Spatial Aspects of Health-Care Employment in Britain: 1. Aggregate Trends

Abstract

In this paper I review aggregate spatial trends in employment in health care. This is a neglected area in the study of employment change. Although much attention has been given recently to the producer services sector, in numerical terms the health-care sector is a major employer and, locally, can provide a substantial proportion of jobs within individual labour markets. I first consider regional trends in health-care employment over time, and then disaggregate these, where possible, by grade of staff. The contribution of health care to total employment is then examined for standard regions arid also for travel-to-work-areas (TTWAs). Possible interpretations of these changes are then discussed. Four interrelated factors are implicated: the impact of the public expenditure policies of successive governments; the effect of policies designed to redistribute resources in the NHS; local decisions on the siting and closing of NHS hospitals; and the impact of private sector growth in health care.