Understanding the determinants of productivity and retention in the health and social care workforce

High-income countries face enormous challenges in adapting to the pressures of an ageing population. Key among these is the increase in demand for health and social care, which will require an increase in the size and productivity of the workforce in those sectors. Policies to date have struggled to achieve this.

This research aims to inform policy by (i) providing causal evidence on the impact of managers on the productivity of nursing teams in hospitals, and (ii) documenting the impact of pay and alternative job opportunities on the ability of the social care sector to attract and retain skilled workers, and exploring the implications for care recipients.

One key challenge is finding a way to cleanly identify whether staffing changes have had a causal impact on patients in hospitals or care homes, because those staffing changes can themselves be a response to changes in the number or mix of patients. Another is the difficulty in objectively measuring the 'productivity' or output of health and social care staff, given the absence of a profit or revenue measure. Past research in this area has been further hampered by data limitations.

This work will overcome these issues through innovative use of administrative data - including bespoke data not previously made available to researchers - and credible strategies to identify causal effects, informed by discussions with experienced nursing professionals.

The first strand of the research will exploit a new, bespoke dataset linking electronic staff roster data to electronic patient records for a large NHS Trust in England. Using methods at the forefront of the econometric literature, it will exploit movements of senior nurse managers across hospital wards to identify the distribution of manager quality in a nursing setting.

It will address the following questions: how important are hospital ward managers in determining the productivity of their nursing teams? Through which channels do 'good' managers have an impact? To what extent does variation in the quality of these managers explain variation in patient outcomes across different wards and hospitals? And could a better allocation of managers to wards improve patient outcomes?

The second strand will use administrative payroll data covering more than 750,000 workers in the adult social care workforce in England. The social care sector, known internationally as the long-term care sector, is labour-intensive and increasingly economically important. Using a broad range of measures of the outside pay and job opportunities for those workers, the research will address the following questions: what impact do local labour market conditions have on retention and turnover?

In particular, what happens when the outside option for care workers changes? What are the implications for the health outcomes of patients in care homes? And why isn't pay in the social care sector more responsive to these local conditions?

The outputs of this project will be high-quality peer-reviewed evidence that directly informs clinical practitioners and UK health and social care policy. The research will build upon and benefit from excellent links with experienced nursing professionals, who will help focus the work on relevant clinical outcomes and aid with interpretation of results.

We will present work in progress and findings to a wide range of audiences, including academics, policymakers, practitioners and the general public, to enable a broad range of users to benefit from the research.