NHS “Hourglass” Structure Holds Back Development Of Support Workforce

  • New working paper released by leading health care skills and training experts

NHS hourglass structureSkills for Health (SfH) has today (12.10.15) published the second in its Working Paper series, analysing what needs to be done to create a high quality sustainable support workforce in the UK’s health sector.

The paper ‘How can we act now to create a high quality workforce in the UKs health sector’ calls for employers to create higher quality roles for support staff and to provide better progression opportunities to develop productivity in the sector.  

The report analyses the drivers shaping the UK’s health sector, highlighting the increasing complexity in terms of how services are delivered and workforce is organised, while considering the challenges this creates in improving efficiency.

SfH identifies that the sector is lacking a high quality intermediate workforce as a result of barriers to progression from support roles to higher skilled ‘registered’ roles.

The paper recommends that developing the support workforce will make a significant contribution to meeting future health care needs.

Ian Wheeler, Head of Research, Labour Market Intelligence & Evaluation at Skills for Health who developed the Working Paper series on the Support Workforce, said: “This report is an important exploration of the support workers role. It takes an in-depth look into the identified skills needed for support workers and explores ways in which the sector as a whole can progress.

“It is evident from our research that policy makers should understand the need to create high quality roles, not just train more people. The development of these roles will not happen without concerted action on the part of employers.

“To implement the report’s recommendations successfully, there needs to be greater clarity around support worker roles and a wider understanding that every job is important and worthwhile. It is only by understanding the contribution and value of the support worker role that the sector will be able to realise its potential in terms of productivity and efficiency.”

Key findings:                                                             

  • While there are many instances where employers have embraced the development of the support workforce, there is also a need for support workers to be held in greater esteem and have better access to progression routes.
  • The provision of training is not enough. Support workers are continually developing their skills yet there are relatively few opportunities to progress through intermediate levels and into higher bands.
  • A lack of skills in this middle section of the workforce also creates issues around progression – in particular the “leap” from Bands 4 to Band 5. There are large numbers of current support workers holding relatively high level qualifications (over 30% of workers estimate themselves to be over qualified), which suggests that many have potential that is not being realised.
  • This is significant considering that the first SfH Working Paper (launched in January 2015) found that for every 1% of activities shifted from Band 5 to Band 4, a total of £100m might be saved across the health sector.


  • Employers need to commit and plan for the support workforce by creating an overall strategy and allowing sufficient budget for developing these roles, while identifying opportunities on a day-to-day basis to consider if a support worker could fulfil the required job.
  • Employers need to recognise that there are a wide range of flexible training and development options such as apprenticeships that can help develop the workforce.
  • Alongside training and development, support workers and the teams they work in need clarity about increased responsibility and what they are able to do. Such clarity will reduce any anxieties amongst colleagues in registered roles about what is expected.

Drawing on Skills for Health’s experience of working with a wide range of employers to explore how their workforces can be reshaped and recalibrated, the report catalogues a list of “ingredients” which have emerged that make such developments sustainable. These 12 key points aim to give those interested in workforce development a practical guide to creating demand for high quality support worker roles in the UK’s health sector. For a free copy of the paper, visit

Skills for Health plans to release a third Working Paper in this series looking at the methods in which employers can use data and intelligence to help shape what they think about the service might need for the future.