It has been documented (UKCES, 2012) that the UK economy has seen a shift from lower skill occupations to higher skill occupations over the last decade. An increase in the average quality of labour can be an important determinant of productivity within sectors of the economy.
ONS has published data on quality-adjusted labour inputs within the economy. This analysis shows how hours worked and the composition of the workforce changes over time. For the industry sectors most closely representing public service provision, i.e. public administration and defence, education and health & social work (sector OPQ), labour quality is estimated to have increased by around 4 percentage points between 2007 and 2012 (ONS 2013).
This analysis of labour inputs feeds into estimates of multi-factor productivity published by (ONS 2012a). Within this analysis, labour productivity can be broken down into a labour quality element, a capital deepening effect and the multi-factor productivity residual.
The analysis in this article investigates whether broad skills groupings in the NHS in England (including GPs and practice staff) have changed since 2002, and how any trends compare with skills changes in the rest of the UK economy over the period 2002 to 2012.
Skills were assessed by assigning occupational categories within the NHS or the whole economy to one of four skills levels based on their typical Standard Occupational Classification (SOC), as determined by the SOC 2000 (ONS, 2000). A similar process has been used in another ONS release which sought to analyse the effect of skill level on pay levels in the public and private sectors (ONS, 2012b). These levels were high, upper middle, lower middle or low skill.
In the SOC 2000 the four skill levels mentioned were evaluated with respect to the:
‘duration of training and/or work experience recognised in the field of employment concerned as being normally required to pursue the occupation competently.’
(Employment Department Group/Office of Population Censuses and Surveys, 1990 as cited in ONS, 2000)
Reference Table 1 provides a breakdown of the SOC 2000 job categories in the four skill levels and Annex A provides a qualitative description of each skill level.
Once categorisation of occupations within the NHS was complete, the number of workers in each skill level, in any given year, could be converted into a proportion (%) of the total NHS workforce. The process of aggregating groups of workers to skill levels determined on SOC 2000 code was carried out across the period 2002 to 2012.
Figure 1 and Table 1 show the proportions of each skill level in the NHS in the year 2012 compared to 2002
|United Kingdom||Number of fte equivalent staff in 2002||Number of fte equivalent staff in 2012|
|Skill level (1-4, 4 being the highest)||Skill level (1-4, 4 being the highest)||Change|
|Consultants (incl. Directors of public health)||24,756||:||:||:||38,197||:||:||:||13,440||54%|
|Registrars and other doctors in training||33,932||:||:||:||52,262||:||:||:||18,330||54%|
|Other medical and dental staff||8,183||:||:||:||10,091||:||:||:||1,908||23%|
|GMPs excluding retainers and registrars||26,833||:||:||:||31,578||:||:||:||47,46||18%|
|Qualified nursing, midwifery and HV staff||:||268,214||:||:||:||305,060||:||:||36,846||14%|
|Qualified allied health professionals||:||48,151||:||:||:||63,198||:||:||15,047||31%|
|Other qualifed st&t staff||:||50,245||:||:||:||69,670||:||:||19,425||39%|
|Qualified ambulance staff||:||14,978||:||:||:||17,755||:||:||2,777||19%|
|Support to doctors and nursing staff||:||:||205,022||:||:||:||225,585||:||20,562||10%|
|Support to ST&T staff||:||:||37,920||:||:||:||51,299||:||13,378||35%|
|Support to ambulance staff||:||:||8,515||:||:||:||12,282||:||3,767||44%|
|Hotel, property & estates||:||:||:||54,382||:||:||:||55,541||1,159||2%|
|Manager & senior manager||30,914||:||:||:||35,650||:||:||:||4736||15%|
|Other and unknown classifications||:||:||495||:||:||:||205||:||-290||-59%|
|Practice staff other than nurses||:||:||55,110||:||:||:||70,851||:||15742||29%|
|Total staff in each skill category||126,941||393,587||379,793||54,382||172,070||470,379||455,239||55,541||:||:|
|Proportion of total NHS staff||13.3%||41.2%||39.8%||5.7%||14.9%||40.8%||39.5%||4.8%||:||:|
percentages may not sum due to rounding
The key findings are that for the NHS in England:
The high skill level group (i.e. professional occupations and managerial positions) has increased the most – by 1.6 percentage points between 2002 and 2012.
Low skill group (i.e. jobs which just require general education) has reduced by a 0.9 percentage point share between 2002 and 2012.
The majority of the NHS is made up of staff from the middle skills groups (‘lower’ and ‘upper middle’ skill), representing 81.0% of the workforce in 2002 and 80.3% in 2012.
The ratio of the high and low skill categories can be calculated demonstrating;
o There were approximately 2.3 highest skill workers to every lowest skill worker in 2002.
o There were approximately 3.1 highest skilled workers to every lowest skilled worker in 2012.
The combined proportion of higher skill level groups (‘high’ and ‘upper middle’ skill, where upper middle skill represents jobs requiring non-compulsory education but not degree level) of the NHS increased from 54.5% in 2002 to 55.7% in 2012, an increase of 1.2 percentage points.
The combined proportion of lower skill level groups (‘low’ and ‘lower middle’ skill) fell from 45.5% in 2002 down to 44.3% in 2012, a decline, subject to rounding of 1.3 percentage points.
A similar skills estimation method was applied to the UK economy using the SOC 2000 codes to categorise jobs. Job numbers for the whole economy were collected from the Annual Survey of Hourly Earnings (ASHE). ASHE data on occupations was processed to assign each individual occupation group a skill level based on their SOC code.
The process was used to calculate the proportion of workers in the UK economy at each skill level and calculated over a comparable time period. Figure 2 shows the proportions of each skill level in the UK economy in the year 2012 compared to 2002.
The background notes section explains how the ASHE data from 2011 and 2012 have been adjusted to be comparable to SOC 2000 definitions which apply to the datasets from 2002 to 2010.
The key findings for the UK economy are:
The high skill group (i.e. professional occupations and managerial positions) increased its share of the workforce by 4.2 percentage points between 2002 and 2012, from 26.6% to 30.8% in 2012.
The low skilled group (i.e. jobs requiring a good education and some level of work experience) reduced in relative importance within the economy by 0.6 percentage points over the period.
The lower middle skill level (i.e. jobs requiring a good education and some level of work experience) also fell in their share of the UK economy by 3.3 percentage points between 2002 and 2012 from 35.5% in 2002 to 32.2% in 2012.
Conversely, the higher two skilled groups, taken together, have increased their share of the UK economy’s occupations, being driven by increases primarily in the highest skill level. Overall the higher two skill levels represented a combined share of 53.4% of the UK economy in 2002 while in 2012 the share had increased to 57.2%, representing a 3.8 percentage point increase.
The ratio of the high and low skill categories can be calculated demonstrating there were;
o 2.4 high skill workers to every low skill worker in 2002.
o 2.9 high skill workers to every low skilled worker in 2012.
Figures 1 and 2 show that 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 lower skills group have around double the representation in the UK economy at 10.6% in 2012 compared to the NHS in England where the low skill group represented less than 5% of the workforce in 2012. 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.
Figure 3 summarises the percentage point changes for each skill group for the NHS and whole economy between 2002 and 2012.
Figure 3 shows a smaller increase in the size of the high skill category in the NHS at 1.6 percentage points when compared to the UK economy which saw a 4.3 percentage point increase in high skilled workers.
Also evident in Figure 3 is a fall in the UK economy’s proportion of lower middle skilled workers. This is in contrast to the NHS which has seen little change in the proportionate size of its lower middle skill group (support and administrative staff).
Figure 4 shows the time series between 2002 and 2012 for four skill levels, as a percentage of the NHS workforce in England.
It can be seen that 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 across the time series from 2002 to 2012.
The largest difference can be seen in the high skill group representing occupations such as GPs and managers. Their share of the NHS workforce in England peaked in 2009 at 15.2%, and has since slightly declined to represent a share of 14.9% in 2012.
There has also been a small decrease in the share of elementary staff (lower skill group) within the NHS, falling from 5.7% in 2002 to 4.8% in 2012. This decrease mainly occurred before 2006, levelling out thereafter.
Figure 5 shows the time series between 2002 and 2012 for four skill levels, as a percentage of the UK economy workforce.
It can be seen in Figure 5 that the largest fall in share of the workforce is in the lower middle skill level. Over the whole time series the lower middle skill level’s share of the UK economy declined steadily from 35.5% in 2002 to 32.2% in 2012.
Although the proportion of NHS staff has fallen in both the low and lower middle skill levels, there is no skill level that has seen an actual fall in the number of full-time employees between 2002 and 2012.
As shown in Figure 6, the number of employees at the low skill level has remained broadly the same, whilst all other skill levels have seen increases in the number of employees that they represent.
Figure 7 shows the change in staff numbers for the highest skill level group in the NHS in England from 2003 to 2012. This demonstrates the drivers behind the growth in the highest skilled group in the NHS.
The key findings are that:
Between 2003 and 2006, increases in the number of registrars and doctors in training have driven the growth in the high skill group.
In 2008 and 2009 there was an increase in manager and senior manager numbers.
In the most recent years between 2010 and 2012 the increases in numbers have slowed overall, with the largest increases being in the number of consultants.
The analysis has shown there are some key differences between the skills composition of the NHS in England compared to the whole UK economy. The NHS 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. In contrast, the highest skill level only has around 5% of the workforce in the NHS in England, compared to around 10% in the wider economy.
There are also a much smaller proportion of basic skill level occupational groups within the NHS labour force, although there is likely to be some masking of contracted out cleaning and catering services for example, which are provided by private companies rather than directly by the NHS. These services are still essential to the running of the NHS, but do not appear as NHS employee occupations.
The time-series analysis has shown that the share of skills groups within both the NHS and whole economy has followed broadly similar trends for the lowest and highest skill groups. The high skill group has increased its percentage point share for both the NHS and whole economy and the lowest skill group has reduced its share of the workforce.
In the middle-skilled categories, the NHS in England differed from the whole economy registering a small percentage point decrease in the lower-middle skill group, compared to a larger decrease in the UK economy. However, the NHS and the UK economy saw similar small decreases in their shares of upper-middle skilled workers.
The change in classification to SOC 2010 has had an impact on the skills groupings of health professionals, with more occupations now requiring degree level qualifications. Future analysis of the skills groupings of the NHS workforce will need to take this into account.
The four skill levels describe the following attributes:
This refers to the ‘professional’ occupations and managerial positions in corporate enterprises or national/local government. These occupations would normally require a degree or equivalent period of relevant work experience.
These are occupations that normally require knowledge associated with post-compulsory education but not to degree level. Technical occupations fall into this category, along with a variety of trades occupations and proprietors of small businesses where sub-degree level training may not be necessary but significant experience in the occupation would still be required.
Lower middle skill describes jobs that require a good level of general education but in addition to a longer period of work related training or work experience. Examples of occupations classified at this level include machine operation, driving, caring occupations, retailing, and clerical and secretarial occupations.
The low skill level requires a general education, usually acquired whilst attending compulsory education. These jobs normally require health and safety training and work related training activities. Examples of occupations defined at this skill level within the SOC2000 include postal workers, hotel porters, cleaners and catering assistants.
Elias, P. and Birch, M. (2010). ‘SOC2010: revision of the Standard Occupational Classification’. Economic and Labour Market Review; July, Vol. 4 Issue 7, 48-55.
UKCES (2012) Working Futures 2010-2020.
Effects of SOC 2010 reclassification
The standard occupational classification system has recently been revised and now recognises a higher level of formal training in several occupations than the SOC2000. The Standard Occupational Classification index is published by the Classification and Harmonisation Unit (CHU) at the Office for National Statistics and is designed to align with the International Standard Classification of Occupations (ISC008). As part of a long-term programme the CHU collaborated with Warwick University to plan a revision to the SOC2000 (Elias & Birch, 2010).
As part of the resulting revision certain occupations within the healthcare sector were reclassified on the basis that a degree level of education was required for new entrants, even though existing staff may not have a degree.
Those occupations were:
Speech and Language Therapists
The effects of those reclassifications have meant that many jobs in the NHS have been reclassified to a higher skill level. The effects of such changes are currently difficult to measure as there is limited data available to separate workers who have formal degree level education from those who joined before those entry requirements were enforced, and do not have degree level education. This analysis may be possible in the future, when the data becomes available.
Proxying SOC 2000 classification for ASHE 2011 and 2012
Data for 2011 and 2012 for the UK economy have been adjusted as they are coded using SOC 2010 in the ASHE source files. Provisional data was available for ASHE 2011 which was coded by SOC 2000 and SOC 2010 separately allowing an fte ratio to be calculated for each skill level.
Further growth in professions in the NHS was adjusted for any change in 2011 and 2012 (as compared to 2011 provisional ASHE data) to keep a fair comparison with the NHS skills analysis (which was based on SOC2000).
The effect of these conversions was minor with the high skill level being adjusted from 30.6% to 30.8%, the upper middle skill level from 25.6% to 26.4%, the lower middle skill from 33.5% down to 32.2% and the low skill up from 10.2% to 10.6% in 2012 and by less in 2011.
For further details of the change between SOC 2000 and SOC 2010 refer to the ‘Relationship between: Standard Occupational Classification 2010 (SOC2010) and Standard Occupational Classification 2000 (SOC2000).’ (ONS, 2012c).
Creating FTE definitions for the whole economy
The data for the UK economy workforce has been converted into full-time equivalent figures so that it is comparable with the NHS workforce data. This was done by compressing the number of recorded part-time staff by a ratio of average part-time hours divided by average full-time hours, in that particular year. This is standard statistical procedure to convert part-time to full-time equivalents and provides robust estimates for the analysis in this paper which is based on proportions of the workforce.
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