The National Health Service (NHS) is one of the largest employers in Europe. Since 2002, the make-up of its workforce in England has changed – and in ways that haven’t always mirrored the changes to the wider UK workforce.
High skilled group share up by 1.6%
Between 2002 and 2012, the high level skill group’s share of the total NHS workforce grew by 1.6 %, from 13.3 % to 14.9%. Meanwhile, the low level skill group’s share fell from 5.7% to 4.8%, a 0.9% decrease.
The middle two skills levels (upper and lower middle skills) representing jobs such as nursing staff, support staff for doctors and nurses and central function administrative occupations make up the largest share of the NHS workforce. These occupations have remained at broadly the same percentage share of the workforce between 2002 to 2012.
In real terms, the number of full-time equivalent NHS employees in the high skill group increased from 126,941 to 172,070 during this period, while the number of workers in the low skill group increased from 54,382 to 55,541.
NHS-wide, there were approximately 3.1 high skilled workers for every low skilled worker in 2012, compared to 2.3 high skilled workers for every low skilled worker in 2002.
Figure 1: Skill levels in NHS in England, 2002 and 2012
- may not sum due to rounding
What’s behind these changes?
Between 2003 and 2006, increases in the number of registrars and doctors in training have driven the growth in the high skill group. In real terms, the number of full-time equivalent registrars and doctors in training rose from 36,402 to 45,422. Between 2008 and 2009 there was also an increase in manager and senior manager numbers from 37,937 to 42,509.
In recent years, between 2009 and 2012, the increases in high skilled job numbers have slowed overall, within the total. Consultant numbers have continued to rise at about 1000 FTEs per year, while manager numbers have fallen around 6800 (16%) between 2009 and 2012.
Between 2002 and 2012, there has been minimal growth of low skilled jobs in the NHS in England. A large proportion of these low skilled jobs are made up of maintenance or support worker roles and it is possible that some of these jobs are now contracted out.
Figure 2: Changes in the share of skills groups, 2002 - 2012
Comparing the NHS workforce to the UK workforce
In 2012, the UK economy had almost equal shares of lower middle, upper middle and high skills levels at 32.2%, 26.4% and 30.8%, respectively, compared to 39.5%, 40.8% and 14.9% for the NHS.
The UK economy had around double the representation of low skilled workers in 2012 when compared to the NHS – 10.6% of the workforce compared to 4.8%.However, the NHS only had around half the higher skills representation in the workforce as the UK economy.
This means that skills in the NHS are skewed towards the higher-middle skill group – representing jobs where technical skill is required, but to less than degree level, and away from the lowest skill group, compared to the rest of the economy. In cumulative terms, 95.2% of the NHS workforce is at lower middle skill level and above compared with 89.4% of the UK economy, in 2012.
What explains these differences?
According to the UK Commission for Employment and Skills (2012) modern drivers on the health sector skills mix include an aging population, technological innovation, policy decisions, consumer demand and environmental change. These drivers have and are likely to continue to change the NHS skills mix, whilst not necessarily changing the skills mix of the UK economy in the same way.
The NHS also has a much higher proportion of upper-middle technical skill level occupations compared to the UK average, due to the requirement of many health professionals to have further education qualifications, but below degree level.
These factors all go some way to explaining why there are currently skills mix differences between the NHS and the whole economy, in respect to skills group shares. With both workforces being exposed to distinct pressures it is likely that these differences will continue to exist.
UK Commission for Employment and Skills. (2012). Health : Sector Skills Assessment 2012. Wath-upon-Dearne: UK Commission for Employment and Skills. Available at: http://www.ukces.org.uk/publications/ssa12-health
These statistics were analysed by the Public Service Productivity team in the Public Policy Analysis division. For further details, see our full report and infographic. Any comments or questions about any of the Public Service Productivity team's publications can be directed to firstname.lastname@example.org.