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3 Introduction to the sector The health and social care sector comprises all NHS institutions and employees institutions and employees in the private health subsector public authorities and private organisations that deliver social care services to adults and children No public service is considered by the UK population to be more important than healthcare, especially the NHS. Levels of investment, levels of patient and public satisfaction and levels of pay for employees are all very important issues and are often debated in the media and by the public. Skill levels within the health sector are just one issue of public interest, and can get lost among those other three, highly political, issues. Nevertheless, the public has a huge dependence on, and takes a particular interest in, the skill level of all health and care employees with whom they come into contact. As an employer, the sector is very important, not only to the very large section of the UK working population whose income depends on it, but also to the organisations, and ultimately the government (in the case of the NHS), who must meet the wage bill. By far the most important issue regarding the NHS, and one that cuts across the political divide, is to ensure that the maximum amount of patient care and satisfaction is derived from every 1 invested in it. Skill levels, therefore, are bound to be one of a few absolutely vital issues for employers in the sector and for government. 3

4 Social care and children s/young people s services are central to the health and wellbeing of individuals and families across the UK. An estimated 2 million individuals are using the services of this sector at any one time, and most families will use them at some time or other. These services safeguard the most vulnerable children and adults in society by preventing and tackling abuse and neglect helping society and the economy by, wherever possible, tackling these issues early Like health, this sector is never out of the public and media spotlight for both positive and negative reasons. The sensitivity of the sector s work, and the vulnerability of the children and many of the adults who are in its care, make the level of skills within it a matter of interest, not just for employers and employees but for the country at large. Perhaps surprisingly, a very large proportion of the workforce is employed by the private sector (large majorities in some types of services). Partly because of this, information on the social care workforce is patchy (freely admitted by the Sector Skills Council (SSC)), in particular for adult social care: there are gaps in data on a wide range of workforce issues, which the SSC is attempting to fill. This edition of the Health and Care Sector Profile was written in March 2011, with the worst of the recession over, but following the announcement of a disappointing 0.5% fall in economic activity in the UK as a whole and large scale cuts in public expenditure. The possibility of a double dip recession had not completely receded, and the effect on the economy of public service expenditure cuts was just starting to be felt. The government had given assurances that NHS spending would be exempt, but the future of those care services (adult and children s) that are in the public sector was less secure, and it remained to be seen what effect reductions in spending would have on front line services. The effect on pay in social care, meanwhile, was bound to be negative, with pay freezes already announced and employee dissatisfaction increasing. There was also an effect on this profile, which relies for its key data on research published by the relevant sector skills councils, much of which was encapsulated in Sector Skills Agreements (SSAs) and Sector Qualifications Strategies (SQSs) published just prior to the recession and long before the current round of public spending reductions. There have been several pieces of published research since that time, and this profile uses the most up-to-date sources it can. However, there are bound to be predictions for development and growth in services and employment possibilities in the sectors which now have to be treated with caution. Wherever that is the case, a suitable caveat is entered in the text. 4

5 We will look at the current economic and fiscal context of health and care in more detail throughout this profile, in particular its effect on training and skills provision. However, it is important not to become excessively focused on these factors at the expense of those which are ever-present, and which will continue to shape the relationship between the health and care sectors and educational providers, regardless of the state of public finances and the political hue (or hues) of the government of the day. Finally, it is important to note whether quoted national figures apply to the UK or England alone. Devolution of powers to the UK nations has created the need for matching data sets. Unfortunately, in the case of England, published research will often, within the same document, switch from figures relating just to England to figures relating to the UK as a whole. Where this carries over to this profile it is flagged up, with apologies. 5

6 Section 1 Composition, size and importance of the sector National level 1.1 Composition of the sector The health sector can be divided into two all NHS institutions and employees institutions and employees in the private sector Each of those can be further divided into four subsectors hospital activities (including nursing homes) medical practice activities dental practice activities other health and care activities Health Sector NHS Private Health Care Hospital activities (including nursing homes) Medical practice activities Dental practice activities Other health care activities Hospital activities (including nursing homes) Medical practice activities Dental practice activities Other health care activities fig 1 The great majority of the workforce works in hospital activities. 6

7 The care and development subsector as a whole can be usefully divided into two broad areas: children/young people and adults. Together, these broad areas comprise children s homes care homes domiciliary care and support services day centres and services social work fostering agencies and services foster carers adoption services nursery and early years work childminding voluntary youth services Connexions day nurseries voluntary and charitable care The sector s workers are employed by a range of organisations including those in the independent and private sector local authorities other public service organisations the voluntary sector Changes in the composition of the sector In response to demographic and other factors, a change is taking place in the composition and functional priorities of the health sector, including an increased focus on public health greater responsiveness to the population s needs and expectations more use of patient pathways requiring multiprofessional and multidisciplinary working more diversity in, and a changing balance between, community and hospital based services the introduction of new technologies organisational change and the need for increased productivity 7

8 saw the culmination of much research into the health sector by Skills for Health, much of which informed its SSA. At that time, it predicted that in ten years time a significant percentage of jobs in health and care would be in new roles, many (it doesn t say how many) of which would be at Band 4 level in the NHS Agenda for Change pay system (see 3.1 later), including assistant practitioners and similar roles. It also predicted a flattening in the current demand for professionally qualified staff in traditional professional roles, partly offset by further new roles based on nationally and locally determined service priorities. This theme has been echoed by Skills for Health s policy documents in the intervening years. The care and development subsector is already a complex one in terms of function and structure, encompassing private, public and voluntary organisations. There are no major structural changes currently taking place in the sector. Skills needs are based entirely on permanent features of the sector and predicted incremental developments in future years. Size and importance of the sector The health sector is very important, both as a vital national service and as a source of employment. In 2010 the sector as a whole employed around 2 million people nationally, of whom over 1.4 million worked in the NHS in England. As well as employees, health is a sector that relies on a large body of volunteers. There are an estimated 300 different paid job roles and over 100 different volunteer roles in health. The workforce can be usefully divided into three broad categories clinical staff (mainly nurses and doctors) the biggest segment support staff in hospitals, clinics and GP practices the second biggest segment infrastructure support staff (managers, central functions, estates, etc) Half the NHS workforce is made up of nurses and people in roles that support doctors and nurses. A huge proportion of the entire NHS and private healthcare workforce work in roles for which The Manchester College s provision is directly relevant, and this makes the sector a priority for employer engagement by the college. More detailed figures on the NHS workforce are contained in Section 3. 8

9 The great majority of the sector s employees (both NHS and private) work in hospitals and nursing homes. The proportions look like this hospital activities 71.7% other human health and care activities 13.5% medical practice activities 11.2% dental practice activities 3.6% 62% of the workforce works full time, and 38% part time. 6% of the workforce is self employed. In 2009, the latest year for which we have authoritative figures, the UK adult social care sector had around 1.75 million paid employees, supplemented by many thousands of volunteers. There had been growth in numbers in recent years, the majority of which could be accounted for by the growth in direct employment of carers by service users who were recipients of direct payments. 9

10 The majority of social care providers are in the private and voluntary sectors, but many of these indirectly work for local authorities. The social care sector also has a sizeable and growing self-employed workforce of both professionally qualified and frontline carers, such as personal assistants other community-based practitioners independent social workers A growing number of people who hold individual budgets or receive direct payments are becoming employers. Finally, the workforce also includes unpaid volunteers who work widely across the sector. For more detailed figures we need to go back to 2006, when there were an estimated 31,000 social care providing organisations, including those run by local authorities, NHS, private and voluntary organisations 55,000 childcare organisations 127,000 registered childminders (individuals or working in nurseries, etc) providing almost 1.5 million childcare places 21,000 registered care homes, of which 1,400 were adult placement homes (the great majority of the 21,000 were in the private or voluntary sectors) 3,700 branches of agencies providing domiciliary care staff and 1,000 providing nursing staff (again, most were in the private sector) 35,000 supported housing/assisted living units, mainly local authority funded 2,000 children s homes, 59% of which were privately owned around 250 independent and around 150 local authority fostering agencies around 60 voluntary and around 150 local authority adoption agencies 35,000 registered childcare providing organisations (day nurseries, playgroups, etc) 76,000 registered social workers These figures are likely to be higher today, but are also likely to dip again as a result of spending cuts and other negative economic factors. It is a peculiar facet of social care (and indeed of healthcare) that the same factors cause both an increase in demand and a decrease of supply. We will look at this in more detail later. 10

11 Public and private expenditure combined within the adult social care and childcare sector is currently around 30 billion per annum. UK public expenditure was more than 18 billion for adult social care. In the year approximately 6 billion was spent upon services for adults with a disability. In addition, people assessed by their council as requiring social care services contributed an estimated 2 billion in charges for residential and community services in (in England, rather than the UK). The workforce can be divided into two (reflected by the two partner organisations in the SSC) those providing series for children and young people (represented by the Children s Workforce Development Council CWDC) those providing social care to adults (represented by Skills for Care, in England) The children s and young people s workforce can be further divided into the following areas early years and childcare: 70% children and family social care: 15% advisery and educational support: 5% other occupational groups: 10% Male and female balance In healthcare the workforce is divided 78:22 in favour of women, although this is heavily weighted towards lower paid occupations. 11

12 In care and development, the workforce in care for children and young people is also predominantly female, with a higher proportion of men at management level. In care and development as a whole, covering all occupations, women make up 80% of the workforce. In some services, for example residential and domiciliary care and early years, the figure is 95%. There are signs, however, that recruitment of men in social care as a whole is now increasing significantly, and it is probable that men will soon make up over 25% of the whole workforce. The proportion of men is much higher in certain subsectors, for example houseparents, residential wardens and social service managers. Ethnicity profile In the health service people within the black and minority ethnic range are well represented at over 15%. Until very recently, figures for ethnicity in social care and childcare were unavailable. However, the over-arching SSC, Skills for Care and Development, is now able to tell us that people from ethnic minorities are represented in the workforce to a degree higher than their proportion of the overall population, but lower than their proportion of the health workforce: one in ten of the adult social care and childcare workforce is from an ethnic minority. What is also interesting to note is that the proportion has been growing quite markedly in recent years, though it still has some way to go yet before it matches the ethnic profile of the users of adult social care and childcare. What is even more interesting is that people from ethnic minorities are much more likely to have higher level qualifications than the average employee in the sector (ie people of all races). Finally, specifically in childcare, the ethnic profile varies: an employee in an early years job role is much less likely to be from an ethnic minority than an employee in other child and young person social care roles. Disability profile The care and development workforce has a higher percentage of employees describing themselves as DDA disabled with a work limiting disability than the all-sector national workforce: 7.48% as against 5.18%. The sector is similarly more highly represented by all people describing themselves simply as disabled :17.9% as against 13.2% in the all-sector national workforce. A roughly similar profile is present in the health sector. 12

13 Age profile In care and development, year olds account for 40% of the total workforce. 35% are under 35 and a quarter are over 50. As a general rule, the older the client, the older the worker; the younger the client, the younger the worker. The youngest people in the sector tend to be occupational therapists and nursery nurses. Regional and local level The health sector has an old and ageing workforce: three-quarters of its employees are 35 or over and a majority of those are over 45. This is an issue that has been identified as a priority for action by the NHS and Skills for Health. 1.2 Health and social care sector in the North West and Greater Manchester Healthcare, particularly the NHS, is a major employer in the North West and Greater Manchester. Skills for Health calculates that there were 220,600 people employed in healthcare in our region in That is over 7% of the region s total workforce in some parts of Manchester the figure is 15% or more, and around 35% of all the North West s health workforce works in Greater Manchester. Another way of looking at the importance of the sector is the number of health employees compared with the population as a whole in the North West, it is one health worker to every 31 citizens in some parts of Manchester, it is closer to one to 16 The workforce in social care and children s/young people s care is also very important to the region, and particularly so in many Manchester wards where social need is greatest. 13

14 In recent years there have been increases in the proportion of the sector workforce made up of people from ethnic minorities and those with disabilities (and an improvement in the sector s ability to monitor those figures). However, although women predominate here as they do nationally, they are less well represented in higher level jobs. The ethnic mix, as it is nationally, is a healthy one, but still does not match that of the services clients. Overall, the most important points to make about the entire health and care sector in Manchester are that it is considerably more important to the working population as a source of employment than it is for the UK as a whole it is more heavily used as a service than the national average, due to social and economic deprivation, particularly in some wards 14

15 Section 2 Context, dependencies and relationships National level 2.1 Impact of the sector on national life As mentioned earlier, employees skills levels within the health sector are just one of a number of high profile issues. However, the public often takes a particular interest in the skills levels of all health and care employees they deal with. Therefore, although it would be difficult to trace an increase in UK economic performance back to an increase in health and care sector skill levels, a link between such increased skills and increased public health and satisfaction would be much easier to demonstrate. Care and development has a less clear cut existence in the nation s perceptions and list of priorities. Whereas we all know that, at some time or other, we will need the health service, we do not all necessarily see ourselves as customers of the care and development subsector, though research shows that we almost certainly will be at some time or other in our lives, either directly or indirectly. Research shows that over two million people every year access publicly funded adult social work/care. There is also less awareness of the sector s breadth of activities in the populace at large, and a consequent tendency to misunderstand what it is and what it does. Nevertheless, today s complex society could not function as it does without the services of this sector in supporting individuals and families when in need creating viable and productive living opportunities and arrangements for people of all ages oiling the wheels of the economy by facilitating the co existence of work and family life The level of skills required within the sector is far higher than the level of social esteem that employees within it tend to receive and, by the SSC s own admission, the level of financial remuneration 15

16 they are able to command. Putting this imbalance right is a fundamental aim of the sector and its SSC. At the same time, the SSC recognises that skill levels in all occupational groups must be as high as possible in order to work to the required standard with people who are vulnerable and have complex and specific needs. The sector has specific government targets to meet, arising from three policy documents published in recent years by the Departments of Health and of Education and Skills Every Child Matters Independence, Well being and Choice Our Health, Our Care, Our Say Skills for Care has encapsulated what it needs to do in a review document entitled Options for Excellence, which is available for download from the Skills for Care website. Impact of the economy on the sector This sector is inevitably subject to a peculiar economic and social fact: pressure on the economy and on government spending simultaneously increases the demand for the sector s services and diminishes its ability to supply them. Whenever the economy is in recession, there are always negative consequences for people s health and well-being and on the stability of family units. Physical and mental health problems always show a net increase as do marital and partnership break-ups, homelessness and general stress levels among the population. These lead to an increase in the need for health and social services which themselves are under pressure, initially from falling tax revenues and ultimately from cuts in public spending to address the fiscal deficit. All political parties are under particular pressure not to let such situations have any direct, tangible effect on the NHS, and the current coalition government has pledged to ring-fence the NHS in this regard. Other services are not protected, however, and as this profile was being written (March 2011), organisations representing adult social care and childcare were already letting it be known how cuts in local authority and other budgets were going to be played out in terms of pay freezes, recruitment freezes and job losses, all of which affect the end user s experience of the services offered. There is always a time lag in statistical information, so the effect of public service spending cuts can, for the time being, only be (fairly confidently) predicted. Nevertheless we do have empirical data on the effect of the recession. Research carried out the Local Government Authority (LGA) and Association of Directors of Adult 16

17 Social Services (ADASS) in April 2009 found that local authorities had experienced increased demand on a number of services as a result of the economic downturn, including the number of people seeking welfare/debt advice housing benefit applications provision for homeless persons the demand for social housing the demand for services for the unemployed, or those at risk of unemployment The survey also found that local voluntary organisations had experienced increased demand for services, in particular debt counselling housing advice employment advice The same research identified a reduction in the supply of services as independent care homes closed, and found that two-thirds of local authorities were expecting an increase in demand for mental health services. There were also reductions in the supply of services, as agencies who supplied social care staff went out of business. Demographic and other factors impacting on the sector The main demographic and other factors impacting on the NHS, the healthcare sector as a whole, and therefore on the skills required by its workforce, are an ageing population, with implications both for the workforce and future service demands the growth of chronic diseases and long term illness increasing emergency hospital admissions changing financial regimes The sector recognises that the training, skills and qualifications agenda is set by the need to the cope with such factors, and with changes in the health and care sector. 17

18 The main demographic factors impacting on the care and development subsector are the need to match the demographic profile of the sector s workforce to that of its client base the need to maintain and, wherever possible, increase levels of service, faced with major cuts in budgets (and increase in demand was predicted for both adults and children s/young people s services even before the recession and the cuts in public spending announced by the Chancellor of the Exchequer in 2011 the need to keep pace with the increasing set of demands placed on the sector as social structures change and become more complex balancing the requirements that emerge from the Department of Health, Department of Education and Department for Business Innovation and Skills Demographic facts affecting the sector s client base include an ageing UK population a rise in the number of households at a rate higher than the population (ie more, smaller households and fragmented families) the number of children affected by divorces and the break up of relationships the increasing number of children who are born with disabilities and illnesses surviving to adulthood the shortage of affordable housing increasing ethnic diversity increased sharing of domestic roles and an increase in the number of women in employment Regional and local level The policy context in which the sector operates has been set, largely, for the last 21 years by the NHS and Community Care Act as a feature of the local economy and society As in so many respects, Manchester presents a dual face in terms of healthcare. There are many examples of excellence in healthcare provision and research in the city, and many of its NHS and other healthcare organisations attract national and international acclaim. At the same time, many parts of the city present significantly higher than average health challenges due to social deprivation, obesity, poor diet and lifestyle and the after effects, among the 18

19 older population, of working in an industrial environment. From an economic point of view it is important to realise that the NHS, under the direction of the Greater Manchester Strategic Health Authority, is one of the largest employers, landowners and purchasers of goods and services in the City Region. Similar factors are at work within the provision and use of adult social care and childcare many examples of excellence in provision over-average dependence on their services a very substantial footprint in terms of employment, purchasing and presence in the social environment Combined, all of these facts create the imperative for the college to engage with the health and care sector as a priority. Demographic factors impacting on the sector As in the UK as a whole, the ageing of the City Region population will have an impact on the health and care sector, including an ageing electorate, and the political consequences of older people s health and care concerns becoming more high profile a growth in the number of dependent and vulnerable older people creating a demand for new jobs in the caring professions, housing, learning, medicine and healthcare 19

20 Section 3 Characteristics National level 3.1 Subsectors, professions and skills In September 2009, the latest date for which figures were available at the time of writing, the workforce headcount of the NHS in England was 1,431,996 85% of whom were involved in providing frontline patient care 15% of whom did the rest: infrastructure, management, catering, property and estates, etc 20

21 Of the frontline staff almost 141,000 were doctors of one kind of another over 417,000 were qualified nurses of one kind or another The NHS in England had just under 45,000 managers. With such a huge workforce, and one in which employees are particularly dependent on each other for the delivery of their services, there is a need for a very clear and robust framework of skills, skill levels and career paths. To embed this, in April 2008 Skills for Health published its Public Health Skills and Career Framework (available on their website) and updated it in March This document is required reading for anyone who engages with the health sector on any issue related to skills and jobs, whether that be with the NHS, local authorities, the private sector or the voluntary sector. At the core of the framework are nine levels of competence and knowledge. Level The employee Typical jobs at this level 1 has little previous knowledge, Volunteer workers skills or experience in public health. May undertake specific public health activities under direction or may acknowledge the value of public health in a wider context 2 has gained basic public health Dental health worker (schools), knowledge through training and/or or admin assistant development. May undertake a range (eg in drug and alcohol team, of defined public health activities community safety unit, public health under guidance or may use knowledge development unit), peer educator, to influence public health in a lay health worker, childcare worker, wider context classroom assistant, crèche worker, refuge worker, refuse worker, health care assistant, community pharmacy support staff 3 may carry out a range of public Stop smoking adviser, health promotion health activities or small areas of resources officer, community food worker, work under supervision. May assist fluoride technician (schools), child smile in training others and could have worker (oral health), health promotion responsibility for resources used assistant, clerical officer in health protection by others. May use public health unit, health trainer, clinical dental educator, knowledge to set priorities and pest control officer, dog warden, porter make decisions in a wider context acting as smoking cessation worker, catering services manager, senior community pharmacy support staff 21

22 Level The employee Typical jobs at this level 4 has responsibility for specific Health visitor assistant, community nursery areas of public health work with nurse, intelligence officer in regional guidance, which may have a breadth government office, primary drugs education and/or depth of application development worker (Healthy Schools), advanced community food worker (nutrition and dietetic service), health protection administrator, health visitor assistant, social care assistant, community-based dental health educator, safety officer (eg in the home or community), housing officer, countryside officer, community relations officer, teacher, planning officer 5 has autonomy in specified areas, Nutrition adviser (health promotion), continually develops own area of work community nutrition worker, public health and supports others to understand it. information analyst in PCT, health protection May contribute to a programme of information officer, community pharmacist, work in multiagency or multidisciplinary environmental technical officer, smoking environment cessation coordinator, oral health promoter, clinical dental health educator, allied health professional, registered nurse 6 has autonomy and responsibility Specialist in community public health in coordinating complex work, nursing (eg school nurse, health visitor, reflecting wider and deeper occupational smoking adviser, senior expertise in own area of work. information analyst in PCT support service, Able to develop, facilitate and regional information officer in HPA, school contribute to programmes of food adviser, pharmacy public health work in multiagency or facilitator, health trainer programme multidisciplinary environment co-coordinator, senior health improvement officer, environmental health officer, drug and alcohol coordinator, health promotion officer, sexual health adviser, oral health promoter 22

23 Level The employee Typical jobs at this level 7 has autonomy and expertise in Health emergency planning adviser in HPA, areas of public health. Will lead on promotion officer, public health dietician/ areas of work within a defined field. nutrition specialist, specialist smoking adviser, health visitor, school nurse team leader, health trainer programme manager, pharmacy public health specialist, environmental health officer, health protection nurse, health improvement manager or programme lead, community development manager, drug and alcohol coordinator, health promotion officer, sexual health adviser, service and corporate planner 8 has a high level of expertise in a Deputy director of public health in PCT, head specific area of work or across a of information in public health observatory, substantial breadth of service delivery director of environmental health, regional and/or programmes. Is accountable health emergency planning adviser, senior for work across boundaries and research fellow, head of public health in agencies. Has leadership responsibility local authority or Community Health and autonomy to act. Sets strategic Partnership (CHP), lead pharmacy public health direction in own area of work. specialist, principal environmental health officer, health protection nurse specialist, nurse consultant, area health promotion manager, head of health improvement and planning, investors for health manager, health promotion commissioner, community development manager, service and corporate planner, cross-sector or multiagency partnership lead 9 sets strategic direction across Director of public health in Primary Care Trust organisations and/or areas of work. (PCT), Strategic Health Authority (SHA) Provides multidisciplinary or or health board, director of public health multisectoral public health observatory, head of adult social care and leadership that determines health, consultant in health protection, priorities. regional or national lead in health improvement, regional epidemiologist, director of community planning Table 1 In adult social care, 72% of employees deliver front-line care, the rest being managers, support staff and so on. In childcare, front-line employees are a slightly larger proportion of the workforce. Two-thirds are involved in fieldwork, 21% in residential establishments and the rest in day care. Qualifications and skills for each job role are well known and documented. 23

24 In children s/young people s care, the skills needed are very varied, depending on job role. However, there are some generic skills required by the whole workforce, including literacy and numeracy communication and interpersonal skills IT skills In addition, the workforce needs the skills that will allow it to ensure the safety of children and young people raise aspirations and encourage children and young people to fulfil their potential help individuals to work in multidisciplinary teams prepare staff for work with children, young people and families Those skills include communication, building rapport and empathy observation and judgement and are underpinned by essential knowledge of the development of babies, children and young people. Managers need skills in leadership and management commissioning and negotiation (for the increasing number of services that are contracted out) These skills are embedded in the Common Core of Skills and Knowledge for the Children s Workforce, which was originally developed by CWDC in consultation with government and stakeholders in 2005 and was substantially revised and republished in It is available as a PDF download from the CWDC website. Similar skill needs can be found in the adult care subsector, where there is a current emphasis on leadership, management, communication and coordination skills. Job opportunities In the health sector, job opportunities exist at all levels, and are dependent on health spending in national terms and local priorities and conditions. However, job vacancy rates in the NHS as a whole have been falling in recent years and are below 1% on average (ie less than 1% of all posts are vacant at any time). This does not indicate a lack of job opportunities, but (as NHS management are keen to point out) increased efficiency in filling posts as people retire or move on. 24

25 In public sector adult social care, vacancy rates stand at 3.1%, twice the national average. The hard-to-fill vacancy rate is also higher: 0.7% for adult social care as against 0.4% across all sectors. Research by the CWDC showed that in 2009 a third of all adult social care workers had been in their current job for less than three years a third for between three and seven years most of the rest for more than seven years Workers in senior positions tend to stay in their current job for longer. The private sector displays similar tendencies, but with the difference here that rates vary very widely between organisations in some private sector organisations, vacancy rates and labour turnover are quite low. Overall, labour turnover is gradually decreasing, but is still far too high. However, even in the public sector these figures can sometimes mask the reality which is that there are significant variations between regions: turnover in the North West is lower than the average, and appreciably lower than in London. The occupations where turnover tends to be highest are occupational therapists children s social workers care workers in children s homes domiciliary care workers day nursery workers after school and holiday clubs In the children s/young people s care sector, qualifications are the principal barriers to moving between jobs and moving into the workforce from elsewhere. This part of the sector finds it difficult to recruit and retain staff due mainly to low levels of pay compared with other sectors (and when one takes into account the relatively high levels of skill required). Current performance of the sector in relation to job opportunities The level at which the sector is performing, in the judgement of its senior managers, its employees at all levels, government and the public, is exceptionally difficult to analyse objectively, since healthcare, particularly the NHS, is such a political subject and a hugely important and emotive issue to the public. Statistics, reports and anecdotal evidence could be quoted to support any 25

26 given conclusion as to how well the NHS as a whole, or any part of it, is currently performing. However, it is generally accepted that improvements in the return on investment are what the sector needs more than any other result in other words, a greater ability to obtain increased levels of performance in patient care (however that is measured) for every extra 1 spent on the sector, whether that money is spent on hospital buildings, equipment, technology, drugs, employee pay or whatever. Skill levels are just one factor in making that possible: a whole set of other factors, not related directly to people s skills, must also be addressed. Nevertheless, a better skilled and better qualified workforce is one pre requisite for the achievement of that principal objective of measurable and publicly accepted improvements in the standard of care. The care and development subsector exists in a vicious circle in which poor pay (pay levels are among the lowest of the professional occupations) and low social esteem combine to create difficulties for recruitment and retention and deter investment in training. The result is that the sector struggles to deliver the standard of care it sets for itself, that the public demands and that its customers deserve. The SSC is trying to implement strategies to redress this underperformance, but not all factors (for example, pay) are within its control. There currently exist ample job opportunities, but a less clear set of career options backed up by effective training and development. The current challenges facing the sector that have an impact on training and development Within the health subsector, current challenges that will have an impact on skills, training and development are identified by Skills for Health as the need to increase productivity and to reform and modernise organisational methods, medical careers and other health professional careers addressing the implications of the European Working Time Directive and the impact of an ageing workforce the requirement for new and extended roles an ageing population, with implications both for the workforce and future service demands an increased focus on public health greater responsiveness to the population s needs and expectations more use of patient pathways requiring multiprofessional and multidisciplinary working 26

27 more diversity in, and a changing balance between, community and hospital based services the introduction of new technologies the growth of chronic diseases and long term illness increasing emergency hospital admissions changing financial regimes Within the care and development subsector, by far the main challenge, and the root of all its other challenges, is the need to improve recruitment and retention. Low pay for comparatively highly skilled jobs leads to poor recruitment and even poorer retention. High staff turnover, in turn, leads to a reluctance on the part of employers to invest in training and development. A vicious circle results, the features of which are a lack of clear career structure an inability to attract graduates an almost exclusive concentration of training efforts and investment on mandatory training rather than developmental training a fear of losing anyone who is developmentally trained low basic skill levels The other challenges include perceived bureaucratic recruitment processes lack of public esteem unsocial hours poor management practices One other feature is the effect that regulation has on costs. For example, employers need to pay for another practitioner to stand in for a trainee in order to meet regulatory requirements. Regional and local level 3.2 Job opportunities in the City Region In May 2010, the latest month for which we have figures, 1,305 North West residents claiming Job Seekers Allowance (JSA) were actively looking for a job in the health sector. In the same period, 1,593 health vacancies were being advertised at Jobcentres throughout the region. However, Manchester was not one of the areas within the North West where vacancies significantly exceeded the number of job seekers. 27

28 Across the region, occupations where the number of vacancies advertised exceeded those being sought by registered job seekers were medical practitioners nurses pharmaceutical dispensers Jobs in non-clinical NHS roles (especially hotel and estates services) are an important source of work for many people in local communities, Manchester wards included, where long-term worklessness is endemic. The college has been, and will continue to be, centrally involved in projects to provide people with employability skills and get them into NHS jobs. Adult social care and childcare also offer many opportunities in the region and city, though surveys have shown that, in Manchester, matching supply and demand in the various job roles can be very difficult. There tends to be at least an adequate supply of nursery nurses, playgroup leaders/assistants and childminders, while there is often a shortage of medical secretaries and social workers at Levels 2 and 3. 28

29 Section 4 Relationship with training and development National level Skills shortages and gaps 4.1 According to the SSA, which is a few years old now, the following skills profile existed 20% of the workforce were studying towards a qualification of some sort those with a Level 2 or 3 qualification already were the most likely to be studying towards another 50% of those studying (ie 10% of the workforce) were studying for an HE level qualification staff in the NHS were, on average, more highly qualified than those in the independent sector in England, more than 1 million health learners were registered in HE, FE and work based learning (WBL), with more FE and WBL provision than HE, and a good match between provision and regional location and growth in the workforce publicly funded provision in health was generally good, but with some variations at different levels of provision FE s links with employers were generally good and helped make training and development relevant to the sector s needs That was in 2008, but as recently as 2011 Skills for Health made a clear statement of the health sector s current and emerging skill requirements (for full details read UK Sector Skills Assessment 2011). Current priority skills needs for the health workforce are in team work, problem solving and communication to help prevent errors in patient care management and leadership skills 29

30 Additionally they recognise the need for greater opportunities for those in largely routine roles (pay band 1-4 levels) to undertake training and development and the need for a reduction in the sector s dependence on non-eu migrant workers. Future skills needs ( ) are going to be in the following priority areas workforce planning the skills needed by small- and medium-sized care providers technology (not just information technology) multiskilling health skills for non-health specialists to assist family carers and facilitate self-care As far as segments of the workforce are concerned, the ones that were identified in 2011 as priorities for skills improvement were those at Level 3 and 4 (Assistant Practitioners) Level 7 (Advance Practitioners) Looking beyond 2020, there will be a need to provide people with the skills associated with the applications of genetics new diagnostic methods robotics In children s/young people s care, the skills required (and in which gaps have been identified) are effective communication and engagement with children, young people and families understanding of child and young person development safeguarding wellbeing of children and young people supporting transitions in the lives of children and young people working in multiagency settings sharing information effectively across different agencies delivering integrated services basic skills in literacy and numeracy commissioning skills leadership and management IT disability awareness 30

31 In adult social care provision, the skill gaps are in literacy, language and numeracy general employability skills communication and interpersonal skills IT skills moving and handling risk assessment food hygiene skills for working with people with long-term needs and in palliative care skills that enable social workers to deliver more preventative strategies leadership and management quality management and improvement commissioning and procurement The sector s performance record in providing training and development for its workforce Compared with many sectors, the health sector s record is not at all bad. Where the sector is, justifiably, concerned is with its ability to respond to future needs, caused by a changing population changing approaches to the provision of healthcare a changing pool of potential employees The care and development subsector s record in providing training and development for its workforce is essentially in two parts a good record in providing mandatory training, required by law for the health and safety of the sector s clients a poor record in providing coherent career progression or developmental training to underpin such a system 31

32 The sector s record in sharing skills problems and solutions Whereas many commercial sectors of employment fail to come together due to commercial competition and fragmentation, the health sector suffers in many ways from its sheer size and the resulting inevitability of bureaucracy; individual major NHS Trusts themselves are large bureaucracies. Essentially the same solutions to problems can be found repeatedly (and expensively) in many locations. Furthermore, the time and expense of research into job roles, skill gaps, training needs and so on, on such a scale, can sap energies and fail to keep up with the pace of change itself. The care and development subsector is less dogged by bureaucratic inertia, but has not, until the creation of the Skills for Care and Development partnership, attempted the radical strategic approach that alone will tackle the vicious circle referred to in this profile. Factors militating against accessing training programmes There is no lack of training and qualification culture within health, but work patterns often militate against accessing continuing development by conventional means. Great progress has been made in recent years by the FE sector (The Manchester College in particular) to open up health and care job possibilities to the long term unemployed and benefit claimants, though more work is still required in this area. This has been and will remain a college priority. The care and development subsector suffers from various factors that work against it accessing the training programmes it needs. The cost of replacing anyone away from work is one of the most all pervasive, and flexibility of provision will have to be a priority for educational providers if this is ever to be tackled. Regional disparities in provision, and in quality of provision, also exist. There is also a reluctance in some agencies to develop staff, other than in order to meet legal requirements, and so equip them with the means of leaving the service and earning more money elsewhere. Current training provision Current training provision is not seen as the key issue by Skills for Health, rather it is this huge sector s ability to move with the times and create a system that allows qualifications, training, pay and recruitment to keep up with the ever quickening pace of change in the sector s working methods and patient needs. 32

33 In care and development, the complaints often voiced by employers are that Regional and local level 4.2 qualifications are too numerous and confusing funding is unclear there are regional gaps in provision short courses that address specific needs are not linked to qualifications Participation of the local health and care workforce in training and development In Greater Manchester, participation in training and development at Levels 2, 3 and 4 within the sector is considerably better than the all sector average. The success rates are also (slightly) above the all sector average. Priority actions for the sector in Greater Manchester The following have been identified as priority actions for the sector in Greater Manchester to collaborate closely with the NHS, both to help it recruit new staff and to address the skills issues of its existing workforce, and with the HE sector to ensure that its provision is geared to current needs to expand apprenticeships to implement the new Health Care Awards effectively to ensure a sufficient flow of social care candidates with NVQ Level 2 and 3 skills from apprenticeships and full time education (approximately 50% of jobs in the sector require qualifications at NVQ Level 2 and 3) to ensure a sufficient supply of places on short courses for mandatory qualifications for childcare workers (for example health and safety risk assessment, first aid) to reduce the attrition rates of staff in the industry; creating clear career development routes and training opportunities will go some way to achieving this 33