- National Health Service (NHS)
- Independent Health care Sector (such as private and charitable healthcare providers)
- Third Sector (health care) (such as small local community and voluntary groups, registered charities, foundations, trusts, social enterprises and co-operatives)
The health sector is made up of hospitals, doctors’ surgeries, dental practices, the ambulance service, nursing homes, residential care homes, complementary medicine and a huge range of other health related activities, from sight tests in opticians to research in medical laboratories. Most people in the health sector work in the publicly funded National Health Service (NHS), which includes:
- primary care (organisations which the public goes to first) – Doctors/General Practitioners (GPs), NHS Walk in Centres, NHS Direct, Out of Hours Emergency Care
- secondary care (organisations which the public are referred onto) – Ambulance Trusts, NHS Trusts/hospitals, NHS Foundation Trusts/hospitals, Mental Health Trusts, Care Trusts (provide joint health and social care activities)
NHS policy in England is directed from the centre by the Department of Health. Local organisations, known as Primary Care Trusts (PCTs), are in charge of providing and commissioning services, controlling the majority of the budget. PCTs are overseen by 10 regional organisations called Strategic Health Authorities (SHAs)
The independent sector includes companies and charities that offer hospital and specialist services usually after referral from a doctor. Operations and other work are carried out in private hospitals, independent treatment centres, mental health units and hospices.
Source: Sector Skills Assessment 2010 and Skills for Health AACA LMI 2010
The health sector is the largest employer in the UK, representing 5.5% of the working age population of the UK and 7.3% of the working age population that are currently in employment.
It is estimated that the sector employs almost 2.1 million people, including:
- over 1.5 million people in the NHS (72%)
- over 0.5 million people in the Independent Health care sector (26%)
- over 42,000 in the voluntary sector (2%)
There is no definitive source of data on the number of volunteers working in the health sector across the UK, but there are an estimated 300,000 people volunteering in the NHS in England. There are a wide range of roles undertaken by volunteers across the sector, such serving tea, driving, ‘meeters and greeters’, radio presenters and counsellors.
Source: Skills for Health AACA LMI 2010, Sector Skills Assessment 2010 and Working Futures 2007-2017
The sector’s workforce grew significantly between 1999 and 2008 together with an increase in public funding from around £47 billion to £102 billion and a period of sustained economic growth across the UK. This growth in employment has taken place in each country of the UK.
Scotland has seen the largest percentage growth with 40.1%, much higher than the UK average of 26.3%. The growth in the health sector also far exceeds the growth seen in the economy as a whole.
Much of this growth in respect of employee numbers has occurred within the NHS. However, there has been a significant growth in employment in the other sub-sectors of health such as the independent sector.
The independent sector has grown as a result of more investment from private medical insurance and consumers willing to spend a greater proportion of their income on healthcare and personal services. The independent sector, particularly in England, has also been funded to deliver care on behalf of the NHS through developments such as Independent Sector Treatment Centres.
The health sector workforce in the UK is forecast to grow from 2,346,000 in 2007 to 2,610,000 in 2017. This represents growth of 263,000 workers or 11.2% over the next 10 years. In England, the predicted growth is from 1,894,000 in 2007 to 2,118,000 in 2017. This represents a growth of 224,000 workers, or 11.8% over the same period.
There will be a need to replace 936,000 employees that will retire (38%) between 2007-2017. Forecasts report that there will a reduction in the overall number of people working within administrative and secretarial occupations, but there will still need to be recruitment activity to replace those leaving the sector and retiring.
Source: Skills for Health AACS LMI report 2010, Sector Skills Assessment 2010 and Working Futures 2007-2017
There are just over 62,000 establishments in the health sector.
Organisations in the independent health sector are mainly found in other human health activities, which is characterised by small organisations. Their growth over the past ten years is consistent with increased plurality of health care provision and is likely to be reflective of the growth in the use of complementary therapists and small independent sector therapists.
The most significant growth in health care establishments has been amongst small and medium sized businesses (those with less than 100 employees), which have grown by almost 14,000 between 1999 and 2008. This is indicative of growth across the independent health sector and the emergence of small and medium sized enterprises delivering health related services outside of the NHS.
65% of health sector establishments have less than 10 employees. The sector has a low proportion of micro establishments (2-4 employees) at 45%. 17% of establishments employ 11-24 employees, 9% employ 25-49 employees and 5% employ 50-99 employees. Larger establishments (with 100 plus employees) account for 3.5% of the sector.
Source: Skills for Health AACS LMI report 2010 and Sector Skills Assessment 2010
The sector is constantly changing as it responds to advances in medical treatments and technology. The way healthcare is delivered, and therefore the roles required to deliver it, are evolving all the time. The career framework that can be used by both individuals working in the sector and organisations supports the need for flexible career routes and pathways that can respond to the changing sector.
Most jobs in the sector will require staff to participate in ongoing learning and development, so that knowledge and skills can respond to the ever changing face and demands of healthcare.
Employers throughout the sector, including the NHS and independent sectors, will be seeking ways to maximise productivity and create a more flexible workforce. Developing new roles and maximising skills utilisation across the workforce will be central to this. Employability skills, such as team working and communication, will be fundamental, as will the development of managers’ and employees’ skills in negotiating and facilitating change.
Source: Skills for Health AACS LMI report 2010 and Sector Skills Assessment 2010
The public sector deficit resulting from the world economic crisis in late 2007 means that the levels of increased funding witnessed earlier in the decade are unlikely to be part of the health sector’s landscape for the foreseeable future. The level of healthcare services that are ‘affordable’ from public funds will be a key area of debate.
The third sector will also face challenges as a result of the recession. For many charities and non-profit making providers, the demand for the services will increase as well-being in the population decreases. At the same time, the levels of donations and available grants will decrease.
Demographic changes in the population, innovations in healthcare provision, the rising incidence and prevalence of people with long-term conditions and the growing expectations of patients themselves are long-term factors affecting the sector. These factors are not only challenging the scale of healthcare provision, but the form in which services are delivered.
Market forces impacting on the independent sector largely influences the types of businesses that are set up, as well as their location. The demographic and economic profile of potential consumers in possible potential locations is an important consideration.
Key areas of policy that is likely to impact significantly on the sector’s workforce
across the UK and have implications for skills include:
- An increased emphasis on the quality of the patient’s experience and control and the greater personalisation of services.
- The delivery of care closer to home and the resultant shift of skills from the hospital sector to primary and community care.
- A continued emphasis on public health – in particular the reduction of health inequalities; this will impact on skills development of the wider workforce.
- Improved productivity and quality – already leading to improvements, such as reduced waiting times and a reduction in healthcare acquired infections.
- Better integrated working across sectors, particularly between health and social care, to help ensure service users experience seamless pathways of care.
Source: Sector Skills Assessment 2010