King's College London

Background

The NHS Acute and Community sectors employ more than 1.4 million people, making the NHS the largest employer in England. Just over half (52%) of those employees are professionally qualified clinical staff. The remainder either provide support to clinical staff in care delivery (32%) or NHS infrastructure support (including estates and management) (16%).

Career progression in the NHS can take two forms. The first is progression within careers (for example, moving from a Band 5 to a Band 6 nurse), the second is moving between occupations (for example, from a health care support worker to an administrator). There is little evidence on the types of movement between occupations in the NHS, on either the clinical or non-clinical side. The exception is for nursing, where we know it is relatively common to train as a nurse after working as a healthcare support worker.

Understanding these patterns of progression through NHS careers could help inform workforce planning and assist in policy design, for example to improve staff retention or diversity. Widening access to quality work is one way the NHS can operate as an “anchor institution”, strategically managing their resources to address local social and economic priorities, reducing health inequalities and delivering social value to local communities. This study will help to quantify the extent to which the NHS is operating in this way.

Aims

We will look at career progression with a focus on moves between different occupations within the NHS. This will complement work already published by the Policy Research Unit (PRU) on progression within occupations. The results will allow the PRU and DHSC to assess whether to prioritise further quantitative and/or qualitative work on career progression and in which areas.

Specifically, there are three workstreams:

1. We will look at how many staff move, and between which occupations (clinical and non-clinical). This will include the extent to which the frequency of these occupational transitions vary by individual staff characteristics (e.g. age, sex, ethnicity), by Trust, and by geographical area. This descriptive analysis will help identify areas of focus for future research within and beyond this project.
2. We will look at the mechanisms that drive these moves including Trust-specific policies, changes in external environments (e.g. housing costs), and changes in individual circumstances (e.g. parenthood, illness/disability).
3. We will look at how individual and collective workforce outcomes (retention, future within-occupation progression, diversity and pay gaps) are affected by cross-occupational mobility. We will consider whether likely motivators of occupational transitions are associated with pay growth, changes in working conditions, such as schedule flexibility, or relocations. We will explore with PRU colleagues at Kings how this work could be enhanced by accompanying qualitative measures on perceptions and motivations for inter-occupational transitions.
   
   

Method

All analysis will be expressed in terms of numbers (quantitative), using descriptive and statistical method. We will use the NHS Electronic Staff Record (ESR) from 2012 to 2021, or the latest available data if updated.

For workstreams 2 and 3, we aim to understand what drives choices to change occupation, and how those choices affect future employment outcomes (e.g. retention and wages). Where it is not possible to establish causal relationships, we will document the patterns or associations. The ESR only covers the Acute/Community and community sectors, therefore we will only consider career progression within that sector. We will explore additional qualitative work with our colleagues at Kings PRU. This might address gaps in the information available, to allow us to explore an issue or aspect in greater detail.

Timeframe

January 2024 – July 2025

Funding

NIHR Policy Research Programme: NIHR206121(03)

Policy relevance

Career progression is important for staff, recognising skill development and often comes with increased pay. The size and diversity of the NHS as an employer means that career moves across occupations can be a valuable option, making the NHS more attractive as an employer. These career moves may also be linked to retention of NHS staff and a vital route to securing a pipeline of staff, with the necessary advanced skills and experience for the NHS of the future.

Knowledge of the direction, size and means by which these career progression pathways occur, is crucial. Also important is an understanding of opportunities open to NHS employees, who move across occupations in the NHS, including improved pay and conditions and any contribution this makes to improved workforce outcomes or unintended consequences.

Involvement

2 July 2024: Elaine Kelly spoke about this study at the Unit PCIE Advisory Group. Questions for discussion at the meeting included:

• What are your perceptions of the NHS as an organisation that can build a career path? Would it affect whether you encouraged a friend/family member to begin a career in the NHS?
• Are there any aspects of staff changing occupations that could concern patients/public?
• How could this project lead to the maximum benefit to patients/public?
• Having heard about the research, are there any areas you think should be investigated further?
• Do you have any thoughts about how findings should be disseminated?

Dissemination

Reports will be shared on the Institute for Fiscal Studies (IFS) website and social media. We will hold a webinar enabling stakeholders and interested members of the public to contribute their views and ask questions. The findings from the project might form the basis for academic work, to be disseminated at academic seminars and conferences.