Published: 22/07/2004, Volume II4, No. 5915 Page 4 5

The UK population will change dramatically in the first two decades of the 21st century, with the demographic time bomb finally exploding when the 'baby boom' generation hits retirement.

The proportion of adults aged from 50-64 will rise from around 27 per cent in 2000 to around 32 per cent in 2010.

By this time, labour force survey figures predict that the proportion of people in this age group will be greater than at any time since the mid-1970s.

Consultants Concours Group executive vice-president Bob Morison says: 'It is a big issue in continental Europe, where the birth rate is at an all-time low, and in the US. The US Bureau of Labour Statistics predicts a shortfall of 8 million workers by 2010.

And this will not affect all industries equally: healthcare will be one of the worst hit because of expanding demand.'

Life expectancy will continue to rise.

It is currently 81 years for women and 76 for men and projections in 2002 suggested that women who were then aged 65 could expect to live to the age of 84, while men could expect to live to the age of 81.

'The UK has more economically active people than ever before - around 28 million, ' says Skills for Health chief executive John Rogers. 'But this can't keep increasing.An increasing proportion of the workforce are women and at the same we are looking at an ageing population - there is a squeeze on all fronts.'

Implications for the workforce

The healthcare industry is likely to be hard hit by an ageing population. The proportion of people with a long-term illness or disability that restricts their daily life increases with age. Among women in the UK, the proportion of those aged 85 or over reporting such a disability in 2001 (74 per cent) was almost triple that for women aged 5064 (26 per cent).Meanwhile, 67 per cent of men aged 84 and over and 27 per cent of men aged 50-64 reported the same problem.

'The ageing population will use more resources in terms of increased demand for healthcare, and there will be a decline in the proportion of economically active people to support them, ' predicts Mr Rogers.

It is not a simple picture - not only will the ageing population drive workforce demand, expectations of healthcare will also be affected by medical and technological advances, social and political factors, and EU enlargement and globalisation.

'As we become wealthier, the demand for healthcare increases, ' says Mr Morison. 'It is what economists call the 'income elasticity' of demand for healthcare. Technology also increases demand for healthcare because we can treat more diseases that, until recently, we didn't even know existed.

Essentially, this means demand for healthcare staff, and better-educated staff, will increase.'

The good news for employment rates is that more older people are working.

Fifty-nine per cent of women aged 5064 were working in 1993, compared to 67 per cent in 2003. Employment rates among men of this age increased from 65 per cent to 72 per cent.

'If people are living longer, healthier lives, then the positive outcome is they can also work longer, ' says Mr Morison.

Implications for the NHS

The NHS employs around 1.3 million staff (218,000 more than in 1997). This workforce is increasing at a rate of 1 per cent a year.What is more, a combination of replacement demand and growth will mean replacing over 80 per cent of the existing workforce by 2010, according to Skills for Health.

But these trends mean the health sector needs to change its working practices as well as recruit huge numbers of staff if demand is to be met.

'We can't just keep doing the same thing, we need to work differently, ' says Mr Rogers. 'It is about how we use the whole of the workforce: we are a UKwide body and have to look at this in terms of competence frameworks - upgrading skills and upskilling the whole of the workforce, and meeting the demand on a more flexible basis.

'We also need to increase the recognition and transferability of skills so that it is easier for people to move between the NHS and the voluntary and independent sectors.'

A key issue for the NHS is its image, particularly among potential young recruits, Mr Rogers believes.

'Perception of the NHS is one of its weak areas, and we probably do not do enough work in schools, ' he says.

'Other industries are going into schools and working with the 14-plus age group.We are competing with the likes of Tesco, City firms and the banks, and we do need to attract a large percentage of school leavers.'

'We know there are areas of excellent practice but this needs to be replicated across the sector.

'One of the features of the nursing workforce in particular is that nurses migrate out of acute care into primary care as they get older, so the acute hospitals, which tend to recruit younger nurses, will be hardest hit.'

Recruitment agency

NHS Partners director John Northrop points out that retaining older staff is just as important as attracting younger people.

'Employers will have to get round the problem of continuing to work after pensionable age, ' he says. 'Surprisingly, most nurses have no fixed plans to retire, and many would delay retiring if offered suitable employment packages.'

Implications for NHS employers

These impending changes present a huge challenge to NHS employers.

Association of Healthcare Human Resource Management president Elaine Way says many are addressing this problem and have the support of the government and trade unions:

'NHS employers are already doing a lot to develop staff, ' she says. 'One example is employers working in partnership with unions to develop and implement strategies to address skills gaps.And many trusts have schemes to allow healthcare assistants and nursing auxiliaries to transfer into professional training to address recruitment difficulties.'

In the past, employers have been reactive to recruitment pressures but, increasingly, employers are becoming proactive in addressing them, Ms Way believes. 'The knowledge and skills framework, which is a core part of Agenda for Change, will give employers the opportunity to identify employees' potential and help staff to express their career aspirations. This will be a useful way of developing people and services.'

However, Mr Northrop says there is still an assumption among managers that salaries are the most important issue, and other approaches to the problem must be secondary. 'A lot of employers think they can't recruit because of low pay, but It is more complicated than that. In a lot of cases, the recruits simply are not there.'

Finding recruits may then be a matter of taking on people who do not have the right education or skills and training them from scratch, adds Mr Northrop.

'The poor standard of numeracy and literacy means employers will have to recruit more people at the bottom, give them basic skills and train them up - that is what the skills escalator is about.'

Mr Morison says ideas are needed to help workers at all levels of the NHS develop their careers and increase their commitment. 'Employers need to reengage people in mid-career, ' he stresses. 'There are implications for all age groups, and you have to design people's careers so they want to stay.

Working arrangements across the board need to be more flexible.'

Learning strategies are also essential to successful recruitment and retention, adds Mr Morison. 'Even entry-level jobs require computer literacy, reading, writing and maths - and some individuals are going to need basic or remedial education, while others will need training in advanced job skills. There must be a learning strategy to ensure the labour supply.'

Acting now makes sense, says Mr Morison. 'If employers provide this training, there will be more reason for employees to stay. Employers can do all of these things now and they will have a good effect in the short term. If you wait until the shortages are here, then they are going to have problems with recruitment and retention.'

Trusts such as University College London Hospitals are looking at ways of developing the existing workforce to address existing skills gaps, and see this as laying the foundations for tackling future shifts in demand.

'The NHS workforce is already the size of Birmingham, and It is growing by 6,000 each year, ' says trust workforce director David Amos. 'We can't go on with that indefinitely. We need to look at increasing the productivity of the people we have already got.'

NHS organisations need to make sure they are doing everything possible to become the employers of choice, stresses Mr Amos. Key strategies for employers include:

eliminating long-term vacancies by developing clear recruitment strategies and making them part of the day-today responsibilities of line managers;

identifying and supporting staff who have a leadership role, from chief executive down;

working with other NHS employers and relevant organisations to develop long-term strategies for recruitment and retention;

filling vacancies internally, and making development plans for staff, so that managers are clear about the skills gaps and future potential of employees.

'We have identified that there are two periods during the year when people are most likely to look for another job, ' says Mr Amos. 'These are at the end of the summer and just after Christmas.'

One way of avoiding wastage at this point is to provide support and advice about career options via line managers.

Trusts need to look at ways of marketing themselves internally to staff, making sure they know there is potential for career development.

Mr Rogers is optimistic about the reaction from employers. 'They are receptive to this and have had to respond to significant change already.

'Many employers are advanced in this process and the work of Skills for Health will provide frameworks to make this transferable across the UK.'

'The development of competences will have a major role in demystifying the barriers between professionals and nonprofessionals. If nurses can see there is a foundation to the way the competence of, say, a healthcare assistant is assessed, it can help.

'Historically, the difference in culture between the two groups has hampered the development of new roles. If you are going to develop a new role, such as assistant radiographer, it is vital you have the confidence of the profession.

'The policy climate means that the inclusion of the private sector, and successfully balancing it with such a big public employer, is also more important than ever.That will be a complex task for Skills for Health, different from most sector skills councils, but a vital one.'

David Highton, Patient Choice Partners managing director, former Skills for Health chair and former Oxford Radcliffe Hospitals trust chief executive

'I very much welcome the establishment of sector skills council Skills for Health because it will promote the use of occupational standards to ensure best practice. I am also pleased to note that its make-up and membership will involve employers, education, trade unions and services users.

'Skills for Health will provide leadership in areas of workforce planning, occupational standards and clinical governance and will therefore help support the work of local employers in raising standards.

'The council will provide a framework to allow people to develop their skills and assure service users of the competence of frontline staff. It will also give people who work through these standards formal recognition of their skills.'

Elaine Way, Association of Healthcare Human Resource Management president