Category Archives: Workforce

In Search of Hidden Healthcare Workforces: NHS Therapists for Children and Young People with Special Educational Needs and Disabilities (Part 2)

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Prof Ian Kessler of the NIHR Policy Research Unit in Health and Social Care Workforce is Professor of Public Policy and Management at King’s Business School. He introduces a new report from the Unit, scoping the demand and supply of NHS therapists for Children and Young People with Special Educational Needs and Disabilities.

This, the second of two blogs, focuses on the supply of, while the first addressed the demand for, therapists for children and young people with Special Educational Needs and Disabilities.

The Supply Side

Commissioning. While the capacity to address this increased demand rests in large part on the scale, structure, and capabilities of the therapy and, as already implied, the wider health and care workforce, the commissioning process for CPY with SEND, is pivotal. Commissioning determines the services available and at what level of resource, inevitably feeding through to determine the workforce required to provide them: to put it crudely, if a service is not commissioned, a workforce is not required. The close connection between service design and the workforce is apparent from various ‘good practice’ commissioning models [1]. These typically distinguish different levels of services linked to the nature of need and support, with implications for the requisite workforce: for example, accessible universal services delivered by a wider workforce; targeted services provided by registered therapists and their support co-workers; and specialist services the exclusive preserve of the registered therapist. Continue reading →

In Search of Hidden Healthcare Workforces: NHS Therapists for Children and Young People with Special Educational Needs and Disabilities (Part 1)

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Prof Ian Kessler of the NIHR Policy Research Unit in Health and Social Care Workforce is Professor of Public Policy and Management at King’s Business School. He introduces a new report from the Unit, scoping the demand and supply of NHS therapists for Children and Young People with Special Educational Needs and Disabilities.

This, the first of two blogs, focuses on the demand for, while the second discusses the supply of, therapists for Children and Young People with Special Educational Needs and Disabilities.

Context

The workforce delivering care and support for children and young people (CYP) with special educational needs and disabilities (SEND) is an elusive one. In part this elusiveness stems from the diffuse and fragmented nature of the workforce as CYP with SEND typically engage with a variety of services- education, health, social care and sometimes housing. Even drilling down into these discrete service segments, tying the SEND workforce down in terms of its size, skill mix, and capacity remains challenging. Take health as an example. CYP with SEND will have a range of developmental, physical, and mental health care needs, addressed by a variety of staff groups to be found in different clinical settings including: nursing in both community, acute and mental health settings, clinical consultants in a similar range of settings, GPs in primary care, and healthcare visitors in the community. Adding to the challenges is the fact that those in any one of these staff groups will have clients which include but are rarely limited to CYP with SEND. With policies often framed by and centred on ‘children and young people with SEND’ as the named client group [1], the hidden nature of the workforce caring for and supporting them becomes a real challenge in meaningfully delivering on the policy initiative. Continue reading →

In Pursuit of Ethically Sustainable Approaches to International Nurse Recruitment

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Prof Ian Kessler of the NIHR Policy Research Unit in Health and Social Care Workforce is Professor of Public Policy and Management at King’s Business School. He introduces a new evaluation from the Unit: International Nurse Recruitment and the Use of Memoranda of Understanding: The Kenya and Nepal Pilots. (1,447 words)

With rising health and care needs as national care systems seek to cope with aging populations, the growing incidence of chronic conditions, and the shock of the Covid pandemic, there has been increasing pressure on the global supply of healthcare workers. Traditionally drawing upon overseas staff, this raises new and important questions for the NHS about how such employees are accessed and managed. The recent NHS England’s Long Term Workplace Plan, 2023, for example, cautions against an over reliance on any specific source of labour. More profoundly, the pressure on the supply of overseas healthcare workers prompts renewed concerns about the ethics of international recruitment as a practice.

Earth seen from space

There has been longstanding debate on the ethics of overseas recruitment by the NHS and other high income countries. This is reflected in international attempts to regulate the practice through, for example, the World Health Organisation Global Code, 2010, designed to ‘establish the ethical international recruitment of health personnel, accounting for the rights, obligations and expectations of source countries, destination countries and migrant health personnel.’ Debate on the ethics of the process has deepened with the new labour supply side pressures, and in response, government-to-government, or bilateral, agreements, whether in the form of Memorandum of Understanding (MoU) or tighter, more formal treaties, have emerged as a potential vehicle for addressing ethical concerns. Continue reading →

Occupational Health and Wellbeing (OHWB) and the Health and Social Care Workforce

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Antonina SemkinaDr Antonina Semkina is Research Associate at the NIHR Policy Research Unit in Health and Social Care Workforce, King’s College London. (613 words)

Unit researchers Antonina Semkina and Caroline Norrie attended the annual Health and Wellbeing at Work Conference that took place in Birmingham National Exhibition Centre on 12-13 March, 2024. The conference featured 13 themes, including Future of Work; Equality, Diversity, and Inclusion; Health and Conditions; and Culture, Values and Engagement, among others. There were 100+ exhibitors representing Occupational Health providers, NHS and social care organisations, consultancies, training agencies, and charities.

Caroline and Antonina recently published the final report from their NIHR-funded study “Exploring the awareness and attractiveness of Occupational Health (OH) careers: perspectives of trainee doctors, nurses, OH trainees, OH career leavers” so they particularly enjoyed the opportunity to connect with and hear presentations from policy makers, researchers, practitioners, and providers in the field of OH. Continue reading →

The NIHR Policy Research Unit in Health and Social Care Workforce Programme of Work: The Next Five Years

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Prof Ian Kessler of the NIHR Policy Research Unit in Health and Social Care Workforce introduces the Unit’s programme of work commencing this year under the 2024-28 award from the NIHR Policy Research Programme.

In the context of ongoing challenges to the recruitment, retention, and motivation of around three million staff employed in health and social care, the NIHR Policy Research Unit in Health and Social Care Workforce in the Policy Institute at King’s College London (KCL) has announced its programme of work as it sets out on its next five years (2024-28).

Developed in consultation with the Department of Health and Social Care, this programme is sensitive to the importance of workforce organisation and management to the delivery of high quality services as the health and care needs of the population change, and as technological and medical advances provide new opportunities to address such needs. The Programme has been framed by key policy initiatives, for example, the NHS England Long Term Workforce Plan (2023) and the DHSC White Paper People at the Heart of Care: Adult Social Care Reform (2021). It comprises the following seven related but discrete projects, with their Principal Investigators (PI):

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What are the experiences, motivations and plans of Health and Care Visa holders and their dependants?

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Kalpa KharichaDr Kalpa Kharicha is Senior Research Fellow at the NIHR Policy Research Unit in Health and Social Care Workforce in the Policy Institute at King’s College London. She leads the Unit’s work on the Health and Care Visa, the report from Phase of 1 of which was published in October 2023. (679 words)

Internationally recruited care workers made the biggest contribution to reducing vacancies in frontline adult social care in England during 2022-3; 70,000 people came to the UK to work in a direct social care role. During this time the number of domestic recruits to care work fell. Vacancies in social care are currently at 152,000.

The increase in international care workers follows changes to government immigration policy in recent years. In particular, the addition of ‘Senior care workers’ and ‘Care workers’ to the shortage occupation list (on 27 January 2021 and 15 February 2022, respectively) allows people from other countries to apply for these jobs, with a licensed UK employer and if eligible for a Health and Care Visa.

Recent announcements on immigration policy mean that from early 2024 (exact date to be confirmed at time of writing), Health and Care Visa holders arriving in the UK after that time will no longer be able to bring their dependants with them Health and Care Visa holders who are already in the UK can bring dependants whilst on their current visa.

As part of our recent research to understand the impact of the Health and Care visa system on the adult social care workforce in England, we spoke to 29 internationally recruited care workers and dependants, as well as 22 social care providers, 8 brokerage agencies and 15 sector skills experts, who shared their views and experiences with us. Continue reading →

COVID-19’s Third Anniversary: Their Story of Wellbeing and Coping from the Health and Social Care Workforce

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The Health and Social Care Workforce Wellbeing and Coping Study has published its Phase 6 Report and Executive Summary. Researchers found the workforce faces continuing substantial pressure, staff shortages and is finding it difficult to cope. In this post, we summarise our findings.

Prof Jill Manthorpe, Director of the NIHR Policy Research Unit in Health and Social Care Workforce at King’s, is a co-investigator on this collaborative research project, involving also researchers from Queen’s University Belfast and Bath Spa University. The study is led from Ulster University (Dr Paula McFadden is Principal Investigator).(1604 words)

Report coverThe 6th Phase of this UK-wide multi-disciplinary study explored the impact of providing health and social care in the post-pandemic era from November 2022 until January 2023. The analysis builds upon the findings from five earlier Phases, beginning during May 2020 following the first wave of the COVID-19 pandemic in the UK. We received 14,400 survey responses from social workers, social care workers, nurses, midwives, and allied health professionals. We conducted 18 focus groups with frontline workers, managers, and Human Resource professionals.

The study provides a unique opportunity to gain in-depth understanding of how the pre- and post-pandemic times have impacted on health and social care workers’ working life, as well as effects on their own health and well-being. Our Phase 6 report presents survey findings collected over the six-months from the end of 2022 and up to early 2023. They reflect a difficult time of unprecedented industrial action in the NHS and continuing pressures on health and social care services. During this Phase, life was returning to pre-pandemic norms for most people in society, there were few remaining public restrictions, the use of face masks had generally ceased, although still being recommended in health and social care encounters and settings. Health and social care services were therefore adapting themselves to a post-pandemic time at the same time as still caring directly for people with illnesses related to Covid-19, and delays in seeking healthcare. Other impacts of the pandemic have placed increasing pressures on health and care services, such as sickness absences, staff vacancies, and retention problems, with mental health problems and new conditions such as ‘Long-Covid’, now affecting workforce stability.

Multiple workplace factors are described as a ‘vicious cycle’. For example, increased job-related pressures, exacerbated by staffing shortages and vacancies (increased use of agency or locum staff) add to job stress and this affects staff’s mental health and well-being. Some respondents indicate lasting or new depression and anxiety, or long-standing distress or trauma because of working through the pandemic. While the survey found many staff had made use of employer’s support services, not everyone sees them as accessible or helpful. Investment is still needed here; the report’s authors recommend. Continue reading →

‘Opening the door’ to employment in healthcare: People with lived experience of homelessness

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Cover of a reportThe NIHR Policy Research Unit in Health and Social Care Workforce has published an evaluation of an access to employment programme in the NHS targeted at those with lived experience of homelessness. The pilot programme involved the homelessness charities Pathway and Groundswell and five NHS Trusts in England. Report author, Ian Kessler, here outlines the programme and the main findings of his evaluation.

Ian Kessler is Deputy Director of the NIHR Policy Research Unit in Health and Social Care Workforce. He is also Professor of Public Policy and Management at King’s Business School. (1,016 words)

Widening participation in the healthcare workforce has long been an important policy objective in the NHS. This has been reflected in an equalities, diversity, and inclusion agenda traditionally centring on gender and race, and more recently on young people with disabilities with the introduction of supported employment programmes by NHS Trusts, such as Project Search and Choice. However, the pursuit of widening participation is a rich policy space, connecting to an increasing range of workforce and broader service priorities.

Framed as ‘anchor institutions’, playing a key role as local employers, NHS Trusts have been encouraged to develop workforces which reflect, in socio-economic and demographic terms, the communities they serve. This role overlaps with moves to bring into the NHS workforce people with lived experience of various health conditions as a means of delivering patient-centred services and more effectively addressing health inequalities. Such moves have been especially evident in the introduction of the peer support worker role in mental health (which our Unit evaluated many years ago). More prosaically, but perhaps most pressing, the search for workforce diversity and inclusion addresses the recruitment and retention challenges faced by healthcare employers, with those at the margins of employment representing a new and reliable source of labour. Continue reading →

Promoting the Health of Women Working in Home Care: towards an inclusive Women’s Health Strategy

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Caroline Emmer De Albuquerque Green, NIHR ARC South London Post-Doctoral Fellow at the NIHR Policy Research Unit in Health and Social Care Workforce, introduces a new report on the promotion of the health of women working in home care, which she co-authored with Unit Director Prof Jill Manthorpe.

Women make up the majority of the home care workforce. They provide essential support to people in the community with social care needs. But, the specific health needs of women working in home care have largely gone unrecognised and unmet. The health of home care workers is not just of interest at times of pandemic; it matters in addressing staff turnover, continuity of care for their clients, sickness absences but also the long-term impact on women’s later lives.

In our report, Submission of evidence on the specific health needs of women in the adult social care workforce in London with a focus on home care workers, we summarised what is known about the specific health needs of women working in home care. The report is co-produced with the assistance of the Proud to Care Board of the Association of Directors of Adult Social Services (ADASS) London which includes home care providers, London Boroughs and other stakeholders.

We submitted it as evidence to the Department of Health and Social Care’s consultation on a new Women’s Health strategy. From what is known, we concluded the following points to consider in such a new strategy: Continue reading →

Workforce planning in the NHS – it is a kludge

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Richard Griffin MBE is Professor of Healthcare Management, King’s Business School. (740 words)

Many years ago, I worked for an NHS Workforce Development Confederation (WDC), that had just been merged with a Strategic Health Authority (SHA). A few months into my role as Director of Education, a colleague asked me a question that has stuck with me ever since. “Who” she said, “owns workforce in the NHS?” A very good question. (1)

Consider the current situation. Is it the Department of Health and Social Care, or Health Education England, or NHS England and Improvement?  Where do Public Health England, Skills for Health or NHS Employers or the Social Partnership Forum fit in? They all have roles. What about regional People Boards? How about Integrated Care System (ICS) People Boards? Or the workforce leads in Primary Care Networks? In Trusts is it HR, or clinical leads like Directors of Nursing or the Learning and Development? It gets even more complex when you consider individual occupations like maternity, where you have Local Maternity Systems, or Allied Health Professions, where you have Councils and Faculties.

From pre-employment to careers information, apprenticeships and beyond, all these bodies are doing good things but not always together. Also, there is no single NHS workforce plan – it is spread across numerous policy documents from the People Plans to the latest Operating Guidance.

Frankly, it is all a bit of a “kludge”. Continue reading →