InSight: Addressing the workforce challenge in health and social care

Increasing demand/supply imbalances in global healthcare are compounded by a similar dynamic in the world’s health and social care workforce. It’s time for operators to think strategically to address staff shortages, say Eilert Hinrichs and Louisa Chaves at L.E.K. Consulting

An ageing population, one demanding more and better healthcare, brings additional pressure on an already-stretched health and social services sector. With more treatments becoming available and the number of potential patients increasing, there is almost no limit to how many staff might be required to support the health and care system.

‘Life expectancy is increasing, but healthy life expectancy isn’t. You’ve got people living longer but often in ill health,’ said Chaves, principal at L.E.K. ‘The provision of health and social care cannot function efficiently or improve without a complete change to the current healthcare staffing model.’

The World Health Organisation (WHO) estimates a projected shortfall of 10 million health workers by 2030, mostly in low- and lower-middle income countries. But it is not just in developing markets where problems with the healthcare workforce is clear. Difficulties in hiring, retention, and education exist across the whole global health and social care sector. It has implications for the overall economy.

‘The health of any economy suffers if its population’s health is suffering,’ said Chaves. ‘There is an economic cost.’

Workforce crisis

In the UK, the House of Commons health and social care committee said that the NHS and social care sectors are facing the greatest workforce crises in their history. While things are slowly improving, numbers remain high. NHS workforce vacancies stood at 112,000 in June, from a peak of 130,000 in December. The adult social care workforce vacancy rate has fallen to 9.9% (152,000) on any given day, from 10.6% (164,000) last year.

Research by the Nuffield Trust suggested that the NHS in England could be short of 12,000 hospital doctors and over 50,000 nurses and midwives, while the number of people on a waiting list for hospital treatment rose to a record of nearly 7.5 million in May 2023.

‘Yet demand on the health and social care sector continues to grow relentlessly with an extra 475,000 jobs needed in health and 490,000 jobs needed in social care by the early part of the next decade,’ it said.

Just as vacancy rates are increasing, workers are leaving the sector often for better pay rates and working conditions.

‘We’re having a real issue in the UK with staff availability, particularly in the low wage sector,’ said Hinrichs, a partner  based in L.E.K.’s London office. ‘If you think about the care sector, for example, it’s difficult to attract staff. They can earn more stacking shelves in supermarkets.’

There’s also a Brexit effect, where many workers left the UK to return to their home countries, and the impact of Covid, which resulted in people choosing to leave the workforce earlier than would have otherwise been the case.

‘Working in a care home setting during Covid came with a significant health risk,’ said Hinrichs. ‘And if you were thinking about retirement at the time, it probably became clear that you don’t want to be doing that kind of job for much longer.’

In addition, the health and social workforce is ageing in tandem with the general population. People are leaving the health and care workforce faster than new staff are joining.

Smaller pool

In the higher skilled sector ‒ doctors, nurses, radiologists ‒ there has been a lack of necessary planning at the macro level to match the growing demand for health services but that is, arguably, understandable.

‘We probably didn’t foresee quite how quickly healthcare outcomes would improve, resulting in people living longer, often with significant healthcare needs,’ said Chaves.

It takes a long time to study and train as a doctor, which ensures there is always going to be a lag between planning and delivery. The net result is operators being left to compete in a diminishing pool of talent at home and abroad.

‘I have not spoken to any provider in social or healthcare that is not telling me that staffing is currently the number one operational and strategic topic,’ said Hinrichs.

A serious strategy is needed for the healthcare sector to deal with demand for health and social care outpacing the growth in the workforce. L.E.K. has identified three areas of focus for healthcare operators to help tackle the problem in the short, medium and long term: retention; improving productivity via digital transformation; and working across the industry with governments to ensure adequate growth of the healthcare workforce in the future.

Reducing churn

‘A key operational issue for CEOs is hanging on to existing staff for as long as possible,’ said Hinrichs. ‘That’s a key short-term focus that all businesses should be pursuing.’

Action to reduce churn can be implemented immediately. Existing staff are often well trained and already know the business well. And it is not just a question of throwing money at the issue. People working in health and social care are already aware that the sector does not provide the highest paid jobs.

‘You’d be amazed at what employees value,’ said Hinrichs. ‘It’s not only about financial reward, but also about being recognised for doing a decent job and being rewarded for that. A sense of appreciation goes a long way with employees.’

Recognition

Investing in the existing workforce, for instance, is one way of motivating employees. Creating a career path and upskilling not only promotes job satisfaction but also releases highly skilled, professionally trained colleagues to maximise their time doing the things that really matter.

‘There’s a subset of people around the dentist, for instance, who could be trained to perform tasks that take dentists away from their main task,’ said Hinrichs. ‘It’s rewarding for dental therapists to do more skilled work and it’s liberating for the dentist to focus on medical problems.’

Developing better career opportunities is part of a package of options that can be employed in creating a more attractive workplace. Something that is key in retaining existing staff and attracting new workers.

‘Companies need to ask themselves: how do I make sure I value my workforce in a way that is appreciated by employees?’ said Hinrichs. ‘That may mean I pay more per hour than others, but non-monetary factors also matter in becoming the employer of choice.’

Medium-term tech

In the medium term, L.E.K. suggests operators think strategically about how technology can improve productivity.

‘Teleradiology is a fascinating business model,’ said Hinrichs. ‘The attractive aspect of teleradiology is that it doesn’t matter where the radiologist is located. Historically, the patient and the report writing took place in the same location. Now, we’re able to have a patient in Birmingham, for example, and a radiologist sitting in Sydney writing a report. We couldn’t do that 20 years ago.’

Technology enables optimisation of existing capacity, wherever that capacity may be based. More importantly, it can help to re-activate radiologists that have exited the system, for example for retirement.

‘Technology has to be part of the answer, but only where it makes sense,’ said Hinrichs. ‘We cannot continue to provide healthcare as we have done in the past. We need to evolve current processes and work practices  because we have an ageing population that needs more health and social care, and we have a declining workforce.’

Technology is not a panacea for operators, however, something that can be switched on immediately to solve staffing problems. Businesses need to consider where and how it can use technology to improve productivity, improve staff engagement, reduce admin activities and release staff do concentrate on what’s most valuable and what they enjoy most: human-to-human interaction.

Long run trade-offs

Eventually, however, addressing the health and social care staffing problem will need input from governments.

‘Workforce planning needs to be at the top of the policy agenda,’ said Chaves. ‘This will ensure that health and social care staffing is looked at strategically over the medium and long term.’

Creating a health and social care system that society finds acceptable is no quick fix. It will require society and the governments it elects to make difficult decisions and trade-offs in spending.