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/sector-skills-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?

Performance challenge (1)

doing more with less

Performance challenge (4) management

capability

The importance of Health and Social Care sector today

Performance challenge (2)

attracting talented individuals

Tackling these performance challenges:

Growth through skills

Imagine where the sector could

be tomorrow

Performance challenge (3)

key skills shortages

Benefits to organisations

What services do the Health and Social care sector offer?

Hospital activities

and nursing homes

Residential care

Child day care

Dental practice

s

GP practice

s

Social work

activities

Specialist practices

What key skills challenges are being faced overall?

Doing more with lessThe 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 andcommunication 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 increasedemand 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

6

• 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.

• 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.

• 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 w

orld-leading standards of care and public health supporting the w

ell-being and econom

ic activity of the population, so supporting the perform

ance of other sectors

•W

orld-class m

anagers drive continuous im

provemen

t and m

aximise

the contribution of em

ployees to deliver service excellence

•S

ervices are delivered in an efficient w

ay that m

aximise

value for m

oney

•The U

K

leads the w

orld in term

s of efficiency and innovation in the delivery of H

ealth and S

ocial C

are services

•The sector attracts the m

ost talented individuals for both training and practice

•The sector recognises talent as a source of com

petitive advantage

•Firm

s and individuals invest optimally in their skills

•E

mployers collaborate on, lead and ow

n skills solutions to the sector’s perform

ance challenges in pursuit of m

utual gain

The sector tomorrow: increasing demand for skills in Health and Social Care

•Em

ployment 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). H

owever, the expansion and

retraction for different occupations reveals a more

challenging picture.

•The m

ajority of employm

ent growth is

projected among highly skilled occupations

(9% across m

anagers, directors and senior officials, professional occupations, associate professional and technical) but this is low

er than across all sectors (16%

), therefore competition for

skills is likely to be high.

•E

mploym

ent 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

•N

ew job openings due to retirem

ent and em

ployment grow

th is significant: 485,000 jobs in professional and 570,000 jobs in caring, leisure and other services occupations by 2020

•E

mploym

ent is also expected to increase among

caring, leisure and other services occupations particularly in S

ocial Care (12%

for Social C

are, but 9%

for Health w

hich is on a par with the all

sector average)

•P

ositions are expected to decrease among

administrative and secretarial (31%

) and skilled trade occupations (33%

), much m

ore 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

Managem

ent practice in hospitals are strongly related to quality of patient care and better productivity. Im

proved m

anagement practices are associated w

ith:•

Significantly low

er mortality rates

•B

etter financial performance

•Q

uality patient careThere is a general perception of poor m

anagement skills in

the H&

SC

sector, however research* has show

n that the UK

delivers strong hospital-m

anagement practices relative to

health expenditure. That said, variation in the quality of m

anagement and outcom

es is evident; in that, better m

anagement scores can be found am

ong:•

Hospitals w

ith clinically qualified managers associated w

ith better m

anagement scores.

•H

igher-scoring hospitals give managers higher levels of autonom

y •

Larger hospitals are better managed.

•P

rivate hospitals (including not-for-profits) achieve higher managem

ent scores than public hospitals.

Across both sectors the skills levels and training of senior staff are strong:

•B

oth sectors fare very well w

hen compared to the all sector

average for Managers and professional w

ithout L4 or above qualification (H

ealth 15%, C

are 30%, all sector

average 39%)

•E

qually, employees receiving training at M

anager, Director

and senior Official O

ccupations is well above the all sector

average of 45%. (H

ealth 61%, C

are 60%)

But, w

hile on the whole skills shortage vacancies are low

er than the U

K 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 m

anagers are SS

V’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.

12

The problemMacIntyre found that managers in the Care sector were often lacking key management and leadership skills and also lacking confidence in the role.

The approachThe 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 benefitsThe 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.

Case study - Front-line leaders programme

The performance challenge Key skills shortages

•In the H

ealth sector, the over-whelm

ing response from

employers in regard to skills requirem

ents was for

greater levels of job specific skills (77% of health

employers identified this as a need com

pared to 54% in

Care and 66%

across all sectors)

•In S

ocial Care sector, em

ployer skills requirements

were highest for job specific skills. In addition to this

employers reported sim

ilar levels of needs across: planning skills, com

munication skills (w

ritten and oral), custom

er handling, ability to work in team

s and problem

solving (all at higher levels than the all sector average for the skill type)

•D

espite generally high proportions of well qualified staff

overall (61% qualified to N

QF Level 4 and above,

compared to 36%

in whole econom

y) there are still significant pockets of low

qualified employees (e.g.

16% of em

ployees in the sector have either no qualification, or are educated to N

QF Level 1 or

equivalent compared to a 19%

economy average).

•D

espite high instances of formal and inform

al training in both sectors

•In the H

ealth 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 C

are sector, employees receiving

training was low

er than the all sector average for professional occupations, associate professional and custom

er service occupations

•A

cross the three main im

plications of skills gaps em

ployers in both health and care report similar

experience of these implications as for all firm

s

•Increased w

orkload 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 m

eeting quality standards (39%

health 38% care and 40%

all sectors)

•H

owever, a particular issue for health and care

employers is difficulties introducing new

working

practices (44% health and 48%

care compared to

38% of all firm

s).

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 problemO

ver 75% of 999 calls to the am

bulance service result in adm

ission to an emergency departm

ent. This is resource-intensive and creates traum

a for patients. S

kills for Health developed a com

petency framew

ork for em

ergency, urgent and unscheduled care to devise a new

role and learning programm

e for E

mergency C

are Practitioners (E

CP

s)The approachE

CP

s are up-skilled to assess and treat patients at the scene, provide clinical support and advice, support prim

ary care staff in home visits or out of

hours cover and work in m

inor injury units.

The benefitsE

CP

s have reduced emergency adm

issions: almost a

third of patients avoided transfer to an em

ergency departm

ent when treated by an E

CP

at the scene. A

lmost a half of elderly patients suffering a fall and

seen by an EC

P did not need to be adm

itted. P

atient satisfaction is higher; as generally patients prefer to be treated close to or in their ow

n homes.

The new com

petency framew

ork provides staff with

the opportunity to develop and progress.

.

ECP attendance costs less than sending an ambulance in response

to a 999 call.

The performance challenge Attracting talented individuals

In Health

•H

owever, there is a concentration of S

kills Shortage

Vacancies reported among professional occupations

in Health (47%

compared to 16%

for Social C

are and 18%

across the economy).

•There are skills shortages reported am

ong Pharm

acists, 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 recruitm

ent is lessening, how

ever employers need to think about alternative

recruitment channels.

In Care

•There are particular S

kills 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.

•S

kills 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).

•S

ocial care also has a high staff turnover rate, of 18%

in the private sector, and 11% am

ong local authorities).

Enhancing the attractiveness of jobs for new

recruits im

proves employer’s ability to recruit and retain

talented individuals. * S

kills shortage vacancies are hard to fill vacancies caused by a lack of applicants with the skills, qualifications or experience

needed** S

kills gaps are a lack of full proficiency amongst existing staff ie not able to do the job to the required level

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.

16

The ProblemAs 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 ApproachIiP 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 benefitsIn 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.

Case study - Caledonia Healthcare: Improving recruitment and retention

Case study- A new foundation degree to improve recruitment and retention

The problemA rising elderly population led to increasing pressure on com

munity nursing services to deliver routine care such as

dietary monitoring, support for those w

ith diabetes, wound

dressing and other routine procedures. At the sam

e time,

care staff were not qualified to carry out these procedures

leading to a resourcing issue for both time-pressured

comm

unity nurses and care staff whose capabilities w

ere being underutilised. For C

arers, lack of suitable progression routes m

eant that retention was low

.

The approachA partnership betw

een Skills for H

ealth, Foundation D

egree Forward,

University C

ampus S

uffolk and MO

VE

Lifelong Learning N

etwork

devised a new Foundation D

egree to enable care staff to becom

e qualified to offer basic care through a blend of w

ork-based and theoretical learning. C

redits can be accumulated and

easily transferred via a structured pathw

ay for career progression.

The benefitsC

are homes recruit and retain the volum

es of staff needed to m

eet future dem

and, benefitting from greater efficiency and

reduced staff turnover. P

atients would experience m

ore timely treatm

ent and greater continuity of care. The w

ider health sector experiences reduced pressure for com

munity nurses and through

reduced hospital admissions because of a lack of capacity

in care homes to provide appropriate care.

Growth through skillsSecuring 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 skillsSecuring 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 skillsSecuring 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 skillsSecuring future success

Apprenticeships and Workplace learning – social careCase 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

•E

vidence across a number of sectors

suggests that employers w

ho invest in training are m

ore likely to survive than those w

ho don’t .....

–Training im

proves organisational survival rates. N

on-training organisations in the Health

sector are 1.2 times m

ore likely to close com

pared to training organisations in Health*.

•A

nd, what is m

ore, the productivity gains for firm

s from investing in

training are seen to be higher than the increase in w

ages experienced by em

ployees

•D

evelopment of com

munication skills

results in a demonstrable shift in staff

behaviours towards patients. S

taff show

greater empathy, greater

responsiveness to patient cues and better style of questioning. The evidence show

s that change is sustained over the long term

.

•G

ood people managem

ent practices are strongly related to low

er patient m

ortality rates. The extent and sophistication of appraisal is particularly strongly related, but there are links too w

ith the level of training for staff, and the w

ay work is organised, for exam

ple the proportion of staff w

orking in teams.

Benefits of training to organisations

In the Social C

are sector, better perform

ing Care

homes have:

•H

igher proportions of staff w

ith relevant qualifications including m

anagerial and supervisory staff, senior care w

orkers and care workers

•G

reater proportions of w

orkers with higher level

qualifications (including care w

orkers at level 3 and m

anagers with professional

and managerial qualifications)

•M

ore experienced staff on hand.

Key messages

The health and social care is a major sector in

employm

ent and economic term

s now and dem

and for services is projected to grow

over the next decade. A

gainst a backdrop of fiscal constraint, several challenges exist w

hich threaten the sector’s perform

ance:

• attracting talented individuals to the sector

• overcoming skills gaps am

ong pockets of low-

qualified employees

• improving the quality of m

anagement capability

across the sectorE

xamples exist of w

here these challenges are being tackled successfully through em

ployer-led skills solutions. If the sector is to realise its potential, this action m

ust be scaled-up and employers m

ust play a greater role in developing the skills needed by their respective w

orkforces. B

y providing training and skills development in the

context of an employm

ent relationship which

recognises the importance of career progression, there

are benefits to both employer and em

ployee .

Work w

ith employers to transform

the UK

’s approach to investing in skills of its people to secure grow

th and prosperity. The U

K C

omm

ission is looking to w

ork with em

ployers to transform the U

K’s approach

to investing in the skills of its people to secure grow

th and prosperity. More inform

ation about the UK

C

omm

ission’s investment funds is available here.