered in an efficient way that
maximise value for money
• The UK leads the world in terms of efficiency
and innovation in the delivery of Health and
Social Care services
•
The sector attracts the most talented individuals for both training and practice
•
The sector recognises talent as a source of competitive advantage
•
Firms and individuals invest optimally in their skills
•
Employers collaborate on, lead and own skills solutions to the sector’s performance
challenges in pursuit of mutual gain
The sector tomorrow: increasing demand for
skills in Health and Social Care
• Employment overall is projected to grow by 1.3 per cent (social care +4.9%,
health -1.3%) between 2010 and 2020 (below all sector average of 5.1 per
cent). However, the expansion and retraction for different occupations reveals a
more challenging picture.
• The majority of employment growth is projected among highly skilled
occupations (9% across managers, directors and senior officials, professional
occupations, associate professional and technical) but this is lower than across
all sectors (16%), therefore competition for skills is likely to be high.
• Employment among positions using higher level qualifications (first degree
level and above) is projected to increase from 28% in health, 26% in care in
2010 to 39% for both sectors in 2020. At both time points this is higher than the
all sector average, 24% in 2020 to 32% in 2020 across all sectors
• New job openings due to retirement and employment growth is significant:
485,000 jobs in professional and 570,000 jobs in caring, leisure and other
services occupations by 2020
• Employment is also expected to increase among caring, leisure and other
services occupations particularly in Social Care (12% for Social Care, but 9%
for Health which is on a par with the all sector average)
• Positions are expected to decrease among administrative and secretarial (31%)
and skilled trade occupations (33%), much more so than across all sectors
(11% and 7% respectively).
The sector tomorrow:
doing more with less
Doing more...
•
The UK population is growing and ageing which is likely to lead to a 20% increase in
demand for residential care, home care, day centres and meals per decade.
•
The number of children referred to Social Services is rising in England (613K referrals
year ending March 2011, 608K in 2010, 547K in 2009, 539K in 2008)
•
Obesity is steadily increasing across the UK, associated with an extra 7 million cases of
diabetes, 6.5 million cases of heart disease and stroke, and between 492,000 and 669,000
additional cases of cancer by 2030.
•
Alcohol-related hospital admissions is rising as is the incidence of binge drinking
With less...
•
Targets of 5% in efficiency savings have been announced across the NHS, requiring annual
savings worth £20 billion by 2014/15.
•
The NHS is facing major restructuring (Health and Social Care Act 2012) including a
challenge to reduce bureaucracy, and reduce the resulting management and
administrative costs.
•
The pay freeze means salaries are under pressure, in the health sector especially: “the
pressure to pay more in real terms will be immense; by 2012-13 GPs will have had their pay
frozen for four years, consultants for three and everyone else for two years.” (John Appleby of
the King's Fund)
9
The performance challenge
Quality of management capability
Management practice in hospitals are strongly related to quality of patient care and better
productivity. Improved management practices are associated with:
• Significantly lower mortality rates
• Better financial performance
• Quality patient care
There is a general perception of poor management skills in the H&SC sector, however research*
has shown that the UK delivers strong hospital-management practices relative to health
expenditure. That said, variation in the quality of management and outcomes is evident; in that,
better management scores can be found among:
•
•
•
•
Hospitals with clinically qualified managers associated with better management scores.
Higher-scoring hospitals give managers higher levels of autonomy
Larger hospitals are better managed.
Private hospitals (including not-for-profits) achieve higher management scores than public hospitals.
Across both sectors the skills levels and training of senior staff are strong:
• Both sectors fare very well when compared to the all sector average for Managers and
professional without L4 or above qualification (Health 15%, Care 30%, all sector average 39%)
• Equally, employees receiving training at Manager, Director and senior Official Occupations is well
above the all sector average of 45%. (Health 61%, Care 60%)
But, while on the whole skills shortage vacancies are lower than the UK average, the occurrence of
skills shortage vacancies as % of all vacancies is concentrated in the managerial and
professional occupations (for health, 42% of all vacancies for managers are SSV’s, and in care
this is 24%)
A key outcome of the Health & Social Care Act is a reduction in bureaucracy and a consequent
reduction in management and administrative costs. The challenge to do more with less means what
is good now will need to be better.
.
The performance challenge
Quality of management capability
Looking ahead at demand for management skills:
• Small growth is expected in the workforce in health and care sectors between 2010-2020.
However, the share of the workforce made up from the top three occupation levels plus caring
occupations is expected to grow while others are expected to retract.
• Demand for skills at level from degree level to doctorate level is expected to increase during
2010-2020 across all sectors including health and care
– But, demand for higher degree and doctorate level in expected to increase above the level for all
sectors. In 2010 the share of employment at QCF 7-8 is around 9-10% for health and social care,
in line with the all sector average. By 2020 this is expected to increase to just over 15% for health
and social care and just under 15% for all sectors
• Meanwhile, the demand from other sectors for skills at the top three occupational levels is also
set to increase, competition to attract these skills will be high which increase the need to
nurture and promote from within the sector.
Meanwhile, if we look at High Performance Working in the sectors the role of good
management is important in enabling the execution of the four indicators used to measure
HPW. Here both health and social care have variable strengths and some weaknesses in relation
to the sector average
– Identifying talent is a strength for both sectors ( 20% health, 28% care and 214% all sectors)
– For both variety in work and discretion in tasks, health is lower than the all sector average
(variety - 51% health, 59% care and 55% UK) (discretion – 42% health, 53% care and 52% UK)
– Flexible working is lower for both sector than the all sector average (27% health, care and UK)
The increased demand for higher levels across the economy will mean increased competition to
attract talent and nurture these skills. Key outcomes of HPW are effective skills utilisation and
progression – this could help to nurture talent and meet future the demand for higher level skills from
growth and replacement demand.
Case study - Front-line leaders programme
The problem
MacIntyre found that managers in the Care sector were often lacking key management and
leadership skills and also lacking confidence in the role.
The approach
The National Skills Academy for Social Care developed the Leader’s programme, designed
for those working or leading to develop the language and values of leadership and peer
learning. The course helped first-line managers respond to high rates of attrition (40% in first
year, 60% in the second year).
The benefits
The programme helped managers better manage their role and gave them the confidence to
cope effectively with the tougher, more personal aspects of the role.
Feedback from attendees has been very positive generating high levels of enthusiasm,
helping participants learn and think about themselves and their roles differently.
12
The performance challenge
Key skills shortages
•
In the Health sector, the over-whelming response from employers in regard to skills requirements was for
greater levels of job specific skills (77% of health employers identified this as a need compared to 54%
in Care and 66% across all sectors)
•
In Social Care sector, employer skills requirements were highest for job specific skills. In addition to this
employers reported similar levels of needs across: planning skills, communication skills (written and
oral), customer handling, ability to work in teams and problem solving (all at higher levels than the all
sector average for the skill type)
•
Despite generally high proportions of well qualified staff overall (61% qualified to NQF Level 4 and above,
compared to 36% in whole economy) there are still significant pockets of low qualified employees
(e.g. 16% of employees in the sector have either no qualification, or are educated to NQF Level 1 or
equivalent compared to a 19% economy average).
•
Despite high instances of formal and informal training in both sectors
•
•
In the Health sector, employees in skilled process, plant and machine operative roles were the
only occupational category less likely to experience training than the sector average
•
Whereas in the Care sector, employees receiving training was lower than the all sector average
for professional occupations, associate professional and customer service occupations
Across the three main implications of skills gaps employers in both health and care report similar
experience of these implications as for all firms
•
Increased workload for other staff (82 per cent for both health and care, 78% across all sectors),
increased operating costs (40% health, 33% care, 45% all sectors), and difficulty in meeting quality
standards (39% health 38% care and 40% all sectors)
•
However, a particular issue for health and care employers is difficulties introducing new working
practices (44% health and 48% care compared to 38% of all firms).
The health of the workforce skills and experience of training is variable across occupations.
The repercussions are felt more widely. In health and social care, new working practices and
their consistent adoption are a fundamental to effective delivery. Investment in skills is key.
Case study – Creating new roles to reduce
emergency hospital admissions
The problem
Over 75% of 999 calls to the ambulance service result in admission to an emergency
department. This is resource-intensive and creates trauma for patients. Skills for Health
developed a competency framework for emergency, urgent and unscheduled care to
devise a new role and learning programme for Emergency Care Practitioners (ECPs)
The approach
ECPs are up-skilled to assess and treat patients at the scene, provide clinical support
and advice, support primary care staff in home visits or out of hours cover and work in
minor injury units.
ECP attendance costs
less than sending an
ambulance in response to
The benefits
a 999 call.
ECPs have reduced emergency admissions: almost a third of
patients avoided transfer to an emergency department when treated by an ECP at the
scene. Almost a half of elderly patients suffering a fall and seen by an ECP did not need
to be admitted.
Patient satisfaction is higher; as generally patients prefer to be treated close to or in their
own homes. The new competency framework provides staff with the opportunity to
develop and progress.
The performance challenge
Attracting talented individuals
The share of all vacancies which are Skills Shortage Vacancies* are lower in Health (12%) and in
Care (9%) compared to the (16%) average across all sectors, but on closer inspection the need
to attract talent for specific occupations becomes apparent.
In Health
• However, there is a concentration of Skills Shortage Vacancies reported among professional
occupations in Health (47% compared to 16% for Social Care and 18% across the economy).
• There are skills shortages reported among Pharmacists, Dental Practitioners, Specialist
nurses occupations and in other physiological sciences and respiratory physiology sectors.
• The share of skills gaps by occupation in health is higher for professionals 8% compared to 4 %
for both care and the all sector average)
 Reliance on international recruitment is lessening, however employers need to think about
alternative recruitment channels.
In Care
• There are particular Skills Shortage Vacancies in personal service occupations in Care, of all
the skills shortage vacancies in care 52% are in the caring occupations (compared to 29% for
health) and 11% across the economy.
• Skills gaps** are also higher than average in skilled trades (8% compared to 4% in care and
5% all sector average) and caring occupations (6% versus 4% for health and 5% economy
average).
• Social care also has a high staff turnover rate, of 18% in the private sector, and 11% among
local authorities).
 Enhancing the attractiveness of jobs for new recruits improves employer’s ability to recruit and
retain talented individuals.
* Skills shortage vacancies are hard to fill vacancies caused by a lack of applicants with the skills, qualifications or experience needed
** Skills gaps are a lack of full proficiency amongst existing staff ie not able to do the job to the required level
Case study - Caledonia Healthcare:
Improving recruitment and retention
The Problem
As a healthcare recruitment company, specialising in recruiting and supplying care assistants, support
workers and nurses, Caledonia Healthcare Limited wanted to attract, recruit, retain and motivate high
calibre professionals and saw Investors in People (IiP) as a fundamental part of becoming an employer
of choice and leveraging human capital.
The Approach
IiP helped Caledonia Healthcare understand what made their people happy through implementing a staff
consultation process. The results revealed innovative solutions for business planning and new ways for
senior managers to communicate with staff.
The benefits
In using a consistent approach to staff development, the firm experienced higher levels of staff
engagement and retention. Gaining and retaining IiP has provided Caledonia Healthcare with a
powerful way of demonstrating that they are a great company to work for – more people want to work for
the organisation and more clients have provided positive feedback on the service they have received.
16
Case study- A new foundation degree
to improve recruitment and retention
The problem
A rising elderly population led to increasing pressure on community nursing services to deliver routine
care such as dietary monitoring, support for those with diabetes, wound dressing and other routine
procedures. At the same time, care staff were not qualified to carry out these procedures leading to a
resourcing issue for both time-pressured community nurses and care staff whose capabilities were
being underutilised. For Carers, lack of suitable progression routes meant that retention was low.
The approach
A partnership between Skills for Health, Foundation Degree Forward,
University Campus Suffolk and MOVE Lifelong Learning Network
devised a new Foundation Degree to enable care staff to become
qualified to offer basic care through a blend of work-based and
theoretical learning. Credits can be accumulated and easily
transferred via a structured pathway for career progression.
The benefits
Care homes recruit and retain the volumes of staff needed to meet
future demand, benefitting from greater efficiency and reduced staff
turnover. Patients would experience more timely treatment and greater
continuity of care. The wider health sector experiences reduced pressure for community nurses and
through reduced hospital admissions because of a lack of capacity in care homes to provide
appropriate care.
Growth through skills
Securing future success
• Across the sector, raising skills is key to raising performance, but while there is no silver
bullet, a mix of actions which push and pull in the same direction can help.
• Employer leadership in the development of solutions and then taking ownership of those
solutions is fundamental to their success and sustainability.
Sources of investment are available to support the implementation of solutions led by
business on behalf of the sector.
•
The Employer Ownership pilots offers employers in England direct access to up to £250 million
of public investment over the next two years to design and deliver their own training solutions.
•
The Growth and Innovation Fund (£9 million invested so far, £29 million to invest in 2012-13)
gives priority to solutions for the sector e.g.:
• Employer commitment and investment in Apprenticeships
• Creation of employer networks to overcome skill problems
• Employer-backed proposals for other skills solutions such as: management and leadership;
professional standards; high performance work practices incorporating people
development (e.g. Investors in People).
• Information and business advice is also important as a solution.
Ultimately this is trying to catalyse sustained investment in the development of the sector’s
workforce led by employers which lies at the heart of an enterprising and dynamic nation.
Growth through skills
Securing future success
Strong links between employers and colleges and universities have been cemented through
the National Skills Academies.
The National Skills Academy for Social Care offers leadership training to:
• Recent graduates through a National Management Trainee Scheme which seeks to
attract people into the sector and develop future leaders.
• Front-line leaders which focuses on how the values and behaviours of leadership at the
front line are crucial to excellent care delivery.
• Senior managers of the future An Aspiring Leaders programme focuses on leadership
within the commercial reality of day-to-day operations.
• New Directors working with the Association of Directors of Adult Social Services
(ADASS) to run a programme to support senior managers when they’re newly promoted
to lead local authority adult social services.
The social care academy also aims to raise the quality of provision by offering quality marks
for organisations and individuals through awarding:
• Centres of Excellence: who demonstrate exemplary commitment to meeting the needs
of learners, compliance with the social model of care, and understanding and measuring
impact of provision on lives of service users.
• Recognised Providers: who demonstrate a professional approach to education and
training in adult social care.
• Endorsed Practitioners: 'sole-trader' training providers who demonstrate a professional
approach to education and training in adult social care.
Growth through skills
Securing future success
The National Skills Academy for Health seeks to raise skills in the sector by offering:
• Specialist Careers Advice and Information
• Brokerage for employers matching training providers to need
• Learning consultancy
• Apprenticeship, Youth and Pre-employment Programmes, including the management of
the Joint Investment Framework
• Partnerships with various organisations delivering the 14-19 diplomas, acting on their
behalf, and providing a comprehensive menu of employment engagement activities
• Support to organisations on how to maintain standards both occupationally and through
qualification requirements via our Skills for Health approval process
• Career development for those supporting learners with language, literacy and numeracy
development needs
Skills for Health are improving the talent pipeline of new entrants into the sector through:
• The Skills Passport will provide a framework for statutory and mandatory skills. to
reduce training costs, improve productivity and increase quality of services. With
investment from GIF, Skills for Health are offering to implement the framework within 60
organisations
• Skills for Health run a Cadet training programme to help young people start a career in
the NHS, whilst continuing to study an academic or vocational qualification, a 14-19
diploma and young apprenticeships.
Growth through skills
Securing future success
Apprenticeships and Workplace learning – social care
Case study research reports that employers believed that Apprenticeships and WPL, often
alongside mandatory training, delivers a number of benefits:
• staff understanding of what care entails and consistency of standards;
• helping to develop staff confidence and capability to deliver a good standard of care;
• investment in training particularly beyond Level 2 offers (personal) development opportunities
help to support staff motivation and retention
• when senior posts become vacant, a pool of suitably trained internal candidates for promotion
will be ready to take up the opportunity to progress.*
In addition, this study of 8 sectors the net cost of WPL in social care was found to be lower
than in many other sectors for both L2 Apprenticeships and L2 NVQ .
Partnerships with employers – Health
• Skills for Health worked with Whittington Hospital NHS Trust to pioneered a competence
based leadership programme for front line managers. The benefits included: managers able to
deal with issues without dependence on senior support , more proactive and raised confidence
and morale.
• NHS Nottingham City and University of Nottingham have developed a ‘competency matrix’
to support staff development for End of Life Care. This has reaped benefits for: patient centred
care, multidisciplinary approaches and increased competence and confidence in clinical
practice.
Benefits of training to organisations
• Evidence across a number of sectors suggests that employers who
invest in training are more likely to survive than those who don’t .....
– Training improves organisational survival rates. Non-training organisations in the
Health sector are 1.2 times more likely to close compared to training organisations in
Health*.
• And, what is more, the productivity gains for firms from investing in
training are seen to be higher than the increase in wages experienced
by employees
• Development of communication skills results in a demonstrable shift
in staff behaviours towards patients. Staff show greater empathy,
greater responsiveness to patient cues and better style of questioning.
The evidence shows that change is sustained over the long term.
• Good people management practices are strongly related to lower
patient mortality rates. The extent and sophistication of appraisal is
particularly strongly related, but there are links too with the level of
training for staff, and the way work is organised, for example the
proportion of staff working in teams.
Benefits of training to organisations
In the Social Care sector, better performing Care
homes have:
• Higher proportions of staff with relevant
qualifications including managerial and supervisory
staff, senior care workers and care workers
• Greater proportions of workers with higher level
qualifications (including care workers at level 3 and
managers with professional and managerial
qualifications)
• More experienced staff on hand.
Key messages
The health and social care is a major sector in employment and economic terms now
and demand for services is projected to grow over the next decade. Against a backdrop of
fiscal constraint, several challenges exist which threaten the sector’s performance:
•
attracting talented individuals to the sector
•
overcoming skills gaps among pockets of low-qualified employees
•
improving the quality of management capability across the sector
Examples exist of where these challenges are being tackled successfully through
employer-led skills solutions. If the sector is to realise its potential, this action must be
scaled-up and employers must play a greater role in developing the skills needed by their
respective workforces.
By providing training and skills development in the context of an employment relationship
which recognises the importance of career progression, there are benefits to both employer
and employee .
Work with employers to transform the UK’s approach to investing in skills of its people
to secure growth and prosperity. The UK Commission is looking to work with employers
to transform the UK’s approach to investing in the skills of its people to secure growth
and prosperity. More information about the UK Commission’s investment funds is available
here.