HEALTH SECTOR REFORM AND TRENDS IN THE UNITED-KINGDOM HOSPITAL WORKFORCE

OBJECTIVES. The authors examine changing trends in the profile and pat terns of employment of the workforce in hospitals in the National Heal th Service (NHS) in the United Kingdom. The effect of the implementati on of the NHS reforms is considered, with particular reference to the changing composition of the nursing workforce. The authors note that t here are problems with establishing trend data because of altered info rmation requirements as a result of the NHS reforms. METHODS. Analysis and review of data from secondary sources and research publications. RESULTS. Although hospital activity rates have grown, patient length o f hospital stays decreased, and patient activity levels increased, the re has not been a linked growth in the size of the nursing workforce. The main changes in the profile of the nursing workforce highlighted a re a marked reduction in the numbers of nursing students and alteratio ns in the skill mix between first-and second-level qualified nurses. T he authors also note a large increase in the number of managerial and administrative staff employed and growth in medical staff numbers. Cha nges in working patterns and increases in contracting for support serv ices and in the use of temporary staff also are discussed. CONCLUSIONS . There have been pronounced changes in the profile of the hospital wo rkforce but little evaluation of the impact of these changes on outcom es of care.