Sector Skills Baseline Study
FOR
HEALTH AND SOCIAL CARE
Executive Summary
2015
Sector Skills Baseline Study HEALTH AND SOCIAL CARE Executive Summary
1. Introduction
1.1 Context
Health and Social Care is one of seven key business sectors in Lancashire that the Local
Enterprise Partnership (LEP) has identified as a future driver of jobs and wealth.
The Lancashire LEP have therefore commissioned a sector skills study and developed a draft
action plan for Health and Social Care in Lancashire.
1.2 Aims
The work was commissioned to provide:
•
A high quality desktop review to establish key issues in the health and social care labour
market;
•
A draft action plan to address the constraints and issues impairing labour market function;
and
•
Analysis and conclusions shaped and validated by employers.
In doing so, this provides a plan for the LEP as it works to maximise growth from the health
and care sector; it assists skills providers to tailor their curriculum offer to meet the needs of
employers; and it provides a set of actions which, when progressed, will set out clear priorities
and enable the LEP and Ofsted to assess providers’ responsiveness to local economic
opportunity and need.
1.3 Approach
A three-stage methodology was used to deliver the baseline study and a draft action plan:
Stage 1: A baseline assessment of key health and social care labour market opportunities and
challenges via a comprehensive literature review and data analysis of the sector. This work
identified a series of issues and subsequent lines of enquiry to inform, test and validate via
the stage two activity.
Stage 2: Extensive 1-2-1 and roundtable engagement with 40 employers, skills providers and
other key stakeholders (thought leaders and network chairs) in the health and social care
sector in Lancashire. Building on the stage one baseline assessment, this work confirmed the
key issues facing the sector and identified the key causal drivers which the stage three draft
action plan should seek to address.
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Sector Skills Baseline Study HEALTH AND SOCIAL CARE Executive Summary
Stage 3: The development of a draft action plan for implementation on behalf of the LEP,
addressing the key issues and drivers which prevent the health and social care labour market
from functioning more effectively. This work included the review/shaping of the draft action
plan via follow-up 1-2-1s with consultees and a special workshop session.
Detailed below is an executive summary of the first two stages of the report:
2

Nature of the sector: employer base, workforce, trends and key influences.

Overview of the key labour market issues and drivers in the sector.
Sector Skills Baseline Study HEALTH AND SOCIAL CARE Executive Summary
2. State of the Sector
2.1 Nature of the Sector in Lancashire
Distribution of Employment - Location
Health and Social Care (HSC) employs more Lancashire residents than any other sector
accounting for 16 percent of all jobs in the county, providing work to just under 100,000
people. With an ageing population (Lancashire’s over-65 population will rise by 23% in a
decade) and growing numbers of younger people with complex needs living longer, demand
for health and care services is set to continue rising. At a district level, Preston, Blackburn with
Darwen and Blackpool have the highest levels of employment in HSC, as figure 1 below shows:
Figure 1: Health & Social Care Employment by district, 2013
The fastest growing location for health and care roles is Burnley, where employment grew by
almost a quarter between 2010-13, followed by Blackburn with Darwen (20% growth).
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Sector Skills Baseline Study HEALTH AND SOCIAL CARE Executive Summary
Distribution of employment – subsectors and concentrations
The largest absolute increase in employment occurred in ‘Hospital activities’ which grew from
34,300 in 2010 to 40,100 in 2013 in Lancashire, a 16.9% increase – reflecting new staffing
requirements introduced in the wake of the Stafford Hospital scandal.
Figure 2: Health & Social Care Employment Change by Sub-Sector in Lancashire, 2010-13
Employment in Health & Social Care Sub-sectors in
Change
2010
2013
Lancashire
No.
%
Hospital activities
34,300
40,100
5,800
16.9%
Social work activities without accommodation for the
8,300
11,500
3,200
38.6%
elderly and disabled
Other social work activities without accommodation n.e.c. 14,600
11,100
-3,500
-24.0%
Residential nursing care activities
4,700
6,000
1,300
27.7%
Residential care activities for the elderly and disabled
7,200
5,900
-1,300
-18.1%
General medical practice activities
5,200
5,800
600
11.5%
Other human health activities
10,100
5,800
-4,300
-42.6%
Other residential care activities
4,200
4,300
100
2.4%
Child day-care activities
3,800
4,000
200
5.3%
Dental practice activities
1,900
2,400
500
26.3%
Residential care activities for learning disabilities, mental
900
900
0
0.0%
health and substance abuse
Specialist medical practice activities
300
400
100
33.3%
Total
95,500
98,200
2,700
2.8%
Source: Business Register and Employment Survey (BRES), 2013
Lancashire is characterised by high concentrations of jobs in social care activities, residential
care and hospital activities, as shown by location quotients (LQ) above the national
benchmark of 1.0.
Figure 3: Health & Social Care Location Quotients in Lancashire
Employment in Health & Social Care Sub-sectors in
Location
Lancashire
Quotient
Social work activities without accommodation for the
1.86
elderly and disabled
Residential nursing care activities
1.41
Hospital activities
1.32
Residential care activities for the elderly and disabled
1.16
Other social work activities without accommodation n.e.c.
1.13
Dental practice activities
1.10
Child day-care activities
1.08
General medical practice activities
1.06
Specialist medical practice activities
0.94
Other residential care activities
0.89
Residential care activities for learning disabilities, mental
0.86
health and substance abuse
Other human health activities
0.72
Total
1.21
Source: Business Register and Employment Survey (BRES), 2013
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Sector Skills Baseline Study HEALTH AND SOCIAL CARE Executive Summary
Analysis at a district level shows very high concentrations of jobs in certain sub-sectors, eg:

The highest LQ is in Burnley – 4.63 for “Social work activities without accommodation for
the elderly and disabled”; closely followed by Chorley, with LQ of 4.47 for the same subsector.

Other high LQs include: 3.46 in Pendle for “Residential care for learning disabilities, mental
health and substance abuse”; 3.30 in Rossendale for “Residential nursing care activities”;
and 3.14 in Ribble Valley for “Residential care for learning disabilities, mental health and
substance abuse”.
Employer base
More than half (55.3%) of the 3900 Lancashire HSC businesses employ nine or fewer people
(2155). However, on average employers in the sector are larger than across the rest of the
economy. Figure 4 shows the breakdown of HSC employers by size compared to the county
average.
Figure 4: Health & Social Care Businesses by Size in Lancashire, 2014
Sizeband – Lancs businesses, 2014 Health and Social Care (%) All Lancashire Businesses (%)
Micro (0 to 9 employees)
55.3%
Small (10 to 49)
36.8%
Medium (50 to 249)
7.4%
Large (250+)
0.5%
TOTAL
100%
Source: Inter-Departmental Business Register (IDBR)
81.5%
15.1%
3%
0.4%
100%
2.2 Profile of the Workforce and Future Demand Signals
Workforce – key points
In summary, when compared to national and local benchmarks the Lancashire HSC workforce
is older, more likely to work part-time and more likely to be female. Census data shows that
health and social care staff in the county are well qualified:
 44% of employees are qualified at level 4 and above (Lancs all-sector average: 30%);
 33% of employees are qualified to level 2 or below (Lancs all-sector average: 44%); and
 4% of staff have undertaken an apprenticeship, compared to 9% across all sectors in
Lancashire.
This reflects statutory training requirements and the high prevalence of professional
occupations in the sector. However, ensuring that there are sufficient, well trained staff to
deliver services is proving increasingly challenging, particularly in frontline roles such as
nursing. In addition to growing service demand, workforce age is a key issue. A Skills for Health
report showed that in 2005 28% of nurses were aged over 50, up from 21% in 1996. This figure
that is likely even higher today. Skills for Care’s National Minimum Data Set (NMDS-SC) on the
social care provides further detail. It shows that 80% of care staff are female and that in
Lancashire, 70% of the care workforce are British.
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Sector Skills Baseline Study HEALTH AND SOCIAL CARE Executive Summary
Future labour demand
Forecasts by Oxford Economics suggest that employment in Lancashire’s HSC sector will grow
by 1,900 (1.7%) in the period 2014-24. The fastest growth in HSC roles is forecast in social work
activities (3.3%). At a district level, Lancaster is predicted to experience the largest increase in
employment in the health and social care sector, growing by 700 jobs over the decade to 2024,
as figure 5 shows:
Figure 5: District-level employment forecasts: Health & Social Care- Change 2014-2024
2.3 Provision in Lancashire
Higher Education
Higher Education Statistics Agency (HESA) data shows that in 2013/14, 16,500 students
(undergraduate and postgraduate) are studying health and social care-related subjects at
Higher Education Institutions in Lancashire. Learner volumes by Lancashire HEI are show
below in figure 6 (note this does not include the learner volumes from the Lancaster Campus
of the University of Cumbria).
Figure 6: HE Students in Lancashire by Institution, 2013-14
Medicine & dentistry
Subjects allied to medicine
Social work
Biological sciences
Total
6
Central Lancashire
610
5,120
1,865
1,665
9,260
Edge Hill
0
3,520
445
1,830
5,795
Lancaster
135
240
185
970
1,530
Total
745
8,880
2,495
4,465
16,585
Sector Skills Baseline Study HEALTH AND SOCIAL CARE Executive Summary
Given extensive HE travel to learn geographies and the opportunity to retain graduates from
across the wider North West in Lancashire, analysis has also been undertaken on learner
numbers across a wider range of HEIs. Figure 7 shows learner volumes and specialisms across
NW universities:
Figure 7: HE Students in NW Universities, by subject 2013-14
Central Lancs
Edge Hill
Lancaster
Cumbria
Manchester
Mcr Met
Salford
Bolton
Liverpool
Liverpool JMU
Liverpool Hope
Chester
TOTAL
Medicine and dentistry
Subjects allied to medicine
Social work
Biological sciences
Total
610
135
3595
45
35
3050
7470
5120
3520
240
2485
4305
2350
4595
1115
1290
3670
80
3720
32,490
1865
445
185
680
130
815
855
200
380
140
365
6060
1665
1830
970
640
2625
3445
1445
825
1785
3105
695
1305
20,335
9260
5795
1530
3805
10,655
6655
6930
2140
6125
7155
915
5390
66,355
Source: HESA
It is notable that ‘subjects allied to medicine’ includes 18,000 nursing learners. Of those
studying biological sciences, 7500 are learning psychology and a further 5000 are sports
science students.
Further Education
A total of 27,600 further education learning aim starts in health, public services and care took
place in Lancashire in 2013/14, down slightly on 30,000 in 2012/13. The vast majority of
delivery is via learner-responsive, classroom-based provision (at least 80%). Figure 8 shows
the breakdown by subsector:
Figure 8: Health, Public Services & Care Sector Starts in Lancashire by Sub-Sector, 2013/14
Sub-sector
Under 16
Medicine and Dentistry
Nursing and Subjects and Vocations Allied to Medicine
1
Health and Social Care
32
Public Services
20
Child Development and Well Being
65
Other
19
Total
137
Source: LEP Data Cube
7
16-18
15
54
3,024
1,342
1,202
28
5,665
19-24
8
388
3,357
334
511
74
4,672
25+
16
1,035
13,917
788
1,122
222
17,100
Total
39
1,478
20,330
2,484
2,900
343
27,574
Sector Skills Baseline Study HEALTH AND SOCIAL CARE Executive Summary
When analysed by level, the bulk of learning aim starts were at level 1 and level 2, as figure 9 shows:
Figure 9: Health, Public Services & Care Sector Starts in Lancashire by Notional NVQ Level, 2013/14
Entry level
Higher level
Level 1
Level 2
Level 3
Level 4 (original)
Level 5 (original)
Not applicable
Grand Total
Under 16
20
16-18
100
19-24
94
52
46
0
1,406
1,601
2,454
73
0
31
5,665
1,517
1,517
615
367
19
137
562
4,672
25+
387
1
3,513
7,100
1,395
655
0
4,049
17,100
Grand Total
601
1
6,488
10,264
4,464
1,095
0
4,661
27,574
Source: LEP Data Cube
Lancashire County Council accounted for the most starts in 2013/14 (community learning), followed
by Blackburn and Accrington & Rossendale colleges. Figure 10 shows the top ten provides in Lancashire
LEP, who together account for almost 70% of all starts in the sector in 2013/14.
Figure 10: Health, Public Services & Care Sector Starts in Lancashire, 2013/14 – 10 largest providers
Provider Name
Lancashire County Council
Blackburn College
Accrington & Rossendale College
Preston College
Manchester College, The
Burnley College
Blackpool & The Fylde College
Runshaw College
Lancaster & Morecambe College
Blackburn with Darwen Unitary Authority
Under 16 16-18
21
24
4
804
5
221
38
428
226
756
62
571
477
249
19-24
484
377
447
312
1,035
235
231
83
139
40
25+
3,250
1,188
1,688
1,447
962
795
531
500
403
750
Grand Total
3,779
2,373
2,361
2,225
2,223
1,786
1,395
1,060
791
790
Source: LEP Data Cube
Health and social care-related apprenticeship delivery in Lancashire is substantial, accounting for
17.4% of all apprenticeship starts by Lancashire residents in 2013-14. In total, 2503 health and carerelated apprenticeship learning aim starts were recorded with 1518 (61%) at level 2 (intermediate),
811 (32%) at level 3 (advanced) and 174 (7%) at level 4 or above (higher). The apprenticeship market
is very fragmented, with around 100 providers delivering L3+ apprenticeships and even more at level
2. Figure 11 shows the largest providers of HSC apprenticeships in Lancashire at Level 3+:
Figure 11: HSC Apprenticeship learning aim starts, 2013-14: ten largest providers to Lancs residents at Level 3+
Health and Social Care
GP Strategies
NCG
Learndirect
Age UK
ESG (Skills)
Lancashire CC
Preston’s College
Kirklees College
Total People
Asset Training
8
69
60
57
47
35
35
4
28
26
21
Dental Nursing
Pharmacy Services
Care Leadership (level 5)
Total
20
17
89
77
64
70
35
35
33
28
26
21
7
23
23
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Sector Skills Baseline Study HEALTH AND SOCIAL CARE Executive Summary
HSC apprenticeship success rates in Lancashire are, on average, two percentage points lower than the
national average (66.9%, compared to 68.9% nationally across all levels). The gap in success rates is
largest at level 4+ (64.8% Lancs, 71.3% England). Success rate performance in Lancashire has been flat,
although national success rate trends have edged lower in recent years.
Provision funding
The Health and Social Care sector in Lancashire is supported via a range of skills funding resources. By
far the largest comes via Health Education England (HEE), responsible for planning and commissioning
training largely via HEIs for NHS occupations, as well as bursaries and grants. A summary of skills
funding sources is contained in the table below. Estimates of HSC skills funding (with the exception of
dedicated HEE, SfC and LCC resources) are calculated as one sixth of overall investment in all sector,
mirroring the proportion of the labour market occupied by HSC roles.
Approx. annual
investment in Lancs Funding route
HSC training
Health
HE provision to meet future
To HEIs (via competitive
Education
NHS needs;
c.£200 million
process) for delivery; to
England
Bursaries to learners
individuals (bursaries etc.)
To colleges and training
Skills Funding Support adult learning and
c.£15 million
providers. Employers will
Agency (BIS) apprenticeships
control apprenticeship funds
Education
All 16-19 learning – eg ATo colleges, sixth forms,
Funding Agency
c.£30 million
Levels, BTECs etc
sometimes training providers
(EFA)
HEFCE (BIS)
Recurrent grants to HEIs
c.£10 million
To HEIs
Address skills and
European
To skills and employment
employment challenges
c.£3 million
Social Fund
providers via SFA/DWP/BIG
including social inclusion
Skills for Care
To employers via LWDP, as
Workforce development
and LCC
c.£750K combined match funding for shortamong care employers
funding
course training
Source
9
Purpose
Local influence
Only via HEE’s Cumbria
/Lancs Local Workforce
Education Group (LWEG)
FE providers must
respond to LEP priorities
FE providers must
respond to LEP priorities
None, learner-led demand
LEP responsible for
prioritising spend to 2020,
and selection of providers
Significant – LWDP an
LCC-owned company
Sector Skills Baseline Study HEALTH AND SOCIAL CARE Executive Summary
2.4 Critical issues
A comprehensive analysis of the critical issues is available in part two of the full report. Key points
include:
10

Health and social care transformation
An ageing population, advances in medical technology and tightening public finances pose
serious challenges for health and social care services nationwide. As in other places,
Lancashire is moving ahead with health and care transformation programmes – bringing new
models of care, growing delivery in community settings to improve outcomes and reduce cost.
This presents fundamental questions to the configuration of health and care service providers,
job roles and the entire training and skills infrastructure that supports the sector. Work to
realign skills delivery in light of looming service transformation and multi-complex care has
barely begun. Transformation will combine to increase demand for key roles (such as primary
care professionals), redesign occupations and ultimately integrate the work of the NHS and
social care professionals – increasingly working in multi-disciplinary teams - around well
designed, sequential packages of care that enables individuals to better manage conditions
and sustain independence.

Skills shortages
The inability of some health services to recruit and retain staff is, in parts of the county,
jeopardising service delivery. One hospital reported that it is carrying over 250 vacancies at
present, although in locations closer to the M62 corridor and in areas of high BME population,
shortages of GPs, nurses and specialist staff are less acute. The causes of this are manifold –
inaccurate workforce planning data leading to a shortage of new recruits; the perceived elitist
nature of many highly-skilled medical roles and absence of vocational routeways; the lack of
an international research hospital on a par with the Christie in Manchester and Alder Hey in
Liverpool limiting the ‘pull’ of Lancashire to newly-qualified staff. In care roles, shrinking public
contracts, low pay (senior care workers often earn under £7/hour) and extensive
accountabilities contribute to high staff turnover. Widening access to careers in health and
social care is of critical importance if skills shortages are to be prevented from becoming more
acute – this includes taking advantage of new, vocational career pathways and seeking to
capitalise on strong local learner demand which is often displaced to other parts of the country
owing to a shortage of training places.

Misalignment of training with employer requirements
Issues with the calibre of new recruits and the availability of work experience to learners were
highlighted, particularly in the care sector. Employers’ preference for on-the-job training was
clear, to ensure that the expectations and skills of new recruits aligned with the needs of the
organisation. Care employers reported weak engagement with skills providers, though there
was better engagement of NHS employers by HEIs. Employer collaboration in shaping FE and
some HE curriculum was felt to be weak, despite the concerns expressed by employers about
the relevance of the curriculum offer. There is an opportunity to significantly improve
employer participation in curriculum planning and delivery, reducing the gap between
employer expectations and the ability of new recruits.
Sector Skills Baseline Study HEALTH AND SOCIAL CARE Executive Summary
11

Health / care disparities
While HSC transformation seeks to develop new, integrated forms of health and care delivery
in the community, a significant disparity is apparent in the employer infrastructure, resource
and training delivered to health employers (often large NHS provider trusts) and care providers
(usually SMEs, privately owned). The former is served by HEE’s sizeable investment, existing
regional and sub-regional employer groups, enjoying strong links to HE and some FE providers.
In contrast, care providers access scant public resource and as employers tend to be smaller
and fragile in nature. Pooling budgets via local devolution to create integrated skills provision
(in line with anticipated integration between health and social care provision) is a radical
option that merits further exploration. No dialogue between health and care employers about
the workforce implications of service transformation appears to be taking place; with a handful
of notable exceptions, there was also felt to be a lack of sector leaders who were willing to
make the issue of skills shortages and workforce transformation a high profile topic in
Lancashire.

Skills provider / employer engagement
Examples of good engagement between employers and skills providers were highlighted
however more commonly a picture of weak interaction with employers (especially SMEs) was
described. Combined with this, feedback suggested that despite cutbacks in state funding,
significant investment is still being made in skills training for the sector in Lancashire. However
very little of this is actually influenced and shaped within Lancashire – there is a job to be done
to ensure that this investment is better joined up, maximising its impact on employers,
improving productivity. This includes the impact of the apprenticeship levy, which creates
opportunities to leverage large employer investment in new apprenticeships (such as those at
level 4 and above) to grow vocational pathways to higher skills – broadening opportunities and
addressing skills shortages at the same time.