Health workforce planning in the US and the UK

Doctor Erin Fraher gave a presentation at the CfWI international seminar, which took place on the 6 July 2010, at the end of her one-year secondment to the NHS Workforce Review Team (WRT) from the University of North Carolina at Chapel Hill.

During her time at WRT Doctor Fraher has been able to draw comparisons between the US and the UK and was struck by the similarities in health workforce challenges between the two countries. Her presentation looked at the changes taking place in the US as a result of the Health Care Reform bill, which will result, among other things, in enhanced workforce planning at national level. Below are some of the key points of the presentation.

US health reform and the resurgence of health workforce planning

Health reform is driving increased:

  • Social accountability for public investments in health.
  • Attention to cost containment through alternative models of care and payment incentives.
  • Debate about ‘value for money’ of physician workforce.

US health workforce planning challenges:

  • Highly decentralised system.
  • Limited funding and until recently, limited national leadership.
  • High degree of heterogeneity between states in workforce planning.
  • Supply modelling: limited data beyond physicians – inability to move beyond ‘counting noses’ to link activity with outcomes.
  • Demand modelling, beginning to think about modelling demand for services, not professions.
  • Difficult metrics – how to define shortage and access issues.
  • Limited investment in evaluation of what works but more importantly, what doesn’t work.

UK workforce planning challenges

One American’s view on CfWI Challenges:

  • Information governance restrictions.
  • Data collection, warehousing, concatenation and cleaning.
  • Finding a balance between top-down versus bottom-up and centralised versus market-driven approaches.
  • Balancing short-term imperatives with long-term view.
  • Defining accountabilities – who decides what?
  • Fostering better linkages between academics and the service.
  • Better use of evidence to point out the 'inconvenient truths'.
  • Making recommendations in absence of hard evidence.

Benefits and opportunities of collaboration

Doctor Fraher also looked at what the two countries might learn from each other with regard to health workforce planning and made the following key points on what the UK might learn from the US:

  • The market often fails – what is role of CfWI in identifying and addressing market failures?
  • More opportunities to connect workforce planners in the service to academics, policy makers, educators.
  • Increased role of academics in building science, providing policy relevant analyses and horizon scanning.
  • Better use of existing data – you are sitting on a gold mine of information that is under-used due to IG concerns.
  • Need for longitudinal data sets and better ability to track health professionals over time.
  • Better utilisation of geographic information systems – maps are powerful analytic and presentation tools.

You can view the presentation in full here Health Workforce Planning in the US and the UK.

Erin Fraher, PhD, MPP

The Cecil G. Sheps Center for Health Services Research

American College of Surgeons Health Policy Research Institute Website