Health and Social Work

Introduction

Health and social work is a major and complex economic activity in Lancashire. It makes a significant contribution to the sub-region's output, in 2004 producing an estimated total gross value added of £1.7bn or 8.2% of the Lancashire total. In terms of workforce size, health and social work is by far the largest single local employing sector, in 2006 providing jobs for nearly 80,500 people, a high proportion of whom are professionally qualified staff. The breadth of its activities and providers is extremely wide ranging from large public and private institutions like hospitals and nursing homes, through medical and dental practices to other human health activities, including those undertaken by para-medical practitioners. There is no clear dividing line between health and social care with the latter providing both charitable and non-charitable social services either with or without accommodation including homes for the elderly and handicapped, orphanages, rehabilitation homes and facilities for the homeless through to a host of social, day-care, support, counselling, welfare, referral and similar activities delivered to individuals and families in their own homes or elsewhere. The sector also encompasses veterinary activities though this is a very tiny component accounting for less than 1% of its total employment.

Employment

The 80,500 employee jobs provided by the health and social work sector in Lancashire in 2006 were equivalent to 13.2% (or nearly one in seven) of employees in all industries and services and compared with a slightly smaller representation nationally of 12.2%. As a basic local service employment is widely spread across the sub-region though close to a half of jobs are to be found in the larger urban centres of Blackburn, Blackpool, Lancaster and Preston (Figure 1). These larger urban centres have tended to increase their shares of health and social work employment over recent years, presumably reflecting the tendency towards concentration and specialisation for many facilities and services. The local importance of the sector is most pronounced in Blackpool where it accounts for about 17% of all the district's employee jobs, followed by a shares of around 16% in Blackburn and Lancaster. Its least impact is found in Fylde and Rossendale where health and social work occupations account for about 7-8% of these districts' jobs.

Figure 1 Health and Social Work Employment by District, 2006

Source ONS - Annual Business Inquiry

A more detailed distribution of health and social work jobs across the sub-region by ward is shown in Figure 2. Significant contributions, i.e. 50% or more, are associated with the location of major hospital establishments but there is a wide distribution of facilities, and thus employment, across both urban and rural areas.

Figure 2 Health and Social Work Employee Jobs as a Percentage of All Jobs by Ward

Source ONS - Annual Business Inquiry

In contrast to the position within most production industries an exceptionally large proportion of the health and social work workforce (over 80%) are female employees of whom nearly a half work on a part-time basis (compared with about a quarter of the male employees). In all, 44% of employees in the sector work part-time.

The sector's activities, and particularly those relating to human health, include some of the largest employing establishments in the sub-region such as individual hospitals. In total the sector comprises over 3,200 separate employment establishments across Lancashire. Statistically, the average size of local employing units in the Lancashire sector is 25 employees – well above the normal average for the services sector. About 37% of the workforce are employed in larger units with 500 or more employees. However, 94% of establishments employ fewer than 50 people and 60% employ fewer than ten (Table 2).

Royal Preston Hospital

The provision of health and social work activities is dominated by public sector providers such as the National Health Service, one of the sub-region's largest employers and by the direct or indirect provision by local authority social services. However, there is also very considerable private/voluntary sector provision and this has grown substantially over recent years with the active encouragement of government agencies. There are far too many private sector providers to list in full but amongst some of the larger organisations are the Abbeyfield Society, a UK-wide volunteer led charity providing housing with support car for older people; Age Concern, providing advice and care services for older people; the Anchor Trust, also offering housing support and care for older people; Barchester Healthcare, offering nursing and personal care for older people; Century Healthcare, nursing and residential care; Careforce Group, providing adaptable domiciliary care services and care for the elderly; Integrate, providing support for adults with learning disabilities; Paragon UK Ltd, independent domiciliary and supported living services; the Ravenscroft Group, engaged in the provision of intermediate care services; and St Catherine's Hospice, providing palliative care for children and adults.

Figure 3 Health and Social Work Establishments

Source ONS - Annual Business Inquiry

Employment Trends

The sector saw a steady jobs expansion throughout post war years, a process that accelerated over the 1960s and 1970s (Figure 2). During the 1980s and early 1990's public sector growth eased but private sector provision took up the running as legislative changes tipped the balance of some health and social care provision towards market-based solutions. The last few years have again seen a rapid growth of employment linked to major public investment in the National Health Service. Over the decade to 2006 health and social work was one of the fastest growing activities in the UK, out-paced only by growth rates in the business services sector. Employee job numbers in Lancashire alone grew by nearly 12,000 (+17%) between 1995-2006, despite experiencing some slight contraction in the latest year.

Figure 4 Health and Social Work Employee Jobs, Lancashire, 1950-2006

Source Ministry of Labour/ONS - ERII Employment Records

Among "human health" activities alone an additional 8,700 new local jobs were created 1995-2006. Over the period there continued to be some jobs growth in hospital activities though there was too some hospital site rationalisation and a tendency towards alternative forms of health care provision. In consequence, a large part of the new health jobs were created within the "other" human health category – that is, health functions not necessarily performed in hospitals or by medical doctors. These have included activities undertaken by legally recognised para-medical practitioners which may include those working in such fields as optometry, hydrotherapy, medical massage, occupational therapy, chiropody, etc. There has also been strong jobs growth in medical and dental practices, presumably reflecting their enhanced role in primary health care provision Table 3).

In the case of social work the pace of jobs growth was particularly rapid over the 1980s when it enjoyed one of the fastest growth rates of any local economic activity. This reflected societal and administrative changes in family and institutional care together with a major expansion of the voluntary and private sector's contribution in, for example, the provision of home help and homes for the elderly. Growth slowed over the 1990s though the decade to 2006 still enjoyed net growth of an additional 2,600 jobs (+12%). This trend concealed some reduction in job numbers in social work activities with accommodation offset by growth in social work activities without accommodation, presumably mirroring the tendency towards greater home-based rather than institutional care and a large increase in the role of private and voluntary sector providers.

General Characteristics

Health care is a substantial component of the economy. Estimates prepared by the Office for National Statistics from the UK National Accounts place total expenditure on health care in 2006 at £109bn or 8.4% of GDP, up from 6.6% a decade earlier. Public expenditure, at more than £95bn in 2006, comprised government current and capital expenditure whilst private expenditure (£14bn) comprised household expenditure on health.

Health and social care in Lancashire is primarily a "local" industry, meaning that the majority of health organisations and practitioners provide services to people living within the region itself. The largest sectors represented in Lancashire are hospital activities (38,000 jobs); social work without accommodation (12,300) – e.g. child care, counselling, welfare, referral, day care, community services, etc.; social work with accommodation (11,900) – e.g. homes for the elderly, orphanages, rehabilitation homes, etc. Medical and dental practice activities employ another 6,200 people with a further 11,000 in "other" human health activities which include para-medical practitioners and others legally recognised to treat patients outside hospitals, medical laboratories, blood banks, ambulance transport, etc. Most of these sectors tend, by their very nature, to be rather labour intensive and this has underlain much of the steady increase in employment over the years. In addition to the formal employee jobs a large number of agency and volunteer workers are also involved with the health and social care sector. By its nature the sector covers a huge range of professions and occupations.

The market for primary health care is heavily regulated and the bulk of total spending is covered by public insurance systems and general taxation, though private health care and social care provision has also expanded strongly over recent years. Real health and social services expenditure has grown at a rapid pace, increasing its share of overall public expenditure and raising concerns about the future financing of health and care services. The 1990s saw some slowdown in the growth of nominal expenditure, largely as a result of regulatory controls, and there has been major changes in the structure and operation of health care systems aimed at further increasing the overall efficiency of these services – i.e. reducing their costs while maintaining and if possible increasing the quality and accessibility of the services. The past few years have seen a further major injection of additional resources, particularly through the National Health Service in a bid to further improve services and jobs growth in consequence was highly robust, though more recent budgetary pressures have partly reversed this position. This increase in spending has coincided with further structural reforms under the government's health plans to create a more devolved, more market-based health service.

Key drivers influencing health and social care provision over future years are likely to include:

• Demographic trends, notably the increase in the average age of the population and more especially the increasing number and proportion of people in the older age groups (75 years+) who tend to place greater demands on health and social services.
• Increased expectations and aspirations amongst the population relating to choice and service delivery.
• Continuing changes in the role of families and their ability to provide care facilities in the home, together with continuing rapid increase in the numbers of one-person households.
• Continued intervention by the private sector in the provision of both health and care.
• Service agreements that are increasingly emphasising the need to engage with local communities and to integrate health care with other community initiatives and with the voluntary sector.
• An expansion in the range of services offered (e.g. infertility treatments, sports medicine, cosmetic surgery) and in the numbers of medical procedures being undertaken on an outpatient basis.
• The requirement for capital to meet the growing sophistication of medical technologies, clinical procedures and pharmaceuticals.

This page was compiled by Peter Kivell.

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