The distribution of healthcare workforces relative to population ill health in England: Repeated cross-sectional analysis of Census data 2001-2021.

Objectives

To investigate inverse and positive care laws for the geographic distribution of different healthcare workforces in England between 2001 and 2021.

Study design

Repeated, cross-sectional, ecologic study at the level of Local Authorities (2001, 2011, 2021) and Integrated Care Boards (2021).

Methods

Using national Census survey data for England from 2001, 2011, and 2021 we correlated the prevalence of ill health in the resident population with the proportion of different health professional groups employed in the resident working-age population. To explore the previously described Positive Care Law for informal care, we correlated with the prevalence of ill health with the proportion of the resident population providing 50+ hours of unpaid care per week.

Results

Across 2001, 2011, and 2021, the distributions of medical professionals and 'health associates and therapy professionals' were consistently inversely distributed relative to population ill health. Nursing professionals and informal caregiving were consistently positively correlated. Data available in 2021 on detailed professional groups revealed wide variation in the distribution of different professional groups relative to population ill health: speech and language therapists (r=-0.456), complementary health associate professionals (r=-0.478), and psychotherapists/cognitive behaviour therapists (r=-0.558) showed the strongest inverse correlation with population ill health. Pharmaceutical technicians (0.774), nursing auxiliaries/assistants (0.764), and care workers/home carers (0.746) were among the most positively correlated.

Conclusions

Inverse and positive care laws for healthcare workforce distribution in England appear largely unchanged over the past 20 years. Marked variation between different health professions suggests the need for targeted actions to improve equitable distribution.