Parkinson Beth, Cullum Nicky, Sutton Matt, Checkland Katherine, Bower Peter, Bramwell Donna, Meacock Rachel
Division of Population Health, Health Services Research and Primary Care, School of Health Sciences, University of Manchester, Manchester, UK.
Division of Nursing, Midwifery and Social Work, School of Health Sciences, University of Manchester, MAHSC, Manchester University NHS Foundation Trust, Manchester, UK.
J Nurs Manag. 2024 Jun 7;2024:7513374. doi: 10.1155/2024/7513374. eCollection 2024.
Shifting care from hospitals into community-based settings is a major policy goal internationally. Community health services in England currently face the greatest workforce shortages of all sectors, threatening the feasibility of this policy. Moreover, little is known about the extent of variation in community workforce provision regionally and how this relates to determinants of need.
To analyse regional variation in the community services workforce in England between 2010 and 2021.
We obtained NHS workforce statistics data on the number of nurses and nursing support staff providing community services at each NHS organisation in England, from March 2010 to November 2021. We aggregated the organisation-level data to both regional and national levels, which enabled us to maintain consistent units of analysis across the decade. To examine longitudinal trends and regional variation in workforce provision, we calculated the number of staff per 100,000 population aged 65+ in each region and each period. We then graphed and summarised the variation and examined the correlations with levels of deprivation and rurality.
There was a twofold variation in community services workforce provision between English regions. In November 2021, the number of staff per 100,000 people aged over 64 ranged from 300 in the South West to 697 in the North West. Most regions experienced a reduction in provision between 2010 and 2021, with a 21.2% reduction nationally. East of England experienced the largest reduction of 39.3%, whilst London experienced a 2.1% increase. In November 2021, regions with more deprived populations had higher workforce provision and regions with a larger proportion of residents living in rural areas had lower workforce provision.
The size of the community services workforce has fallen relative to population needs, contradictory to the policy priority to enhance care in the community. There was substantial regional variation in the size of the workforce, which has persisted throughout the decade. Workforce provision was higher in more deprived areas but lower in rural areas, potentially impacting equitable access in rural areas.
将医疗服务从医院转移到社区环境是一项国际主要政策目标。英国的社区卫生服务目前面临着所有部门中最严重的劳动力短缺问题，这威胁到了这项政策的可行性。此外，对于社区劳动力供应在地区间的差异程度以及这与需求决定因素之间的关系，人们了解甚少。
分析2010年至2021年期间英格兰社区服务劳动力的地区差异。
我们获取了2010年3月至2021年11月期间，英格兰每个国民保健服务（NHS）机构中提供社区服务的护士和护理支持人员数量的NHS劳动力统计数据。我们将机构层面的数据汇总到地区和国家层面，这使我们能够在整个十年间保持一致的分析单位。为了研究劳动力供应的纵向趋势和地区差异，我们计算了每个地区和每个时期每10万65岁及以上人口的工作人员数量。然后，我们绘制并总结了这些差异，并研究了与贫困程度和农村地区情况的相关性。
英格兰各地区之间社区服务劳动力供应存在两倍的差异。2021年11月，每10万64岁以上人口的工作人员数量从西南部的300人到西北部的697人不等。大多数地区在2010年至2021年期间供应减少，全国范围内减少了21.2%。英格兰东部减少幅度最大，为39.3%，而伦敦则增加了2.1%。2021年11月，人口贫困程度较高的地区劳动力供应较高，而农村居民比例较大的地区劳动力供应较低。
社区服务劳动力规模相对于人口需求有所下降，这与加强社区护理的政策重点相矛盾。劳动力规模存在显著的地区差异，且在整个十年间一直存在。贫困程度较高的地区劳动力供应较高，但农村地区较低，这可能会影响农村地区的公平可及性。
