Health policy 132 (2023) 104827

Contents lists available at ScienceDirect

Health policy
journal homepage: www.elsevier.com/locate/healthpol

Strategic workforce planning in health and social care – an international

perspective: A scoping review
Claire Sutton a, b, *, Julie Prowse a, b, Lynn McVey a, b, c, Mai Elshehaly a, c, d, Daniel Neagu a, d,
Jane Montague a, b, c, Natasha Alvarado a, b, c, Chris Tissiman e, Kate O’Connell e, Emma Eyers b,
Muhammad Faisal a, b, Rebecca Randell a, b, c
a
Workforce Observatory, University of Bradford, UK
b
Faculty of Health Studies, University of Bradford, Bradford, UK
c
Wolfson Centre for Applied Health Research, Bradford, UK
d
Faculty of Engineering and Informatics, University of Bradford, Bradford, UK
e
Leeds Health and Care Academy, Leeds, UK

A R T I C L E I N F O A B S T R A C T

Keywords: Effective strategic workforce planning for integrated and co-ordinated health and social care is essential if future
Strategic workforce planning services are to be resourced such that skill mix, clinical practice and productivity meet population health and
Health and social care social care needs in timely, safe and accessible ways globally.
This review presents international literature to illustrate how strategic workforce planning in health and social
care has been undertaken around the world with examples of planning frameworks, models and modelling
approaches.
The databases Business Source Premier, CINAHL, Embase, Health Management Information Consortium,
Medline and Scopus were searched for full texts, from 2005 to 2022, detailing empirical research, models or
methodologies to explain how strategic workforce planning (with at least a one-year horizon) in health and/or
social care has been undertaken, yielding ultimately 101 included references.
The supply/demand of a differentiated medical workforce was discussed in 25 references. Nursing and
midwifery were characterised as undifferentiated labour, requiring urgent growth to meet demand. Unregistered
workers were poorly represented as was the social care workforce. One reference considered planning for health
and social care workers. Workforce modelling was illustrated in 66 references with predilection for quantifiable
projections. Increasingly needs-based approaches were called for to better consider demography and epidemi­
ological impacts.
This review’s findings advocate for whole-system needs-based approaches that consider the ecology of a co-
produced health and social care workforce.

1. Introduction has been outlined as a composite of horizon scanning to identify future

drivers of care needs; scenario generation or modelling to simulate
1.1. What is strategic workforce planning in health and social care? possible future outcomes and their impacts; workforce modelling to
frame the future workforce demand and supply; and policy analysis to
Strategic workforce planning in health and social care has been forecast policy implications [4,5]. Willis et al. [6] noted the healthcare
described as a technical process to predict demands for care, and the workforce is complex and planning approaches need to capture such
staff required to provide it [1,2]. Kroezen et al. [3: 87] stated health complexity not only in terms of the myriad of factors at play within
workforce planning ensures `the right number of people, with the right systems, but also to account for the uncertainty of factors and extended
skills, are at the right place, at the right time to deliver the right services timeframes over which planning needs to occurs. Strategic planning is
to those in need of them.’ In the past strategic health workforce planning co-ordinated with the organisation’s longer-term plans and typically

* Corresponding author at: Faculty of Health Studies, University of Bradford, Richmond Road, Bradford, BD7 1DP, UK.
E-mail address: [email protected] (C. Sutton).

https://doi.org/10.1016/j.healthpol.2023.104827
Received 13 October 2022; Received in revised form 6 April 2023; Accepted 17 April 2023
Available online 18 April 2023
0168-8510/© 2023 The Authors. Published by Elsevier B.V. This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/).
C. Sutton et al. Health policy 132 (2023) 104827

occurs over a two-to-five-year period with a focus on the quality and size people-centred care and welcomes digital innovations to aid service
of the workforce [7]. efficiency. Bronsoler et al.’s [23] discussion paper advocated for
Increasingly integration within and between health and social care improved patient outcomes and heightened health worker productivity
has been identified as essential for future health and social care provi­ resultant from implementation of health information technologies.
sion around the world [8,9]. However, the progress towards such pro­ Increasingly health workforce planning shifts from simple ap­
posed integration of health and social care has been debated. In the proaches that utilise professional to population ratios and health worker
United Kingdom (UK) for example, work of the Nuffield Trust [10] and density statistics, prizing single parameters such as supply/demand of a
Miller et al. [11] both noted limited evidence to support such policy single professional group or service, to more complex and comprehen­
ambition in terms of improvements in patient health outcomes or service sive approaches that engage population health needs [24,14].
integration. Moreover Anderson et al. [12] noted the historical exclusion Needs-based workforce planning strengthens health systems (respond­
of social care from workforce planning in health and care in the United ing to population health requirements) yet depends on capacity building
Kingdom as well as identifying data limitations and lack of strategic to provide the services people need [25].
planning as debars to integration in health and social care workforce Whilst service configuration and capacity may more easily be pre­
planning. Definitions of strategic workforce planning in health and so­ dicted during times of endemic disease, pandemic requirements, such as
cial care must account not only for its technicality and complexity, those experienced during COVID-19 are unique and specifically chal­
multi-factorial elements including their combinations, and timeframes lenging for health workforce planners to forecast and incorporate into
but also for a sustainable workforce of integrated services uniting health planning approaches [26]. Kunjumen et al. [14] encourage health policy
and social care. Whilst the World Health Organization [13: 9] advised its planners to be responsive to evolving emergency situations such as na­
member nations `have inclusive institutional mechanisms in place to tional and international responses to establish surge capacities within
coordinate an intersectoral health workforce agenda’, it is questionable health services. Strategic workforce planning in health and social care
how well health workforce planning has effectively incorporated social must also include levels of resilience to manage unprecedented health
care to achieve this ambition. and care needs [13].

1.2. Why is strategic workforce planning in health and social care of 1.3. What does this article contribute?
global importance?
This article presents an international academic literature review
Strategic workforce planning in health and social care is essential to depicting how strategic workforce planning has been undertaken around
ensure the provision of sustainable, safe, accessible health and social the world in a variety of health and care settings over the past seventeen
care services that meet the needs of and are utilised by populations years (2005–2021). It also describes illustrative frameworks, models and
around the world with a health workforce that is universally available, tools to support strategic workforce planning. To the authors’ knowl­
accessible, acceptable and of high quality [13,3,14]. Freer [15: 1] pre­ edge this is the first review that has sought to aggregate strategic health
dicted increasing the supply of the health workforce to meet current and social care workforce planning approaches, as well as identify gaps
demand would not be adequate, calling for a paradigm shift to `identify, in approaches such as backtesting. The review reinforces the literature
train, allocate and retain health workers.’ Szabo et al. [16] noted the about supply/demand deficits in specific workforces as well as the
global shortage of healthcare workers impacts ambitions for Universal drivers for needs-based planning approaches. It illustrates international
Health Coverage (UHC) calling for closer consideration of the health collaborations to share intelligence regarding health workforce planning
worker demography with an especial focus on inequities identifiable by globally.
gender, migration and ageing. Szabo et al. [16] noted scrutiny of the Increasingly, there is an interest in the provision of integrated health
health workforce demography is essential if UHC and the Sustainable and social care, and improving access to and use of, safe, quality care to
Development Goals (SDGs) are to be achieved. achieve the ambition of integrated health and care services aligned to
The World Health Organization [17: 2] identifies four key parame­ the World Health Organization’s SDGs. Whilst there have been inter­
ters within `a policy matrix’, denoted within their toolkit for a sustain­ national collaborations [3] and global efforts [14] to share intelligence
able health workforce targeted toward policy makers around the world. with respect to planning the health workforce, there has been very
The toolkit focuses on health workforce supply concerns, including ed­ limited consideration globally to plan for an integrated health and social
ucation and performance, planning and investment, capacity-building, care workforce; a `whole’ workforce for integrated care. Strategic
analysis and monitoring, noting policies must address the production workforce planning, regardless of analytical approach, needs to inte­
of the health workforce, inflows and outflows, maldistribution and in­ grate health and social care through whole system thinking, if acces­
efficiencies. Figueroa et al.’s [18] review examines the roles of health sible, utilised, care for all, across the lifespan, is to be provided.
leaders and workforce managers, from a global perspective, tasked often
to deliver on such policy and strategy ambitions, noting ongoing pri­ 2. Materials and methods
oritisation for reforms of cost, consolidation of hospitals and reconfi­
guration of primary healthcare for efficiencies. 2.1. Study design and rationale
The Organisation for Economic Cooperation and Development
(OECD) [19: 15] identified that health and social sectors employ 10% of Scoping reviews are noted as suitable for evidence synthesis, clari­
the workforce in OECD countries with concerns not only for global fication of concepts and identifying opportunities for and approaches to
shortages of workers but also for `the right mix of health workers, with further research [27]. A scoping review was identified as an appropriate
the right skills, … providing services in the right places, to better approach to determine a range of available evidence on the ways stra­
respond to changing population health needs.’ The OECD [19] noted tegic health and social care workforce planning is undertaken globally.
increasingly aged populations with chronic morbidities effect additional The five-stage framework proposed by Arksey and O’Malley [28] was
health and care needs that would require policy initiatives to drive utilised to scaffold the review. The Open Science Framework (https:
innovative service delivery utilising technologies and new health and //osf.io/) and Figshare (https://figshare.com/) were searched for
care worker roles. Long et al. [20] noted urgency for low- and registered scoping reviews on strategic workforce planning in health and
middle-income countries to embrace digital innovations to support social care with none identified.
health worker development and support service provision in remote
settings. More recent OECD working papers [21,22] have promulgated
global attention towards policy that drives the health workforce towards

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Table 1
Inclusion and exclusion criteria for full text screening.
Criterion Inclusion criteria Exclusion criteria
category

Type of source Published qualitative, quantitative, mixed methods studies, policy, strategy, Reviews, case reports, letters, book chapters, books, guidelines, comments,
guidance and framework documents discussions, editorials, conference abstracts, study protocols, master or
doctoral dissertation or theses
Source Full texts available from Google, University of Bradford library or inter-library Abstracts for which a full text was not available via Google, University of
availability loan requests Bradford library or inter-library loan request
Language English Any other language besides English
Area of Area 1: Area 1:
enquiry Accounts of how strategic workforce planning has been undertaken for service Focus on operational or short-term planning (less than one year); staff
provision at least one year in advance with strategic workforce planning defined scheduling; does not anticipate future requirements or preparations for future
as `a technical task – using data to develop projections of expected demand for requirements.
care and of how that demand can be met with a sufficient number of trained and
appropriately skilled staff’ (The King’s Fund 2018: 2).
Area 2:
Models and/or methodologies that may be characterised as `judgemental,
mathematical and a mix (of these)’ (6:251). May include technologies and tools.
Area 3:
Evaluations of models and/or methodologies. Area 2:
Models and/or methodologies that are ‘operational’ and/or ‘tactical’[6].
Do not describe a particular model and/or methodology.
Area 3:
Do not evaluate models and/or methodologies.

Diagram 1. The selection processes for the included literature of the review.

2.2. Search strategy #1 (“workforce” OR “human resource*” OR “personnel” OR “staff*”

OR “manpower” OR “labour”) N3 (“planning” OR “demand” OR
Searches of the international literature, using the search strings (#1 “supply” OR “modelling”) AND #2 “healthcare” OR “social care” OR
AND #2) presented below, were run in Business Source Premier, “domiciliary care” OR “community care” OR “residential care” OR
CINAHL, Embase, Health Management Information Consortium, Med­ “primary care” OR “secondary care” OR “tertiary care” OR “hospi­
line and Scopus with the following date range: 2005 to 2021 for English tal*” OR “general practi*” OR “ambulance service*”
language items with at least an abstract available. EndNote® was used to
In addition to the literature identified in academic databases, sup­
manage the review’s bibliography. An information specialist provided
plementary literature was identified from two Google searches (#a; #b)
guidance in carrying out the literature searches.

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Table 2
Summary of findings from included literature (drawing on details presented in Appendix 2)
Surname of Lead/Sole Author/s Method/Framework for Strategic Workforce Planning Region and Time Frame of Workforce Implicated
(Date of Publication) Prediction (where available)

Abel (2018) Predictive risk modelling for supply/demand United Kingdom General practice
Ahern (2019) Needs-based workforce planning; simulation model using scenario Europe Oral health
analyses
Amorim-Lopes (2021) Enhancing workforce modelling (mathematical) by embedding Portugal Health
scenario building
Ansah (2015) ‘Singapore Eye Care Workforce Model’ Singapore, 2017 – 2040 Ophthalmologists
Asamani (2021) Needs-based workforce planning including training requirements Ghana, 2020 – 2035 Primary health
Ball (2010) ‘Birthrate Plus’ - framework United Kingdom, 2001 Midwifery
onwards
Ball (2020) Safe-staffing policies’ impacts United Kingdom, 2009 - Nursing
2017
Bam (2021) Workload-based framework International/South Africa Diagnostic radiography
Batenburg (2015) Health workforce planning characteristics (supply and demand Europe Health
modelling)
Baumann (2016) Policy impact assessment Canada Health
Birch (2021) Integrated needs-based framework International/United Health
Kingdom
Blank (2017) Productivity modelling The Netherlands Hospital care
Centre for Workforce Intelligence Workforce planning framework United Kingdom Health
(2014)
Cowards (2016) Systems dynamic modelling South East England Primary care
Chung (2021) Prediction modelling Taiwan Nursing
Dejaco (2018) Requirements in workforce planning European Rheumatology
Department of Health and Social Policy United Kingdom, 2012 - Health and social care
Care (2016) 2017
Department of Health and Social Policy mandate to Health Education England United Kingdom Health and social care
Care (2021)
Department of Health and Social Policy United Kingdom Health and social care
Care (2022)
Dol (2020) Needs-based framework Tanzania Mothers as health workforce
Gallagher (2010) Modelling using skill mix, supply and demand data United Kingdom Dental
Gupta (2015) Interactive dynamic modelling tool United States Pathology
Health Education England (2018) ‘WRaPT’, planning tool using capabilities, trends and case studies United Kingdom Health
Health Resources and Services ‘Technical Documentation for Health Resources Service’, modelling United States Health
Administration (2019) tool for specific professions
Hu (2016) Planning model using linear programming United States Health
Kanagaratnam (2019) Illustration of ‘WRaPT’ United Kingdom Health
KPMG (2021) ‘Health and care transformation: how to get workforce planning International Health and care
right’, range of bespoke workforce planning solutions
Koichubekov (2021) System dynamic model (using Any Logic) using workforce flow, Serbia, 2018 - 2030 General practitioners
demography and disease prevalence
Laurence (2016) Simulation model for supply and need for general practitioners Australia General practitioners
Laurence (2017) Needs-based model Australia General practitioners
Laurence (2018) Needs-based model using scenarios Australia, 2013 - 2033 General practitioners
Lavieri (2009) Linear programming Canada, 20-year planning Nurses
horizon
Leerapan (2021) System dynamics simulation modelling to supply/demand balance Thailand Health
Looi (2021) Practitioner-to-population ratios; call for needs-based workforce Australia Psychiatrists
planning
Lopes (2018) Agent-based simulation modelling Portugal Physicians
Mabunda (2021) Implementation of Workload Indicators of Staff Need (WHO) South Africa and Peru Primary care
Maenhout (2013) Modelling nursing staff structures for scheduling Belgium Nursing
Maier (2018) Effects of new roles in workforce planning International Nurse practitioners and physician
assistants
McCarty (2013) Composite modelling in health workforce planning Australia Health
Monitor (2014) Strategic workforce planning guidance United Kingdom Health
National Audit Office, Department Workforce strategy United Kingdom Health
of Health and Social Care (2017)
National Health Service (2020) Workforce plan United Kingdom Health
National Health Service (2021) Workforce plan United Kingdom Health
Northern Ireland Assembly (2016) Workforce strategy Northern Ireland Health
Organisation for Economic Workforce projection models International (OECD Heath
Cooperation and development countries)
(OECD) (2013)
OECD (2016) Workforce policies International (OECD Health
countries)
Panzera (2016) Four stage workforce planning: needs assessment, remodelling of Australia Health
health services, workforce redesign, innovations and training
Penny (2016) Four step workforce planning methodology: scoping the workforce Australia Health
planning strategy, alignment, profiling the workforce, developing
strategies to address gaps
Pepler (2019) Indigenous models of care for planning population health and social Canada Health and social care
care workforce; whole system approach
(continued on next page)

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Table 2 (continued )
Surname of Lead/Sole Author/s Method/Framework for Strategic Workforce Planning Region and Time Frame of Workforce Implicated
(Date of Publication) Prediction (where available)

Pittman (2016) Management of workforce changes; whole system perspective United States Health
Queensland Health (2020) Regional strategy for health workforce Australia Health
Ranta (2015) Project modelling New Zealand Neurologists
Reulen (2009) Supply/demand projections Europe Neurosurgery
Robboy (2015) Dynamic modelling to forecast demand United States Pathology
Roberts (2013) Service analysis: staffing level, service quality and cost United Kingdom Palliative care
Russo (2020) Integrated workforce modelling: socioeconomic and United States Hepatology
epidemiological factors
Santric Milicevic (2018) Supply/demand projections Serbia Public health
Scheffer (2020) Workforce profiling using medical school places and physician Brazil and Spain, 1998 - 2017 Physicians
densities
Schofield (2006) Demand for hospital bed-days: demographic change model Australia, to 2050 Health
Scottish Government (2019) Workforce plan Scotland Health
Segal (2011) Needs-based workforce planning framework to skill mix and hours; Australia Health
Workforce Evidence-Based (WEB) model
Segal (2018) Needs-based workforce model Australia Community mental health care for
infants, children and adolescents
Simkin (2021) Integrated needs-based workforce planning toolkit; patient use of Canada Primary care
services
Skills for Care (2022) A practical guide for workforce planning England Social care
Skills for Care (No date) Web-based data for workforce description, analysis and planning England Social care
Skills for Health (2022) ‘Six Steps Methodology to Integrated Workforce Planning’ England Health
considering workforce size, skills, demand, demography and budget
Smith (2009) Service analysis: patient dependency, flow and skill mix United Kingdom Nursing
Somerville (2015) ‘Victorian Assistant Workforce Model’; developing workforce Australia Allied health professions
capacity
South West Yorkshire Partnership Excel based regional health workforce planning tool England Health
NHS Foundation Trust (No date)
Spetz (2015) Forecasting model for use of long-term care United States Workforce involved in care of the
older adult (over 65 years)
Stordeur (2010) Supply impacts of numerus clausus Belgium Physicians
Streeter (2017) Application of ‘Health Workforce Simulation Model’ United States Primary care
Taghavi (2021) Population-need workforce planning model to forecast staff need; Canada Palliative care
linear programming
Teljeur (2010) Stochastic modelling using policy interventions Ireland General practitioners
Teusner (2016) Workforce modelling: productivity, skill mix, workforce Australia Dental services
composition and task shifting
The Health Foundation (2019) ‘Think-tank’ report on key areas for action in health and social care United Kingdom Health and social care
workforce planning
The King’s Fund (2018) ‘Think-tank’ report on roundtable discussion: strategy for health and United Kingdom Health and social care
care workforce in England
Theppanya (2016) Workforce modelling: situation analysis, project of staff Lao Health
requirements and solutions
Thongsukdee (2020) Agent-based modelling Thailand Physicians
Tomblin Murphy (2011) Service analysis; conceptual framework Canada Nursing – hospital care
Tomblin Murphy (2012) Needs-based planning Canada Nursing
Tomblin Murphy (2013) Service-based planning framework Canada Staff for domiciliary and residential
care of older adults
Van Greuningen (2012) Evaluation of workforce planning model The Netherlands General practitioners
Van Greuningen (2013) Workforce projection modelling accuracy – back testing (1998 – The Netherlands General practitioners
2011)
Vanderby (2014) Simulation using system dynamics United States Cardiac surgeons
Vigersky (2014) Supply/demand projections United States, to 2025 Endocrinology workforce
Vile (2016) Demand forecasting and labour scheduling modelling Wales Emergency medical services
Von Eitzen-Strassel (2014) Skill mix analysis The Netherlands General practitioners
Welsh Parliament (2020) Workforce strategy Wales Health and social care
West Yorkshire Health and Care Regional workforce strategy England Health and social care
Partnership
Whitehouse (2020) Supply/demand projections United Kingdom Neurosurgery
Whole Systems Partnership (2022) Strategic workforce planning framework: ‘SWiPe’ United Kingdom Health
World Health Organization (2010) Supply-focused workforce planning models and tools International Health
World Health Organization (2010) ‘Workload Indicators of Staffing Needs’ (WISN) – supply focused International Health
workforce planning tool
Wranik (2008) Typology of health human resourcing strategies: micro- to macro- International Health
levels
Yao (2016) ‘Birthrate Plus’ – application of model China Midwifery
Yasutake (2012) Four-point plan to augment workforce Hawaii, to 2020 Health

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detailed below, and hand searching references lists from previously [49], the Netherlands [50–52] Kazakhstan [53] and Australia [54–56].
identified literature as well as reviewers’ personal libraries. The shortage of registered nurses is noted from generic and specific
perspectives in the literature. For example, there is an enduring deficit of
#a “strategic workforce planning” health; #b “strategic workforce
nurses in the UK [57] and a commitment to 50 000 more nurses in the
planning” “social”
UK’s National Health Service (NHS) by 2025 [58]. Unlike the literature
regarding the medical workforce, which can be differentiated by spe­
2.3. Initial screening cialty, the literature about the nursing workforce has given nurses a
homogenous identity with the nursing workforce differentiating the
In total 6894 references were identified from six academic databases. nursing workforce by patient outcomes [59,60], patient
Following de-duplication, the title/abstract of 6105 references were dependency-acuity [61,62], the importance of needs-based planning
divided among a team of nine reviewers and screened once using the [63], organisation of nursing staff [64] and safe staffing [65]. Penny and
algorithm presented in Appendix 1. This yielded 654 references that Fennah [66] identified a lack of specific methodologies for strategic
were subsequently divided between two reviewers for full text retrieval workforce planning in community nursing, noting strategic planning is
and screening utilising inclusion/exclusion criteria (presented in Table 1 essential for long term workforce solutions.
below). Birthrate Plus®, a key methodology to plan the midwifery workforce
The first 80 items of the two Google searches [29] were screened by in the UK [67,68] and in China [69], dominates the literature about
one reviewer with a total of 26 items identified for full text review using midwives. Both Ball and Washbrook [67] and Yao et al. [69] noted an
the inclusion/exclusion criteria in the subsequent section. Seven items imbalance in the midwifery workforce supply to provide current levels
from reviewers’ personal libraries were also included. of care, advising patient acuity and the contribution of support workers
are essential components in planning the midwifery workforce. Allied
2.4. Inclusion and exclusion criteria for full text screening and data health professionals have minimal representation within the literature
extraction [70,71]. Unregistered health workers are under-represented within the
literature and as contributors to specific disciplines only [72,73].
Inclusion and exclusion criteria for full text screening are presented The adult social care workforce is a marginal presence within the
in Table 1. Inclusion criteria privileged empirical research, for example literature as required workforce to meet the increasing demand for long-
studies. Owing to the volume of included literature, reviews were term care manifest through a growing aged population [74,75].
excluded. Three areas of enquiry were identified. These areas of enquiry
were also used to categorise broadly and extract data from the literature 3.1.3. Health and social care services and needs
of this review. Data extraction was undertaken as an iterative process. Health services are addressed by a range of references (subsequently
All full text screening and data extraction was carried out by two re­ discussed). By contrast social care needs are discussed in the work of two
viewers contemporaneously. articles. Spetz et al. [74] discussed the long-term care needs of older
adults and the differential use of such services by ethnicity whilst Pepler
3. Results and Martell [76] advocated for the importance of planning for and
providing health and social care that is responsive to the needs of
3.1. Overview of the literature indigenous peoples.
In-patient health workforce demand within the literature has been
A simple diagram to show the selection process of included items is planned for variably but includes the use of estimates of bed-days [77],
presented below (Diagram 1). Table 2, below, presents a summary of patient dependency-acuity [61], workforce productivity [78], accessible
findings from included literature drawing on details presented in Ap­ and safe care [65].
pendix 2. Appendix 3 offers named examples of workforce models. The Community-based care is represented within the literature with il­
results of the review are presented to reflect the key areas of enquiry as lustrations of specialist services and denoted current deficits [79,66,80].
denoted in the above table with the exception of Area 3, for which there Segal et al. [79] utilised a needs-based model to identify a deficit of 947
was very limited evidence. personnel and AU$126 million, five times the current provision, for
tertiary-level community mental health care for infants, children and
3.1.1. Date range and type of literature adolescents in South Australia. In response to an identified lack of ap­
The distribution of literature across the date range of this review is proaches suitable to plan the future nursing workforce for a child and
presented in Bar chart 1 (below). Most included literature was published youth community health service in Queensland, Australia, Penny and
in either 2016 or 2021 (13 items each), with more limited literature Fennah [66] designed their own four stage approach. Similarly, Taghavi
published before 2010. Most empirical research of this review provides et al. [80] designed, implemented and reported a population-need
workforce modelling illustrations with 58 of the 101 references (see Bar workforce planning model, utilising linear programming within an op­
chart 2 below). Most of the 12 policy and strategy documents are from erations research approach, for a community-based palliative care
nations of the United Kingdom with one document only from elsewhere multidisciplinary team to predict staffing to 2038.
(Queensland, Australia). The increased need for care services for older adults and those with
chronic disease globally is noted [81] but there are limited specific il­
3.1.2. Groups of health and social care workers represented lustrations within the literature regarding how the workforce for such
The medical and dental workforces are most heavily represented need is planned. Tomblin Murphy et al. [82] examined home and
within the review’s literature with 28 items. Gallagher et al. [30], Ahern long-term care provision in Nova Scotia, calling on policy makers to
et al. [31] and Birch et al. [32] discussed the oral health workforce consider the type of service required by service users. Segal and Leach
including dentists. Several references denoted the supply/demand for [83] identified the importance of the multidisciplinary team to provide
physicians [33–36] or medical workforce [37] with others focused on optimal care for those with chronic disease yet a lack of literature to
individual specialities including psychiatry [38], neurosurgery [39,40], explain and plan for the skill mix required to deliver it. Segal and Leach
public health [29], endocrinology [41], cardiac surgery [42], neurology [83] advocated for the use of needs-based workforce planning to meet
[43], pathology [44], hepatology [45], ophthalmology [46] and rheu­ the complex needs of those with chronic disease noting three tiers of
matology [47]. consideration: 1. population needs assessment aligned with
There is notable concern for the supply and demand for general best-practice care competencies, 2. regional service requirement as
practitioners and the general practice workforce in the UK [48], Ireland full-time equivalent competencies aligned with occupations required to

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Bar chart 1. Number of references by year.

Bar chart 2. Number of references by categories of literature

deliver such competencies, and 3. policy implications including sup­ et al. [31: 2] defined provider supply by: `existing stock, flow and newly
ply/demand comparisons, resource, education and training trained’.
implications. Birch et al.’s [85] more contemporary work noted reliance on pro­
vider (supply/demand) projections by singular profession, a lack of
3.2. Approaches to strategic workforce planning in health and social care integration in health workforce planning with service provision and
funding, a lack of consideration for the requisite skill mix to best meet
Projection approaches, which the World Health Organization [84] population needs, a lack of consideration of the contribution of new
have grouped into those using workforce-to-population ratios, health roles and task substitution to improve service capacity and efficiency
needs, service demands and service targets, have been often used for and lack of consideration for productivity. Despite the challenges of
health workforce planning yet identified by the OECD [81] as limited. workforce supply/demand projections there are a variety of illustrations
within the literature which have demonstrated supply/demand ap­
3.2.1. Workforce supply and demand approaches proaches often culminating in supply/demand growth predictions from
Historically, workforce supply and demand have founded workforce scenario generation.
projections, where `supply’ can be described as the number of staff or Reulen et al. [39: 719] presented data on the characteristics of the
skills to provide care, and `demand’ can be described as the required neurosurgical workforce from 27 European countries, with the aim of
(number of) staff or skills to provide care [84]. More recently Ahern identifying the demand for neurosurgeons (‘real needs of neurosurgeon

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per population’) and number of neurosurgeons in training. Reulen et al. [63,83,85,87]. Of note there are multiple illustrations within the liter­
[39] collated primary survey data to identify the number of neurosur­ ature of needs-based approaches in workforce planning in community
geons of each country, the number of neurosurgical operations per [79,80] and primary care settings [55,56,88,89]. Health and social care
million population per year, the nature of the neurosurgical case load, services’ access, utilisation and configuration for efficacy, as well as
implementation of a numerus clausus (capped trainee number), average efficiency, notably cost efficiency, are dependent on population needs
annual intake of new trainees, the annual loss rate, annual intake against [85] and as such workforce planning models are recommended to
annual loss rate and total number of neurosurgeons. Reulen et al. [39] consider demographic and epidemiological perspectives [88]. The
noted there was considerable variation in neurosurgeon-to-population King’s Fund [2: 4], in relation to the UK’s health and social care work­
ratio, those countries with fewer neurosurgeons undertook fewer force planning ambitions noted that prioritising `standards of care,
neurosurgical operations, a numerus clausus was used in 13 of 27 targets or what patients … want … will provide a different picture of
countries and annual attrition rates owing to retirement for instance, workforce requirements.’
range from 2.3% to 3.36%. Whitehouse et al.’s [40] later UK based Facets of population demography and epidemiology in needs-based
neurosurgical workforce projection research again utilised primary workforce planning approaches are variably considered within the
survey data with the aim of identifying changes in the number of literature. Segal and Leach’s [83] workforce modelling for primary and
consultant neurosurgeons over a five-year period (2014–2018) and community care, espousing a needs-based approach, organised their
those who had achieved a Completion of Certificate of Training. workforce planning framework by population health status and
Whitehouse et al. [40] went on to develop neurosurgeon workforce best-practice care to provide for population health, regional service re­
projections with five alternative scenarios based on changes in consul­ quirements by full time equivalent requirement and occupations
tant retirement numbers, consultant post increases and non-trainees required to deliver best-practice care and policy implications. Segal
appointed. They concluded current trends in the UK neurosurgical et al.’s [79] later work, in modelling for a tertiary-level community
workforce projected a deficit in supply. mental health service for young people, framed a needs-based workforce
Vigersky et al. [41] developed supply/demand projections for the within regional planning and workforce, needs analysis, the regional
endocrinology workforce of the United States utilising primary survey workforce, clinical workforce costs and service delivery implications.
data on endocrinologist demographics and non/clinical practice with Panzera et al.’s [90] action research to inform health services
secondary data from national medical associations and boards. Supply commissioning in Northern Queensland, Australia, utilised a four staged
was derived from endocrinologists in training and those who had approach starting with a health needs assessment phase including
completed training. Attrition rate was defined by emigration, change in identification of essential services, remodelling to facilitate prioritisa­
professional activity, leave, retirement or death data. Algebraic tion to meet needs, workforce redesign and development to identify and
formulae were derived to generate supply figures by full time equiva­ project requisite skill sets and lastly a training plan to effect workforce
lents and demand by number of visits as well as full time equivalents. reconfiguration and training pathways. Within Ahern et al.’s [31: 3]
Three scenarios were generated to project supply/demand possibilities. modelling, `need’ is categorised by `population’, `health status’ and
The first two scenarios considered factors affecting the workforce `level of service’. Dejaco et al.’s [47] points to consider in rheumatology
environment such as increased training positions, whilst the third sce­ workforce requirements noted the importance of identifying need for
nario sought to identify the number of training positions required to care based on prevalence and referral rates of diseases managed by
address the supply/demand imbalance in five and ten years respectively. rheumatologists, current and future demographics, sociocultural char­
Ranta et al. [43] similarly gathered primary survey data on New acteristics and disease trends.
Zealand’s neurology workforce in public hospitals for workload and National and regional health needs and priorities are frequently
productivity analyses by full time equivalents and patient contact identified and driven by governmental policy ambitions. For example,
equivalents (PCEs) for supply/demand projections. They noted antici­ the recent paper from the UK’s Department of Health and Social Care
pating future supply/demand balance was challenging owing to con­ [91]: Section 1.8 identified the importance of integration between
founding factors and practice variation. Scenario modelling was also health and social care services to provide `co-ordinated’ services that
used to understand the impacts of increased training opportunities, new provide `the right care, in the right place, at the right time’ through a
roles, novel technologies and service delivery changes for efficiency. `shift to prevention … to address people’s needs … .’ Queensland Health
Ranta et al. [43] concluded a supply/demand imbalance for the New [92: 4] noted health services are increasingly in demand, and this de­
Zealand neurology workforce yet advocated for the use of PCEs to better mand must be delivered through a `networked’ approach that is sus­
quantify productivity for service demand projections. tainable, provided at `whole-of-system’ level and is responsive.
Teljeur et al. [49] described a supply/demand analysis using general Queensland Health [92] outlined a strategic planning approach to pro­
practitioner visits as indicators of demand with supply enhancement vide such health services that considers workforce capacity, capability
projections based on four potential policy directives: increasing training (skills), sustainability and diversity, design (including strategic and
places, international recruitment, incentivising later retirement and the organisational) and the culture of the health work environment for
upskilling of practice nurses to substitute for general practitioners for wellbeing and performance.
some tasks. Scheffer et al.’s [36] comparative analysis of the supply of Local and regional approaches for delivering on such governmental
physicians and specialist trainees in Brazil and Spain examined the ambitions for population health and social care needs identify nuanced
impact of increased training places, notably via private medical schools, considerations. Pepler and Martell [76] pointed to the importance of
to augment supply growth rate. They found the policy initiative of planning a health and social care workforce that is sensitive and
limited efficacy and called for service-use appraisal, multidisciplinary competent to provide care that befits indigenous peoples calling notably
care and the better consideration of demographic and epidemiological for increases in indigenous professionals to better represent as well as
factors in workforce planning. provide for, First Nations, Inuit and Metis peoples and their needs.
Whilst supply/demand projections are traditional and embedded Pepler and Martell [76] noted a disproportionate burden of chronic
approaches in workforce planning, needs-based approaches including disease among indigenous peoples noting their late utilisation of
service level and utilisation have gained increased attention around the services.
world [2,38,47,85–87]. There has been a similar interest in geographic variation in specialist
health services. For example, Russo et al. [45] noted a need to encourage
3.2.2. Health and social care needs-based planning approaches hepatologists to areas outwith specialist centres. Ranta et al.’s [43]
Population health needs approaches to health and social care analysis of the New Zealand neurology workforce noted access to
workforce planning have been used increasingly over the last decade specialist neurologist/s in rural parts of the country is especially limited.

8
C. Sutton et al. Health policy 132 (2023) 104827

Appendix 2
Included literature.
Lead author (Country/ies or Date of Headline of workforce planning approach (May include document title Sourced from Type of
continent to which workforce publication in italics) literature
planning pertains)

Abel, G. (United Kingdom) 2018 Predictive risk modelling for general practice; supply/demand imbalance Database Empirical
research/
modelling
Ahern, S. (Europe) 2019 Needs-based workforce planning model (in Microsoft Excel) for oral health Database Empirical
workforce; simulation model based on framework of Birch et al. (2007); research/
scenario analyses modelling
Amorim-Lopes, M. (Portugal) 2021 Enhancing workforce modelling by embedding scenario building within Database Empirical
mathematical planning models research/
modelling
Ansah, J. (Singapore) 2015 Singapore Eye Care Workforce Model to forecast ophthalmologists (2017 to Database Empirical
2040); workforce stocks; system dynamics; three components: eye disease; research/
demand and workforce requirements; four scenarios modelling
Asamani, J. (Ghana) 2021 Needs-based health planning framework (in Excel); fifteen-year projection Database Empirical
(2020 to 2035) of health workforce supply, needs, gaps and training research/
requirements in primary health care in Ghana modelling
Ball, J. (United Kingdom) 2010 Overview of theoretical framework of Birthrate Plus® (BR+) and Database Empirical
subsequent studies (since 2001) of BR+ implementation research/
modelling
Ball, J. (United Kingdom) 2010 Birthrate Plus®, ratios of births to midwives to plan for additional staffing Database Empirical
needs from `out-of-area’ deliveries and follow-up postnatal care research
Ball, J. (United Kingdom) 2020 Nursing workforce staffing description (2009 to 2017); impact of safe Database Empirical
staffing policies research
Bam, L. (International/South Africa) 2021 Diagnostic radiographer staffing requirements by workload-based Database Empirical
framework research/
modelling
Batenburg, R. (Europe) 2015 Score European countries by health workforce planning characteristics: data Database Empirical
infrastructure; workforce planning mechanism; use of health workforce research
modelling (focus on supply and demand modelling)
Baumann, A. (Canada) 2016 Description of policy impact Google Empirical
research
Birch, S. (Europe) 2020 Apply integrated needs-based framework (based on Birch et al. (2007) to re- Database Empirical
configure care delivery; re-allocation of treatment tasks; impacts on care research/
costs by pay, productivity and practice style modelling
Birch, S. (International/United 2021 Design of `fit for purpose’ workforce planning model for oral health Database Empirical
Kingdom) workforce: model including changes in demography, epidemiology, care research/
pathways and productivity modelling
Blank, T. (The Netherlands) 2017 Modelling productivity growth using factor technical change (FTC) for a Database Empirical
Dutch hospital (2003 to 2011); improve forecasting for demand research/
modelling
Centre for Workforce Intelligence 2014 Robust workforce planning framework, An introduction; framework to include Reviewer’s Think-tank/
(United Kingdom) horizon scanning, scenario generation, workforce modelling, policy personal library Academic report
analysis; supply and demand (workforce modelling) orientated
Coward, M. (England) 2016 Project report for primary care strategic workforce planning in South East of Google Think-tank/
England; system dynamics modelling Academic report
Chung, M. (Taiwan) 2021 Prediction model for nursing staff in cancer care using fuzzy sets to account Database Empirical
for uncertainties to improve flexibility of results research/
modelling
Dejaco et al. C. (Europe) 2018 Ten points to consider in Europe rheumatology workforce requirement Database Empirical
studies research/
modelling
Department of Health and Social Care 2016 Workforce planning for health, public health and social care; webpage Google Policy/Strategy
(United Kindgom) providing links to a collection of policy paper (2012 to 2017) each relation
to individual medical specialties
Department of Health and Social Care 2021 DoHSC mandate to Health Education England (HEE), requirement of the Reviewer’s Policy/Strategy
(United Kingdom) Care Act 2014; HEE’s responsibility for workforce planning, education and personal library
training; policy paper
Department of Health and Social Care 2022 Joining up care for people, places and populations; policy paper Reviewer’s Policy/Strategy
(United Kingdom) personal library
Dol, J. (Tanzania) 2020 Needs-based framework examining contribution of mothers as health Database Empirical
workforce resource; conceptual framework (as in Tomblin Murphy 2011 research/
and in Birch 2007) modelling
Gallagher, J. (United Kingdom) 2010 Modelling dental workforce skill mix using supply and demand data and Database Empirical
scenario planning to assess impacts of variation in staff competencies (2005 research/
to 2028) modelling
Gupta, S. (United States) 2015 Interactive dynamic modelling tool; scenario-based; for analysis of United Database Empirical
States pathologist workforce to forecast supply and demand research/
modelling
Health Education England (England, No date Webpage of HEE Star; solution-focused workforce planning framework Reviewer’s Modelling tool/s
United Kingdom) personal library
Health Education England (England, 2018 WRaPT, website: health workforce planning intelligence sub-categorised Google Modelling tool/s
United Kingdom) into capabilities, trends and case studies
(continued on next page)

9
C. Sutton et al. Health policy 132 (2023) 104827

Appendix 2 (continued )
Lead author (Country/ies or Date of Headline of workforce planning approach (May include document title Sourced from Type of
continent to which workforce publication in italics) literature
planning pertains)

Health Resources and Services 2019 Technical Documentation for Health Resources Service; guide to modelling Google Modelling tool/s
Administration (United States) health workforce focus on specific health professions
Hu, W. (United States) 2016 Health workforce planning model using linear programming methodology; Google Empirical
test lookahead policy using model research/
modelling
Kanagaratnam, S. (United Kingdom) 2019 Description and illustrations of workforce planning framework (Workforce Google Empirical
Repository and Planning Tool (WRaPT)) from Health Education England research/
modelling
KPMG 2021 Health and care transformation: how to get workforce planning right; website Reviewer’s Modelling tool/s
advertising a range of workforce planning resource personal library
Koichubekov, B. (Serbia) 2021 System dynamic model (using Any Logic) including general practitioner Database Empirical
flow, demography and disease prevalence (2018 to 2030); three scenarios research/
for forecasting modelling
Laurence, C. (Australia) 2016 Simulation model to estimate supply and need for general practitioners Database Empirical
research/
modelling
Laurence, C. (Australia) 2017 Needs-based model for general practitioner requirement (2013 to 2033); Database Empirical
simulation model; scenario modelling (policy/non-policy) research/
modelling
Laurence, C. (Australia) 2018 Needs-based model to estimate general practitioner requirements (2013 to Database Empirical
2033) using five scenarios research/
modelling
Lavieri, M. (Canada) 2009 Linear programming hierarchical planning model to determine number of Database Empirical
nurses to train and recruit over a 20 year planning horizon research/
modelling
Leerapan, B. (Thailand) 2021 System dynamics simulation modelling of health care workforce by group Database Empirical
model building to understand supply/demand im/balance research/
modelling
Looi, J. (Australia) 2021 Psychiatrist-to-population ratio projections; call for needs-based workforce Database Empirical
planning research/
modelling
Lopes, M. (Portugal) 2018 Agent-based simulation modelling for medical workforce; `physician’ as Database Empirical
agent research/
modelling
Mabunda, S. (India, South Africa and 2021 Implementation of WISN for primary care in India, South Africa and Peru Database Empirical
Peru) research
Maenhout, B. (Belgium) 2013 Modelling nursing staff organisational structure for scheduling Database Empirical
research/
modelling
Maier, C. (Eight countries) 2018 Inclusion and effects of new roles (nurse practitioner and physician Database Empirical
assistants) in workforce planning research
McCarty, M. (Australia) 2013 Overview of key elements in Australia’s health workforce planning: Database Empirical
composite modelling research
Monitor (United Kingdom) 2014 Strategic workforce planning tool/guidance for health workforce Google Modelling tool/s
National Audit Office, Department of 2020 National report (description and strategy) on the United Kingdom’s nursing Google Policy/Strategy
Health and Social Care (United workforce; challenges to workforce planning: understanding future need;
Kingdom) performance of current and future supply; workforce plan; information/
data; integrating workforce, finance and performance; coverage of all types
of staff in planning
National Health Service (England, 2017 Facing the Facts, Shaping the Future, A draft health and care workforce strategy Google Policy/Strategy
United Kingdom) for England
National Health Service (United 2020 WE ARE THE NHS: People Plan for 2020/2021 – action for all Google Policy/Strategy
Kingdom)
National Health Service (United 2021 The future of NHS human resources and organisational development; vision and Google Policy/Strategy
Kingdom) actions for four pillars of `We are the NHS: People Plan for 2020/2021′
Northern Ireland Assembly (Northern 2016 Health and Social Care Workforce Strategy 2026, Delivering for Our People Google Policy/Strategy
Ireland, United Kingdom)
Organisation for Economic Cooperation 2013 Health Workforce Planning in OECD Countries, A Review of 26 Projection Google Think-tank/
and Development (International) Models from 18 Countries Academic report
Organisation for Economic Cooperation 2016 Health Workforce Policies in OECD Countries Google Think-tank/
and Development (International) Academic report
Panzera, A. (Australia) 2016 Four stage workforce planning approach: needs assessment, remodelling of Database Empirical
health services, workforce redesign, innovations and training research/
modelling
Penny, R. (Australia) 2020 Four-step workforce planning methodology: scope the workforce planning Database Empirical
strategy; alignment; profile the workforce; develop strategies to address research/
gaps modelling
Pepler, E. (Canada) 2019 Use of indigenous models of care for population health; health and social Database Empirical
care workforce; systems thinking; scenario planning; population health research/
simulation; whole system approach modelling
Pittman, P. (United States) 2016 Management of workforce changes; whole system perspective rather than Database Empirical
single professions research
Queensland Health (Australia) 2020 Regional strategy; frameworks and associated tools for health workforce Google Policy/Strategy
planning in Queensland, Australia
(continued on next page)

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C. Sutton et al. Health policy 132 (2023) 104827

Appendix 2 (continued )
Lead author (Country/ies or Date of Headline of workforce planning approach (May include document title Sourced from Type of
continent to which workforce publication in italics) literature
planning pertains)

Ranta, A. (New Zealand) 2015 Supply/demand projection modelling for neurologist workforce Database Empirical
research/
modelling
Reulen, H. (Europe) 2009 Supply/demand projections for neurosurgical workforce Database Empirical
research/
modelling
Robboy, S. (United States) 2015 Dynamic modelling/interactive system of algebraic formulations to forecast Database Empirical
demand for pathologist services research/
modelling
Roberts, D. (United Kingdom) 2013 Service analysis: palliative care; staffing level; service quality and cost Database Empirical
research
Russo, M. (United States) 2020 Integrate workforce framework model of hepatology workforce: Database Empirical
socioeconomic factors; epidemiological factors research/
modelling
Santric Milicevic, M. (Serbia) 2018 Supply/demand projections (to 2025) for public health workforce; use of Database Empirical
Microsoft Excel research/
modelling
Scheffer, M. (Brazil and Spain) 2020 Physician workforce description using longitudinal data 1998 to 2017; Database Empirical
association medical school places and physician densities in Brazil and research/
Spain modelling
Schofield, D. (Australia) 2006 Future demand for hospital bed-days (to 2050); demographic change model Database Empirical
research/
modelling
Scottish Government (Scotland, United 2019 An Integrated Health and Social Care Workforce Plan for Scotland Google Policy/Strategy
Kingdom)
Segal, L. (Australia) 2011 Application of needs-based workforce planning framework to predict health Database Empirical
workforce team’s skill mix and hours; Workforce Evidence-Based (WEB) research/
planning model modelling
Segal, L. (Australia) 2018 Needs-based workforce model for community mental health care of infants, Database Empirical
children and adolescents research/
modelling
Simkin, S. (Canada) 2021 Integrated needs-based primary care workforce planning toolkit; patient use Database Empirical
of services research/
modelling
Skills for Care (England, United 2022 A practical guide for strategic workforce planning, shaping and commissioning; Google Think-tank/
Kingdom) Key consideration for local authorities in planning for the social care Academic report
workforce; manual
Skills for Care (England, United No date Workforce intelligence; Website providing data and publications regarding Google Think-tank/
Kingdom) workforce data, description, analysis and planning Academic report
Skills for Health (United Kingdom) 2022 Six Steps Methodology to Integrated Workforce Planning; approach for Google Modelling tool/s
`workforce of right size … right skills … taking into account … demand …
local demographic situation … to the budget …’
Smith, S. (United Kingdom) 2009 Service analysis: nursing workforce requirement based on patient Database Empirical
dependency-acuity, patient flow, skill mix research
Somerville, L. (Australia) 2015 Developing workforce capacity: allied health professions; Victorian Database Empirical
Assistant Workforce Model – Allied Health research/
modelling
South West Yorkshire Partnership NHS No date Workforce & Success Planning Round 2021–22; Excel based regional health Reviewer’s Modelling tool/s
Foundation Trust (England, United workforce planning tool personal library
Kingdom)
Spetz, J. (United States) 2015 Forecasting model for use of long term care by people aged 65 years and Database Empirical
over research/
modelling
Stordeur , S. (Belgium) 2010 Supply impacts of numerus clausus for physicians Database Empirical
research/
modelling
Streeter, R. (United States) 2017 Application of Health Workforce Simulation Model to examine the Database Empirical
geography of primary care research/
modelling
Taghavi, M. (Canada) 2021 Population-need (community based palliative care specialist teams) Database Empirical
workforce planning model to forecast staff need for next 20 years; research/
operations research; linear programming modelling
Teljeur, C. (Ireland) 2010 Stochastic modelling for probable future supply of general practitioner Database Empirical
based on four policy interventions research/
modelling
Teusner, D. (Australia) 2016 Dental service provision and capacity analysis by workforce modelling: Database Empirical
productivity, skill mix, workforce composition, task shifting research/
modelling
The Health Foundation (United 2019 ‘Think-tank’ report on key areas for action in the health and social care Google Think-tank/
Kingdom) workforce of the United Kingdom Academic report
The King’s Fund (United Kingdom) 2018 ‘Think-tank’ report on roundtable discussion about strategy for health and Google Think-tank/
care workforce in England: supply/demand scenarios, productivity, Academic report
workforce planning, modelling, data
(continued on next page)

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C. Sutton et al. Health policy 132 (2023) 104827

Appendix 2 (continued )
Lead author (Country/ies or Date of Headline of workforce planning approach (May include document title Sourced from Type of
continent to which workforce publication in italics) literature
planning pertains)

Theppanya, K. (Lao) 2016 Provincial workforce planning: situation analysis; projection of staff Database Empirical
requirement; solutions research/
modelling
Thongsukdee, P. (Thailand) 2020 Physician supply; agent-based modelling; systematic approach; sensitivity Database Empirical
analysis research/
modelling
Tomblin Murphy, G. (Canada) 2011 Service analysis: nursing inputs and outcomes of hospital care; conceptual Database Empirical
framework of health-care system research
Tomblin Murphy, G. (Canada) 2012 Needs-based planning to reduce nursing workforce shortage Database Empirical
research/
modelling
Tomblin Murphy, G. (Canada) 2013 Service-based planning framework for older adults in home and long term Database Empirical
care research/
modelling
Van Greuningen, M. (The Netherlands) 2012 Evaluation of Dutch health workforce planning model when applied to Database Empirical
general practitioner workforce research/
modelling
Van Greuningen, M. (The Netherlands) 2013 Workforce projection modelling accuracy; backtesting; general practitioner Database Empirical
workforce 1998 to 2011 research/
modelling
Vanderby, S. (Canada) 2014 Cardiac surgeon workforce modelling/simulation using system dynamics; Database Empirical
includes demand and supply components; feedback loops; facilitates research/
scenario exploration modelling
Vigersky, R. (United States) 2014 Supply/demand projections for endocrinology workforce (to 2025) Database Empirical
research/
modelling
Vile, J. (Wales) 2016 Emergency services management; demand forecasting; labour scheduling Database Empirical
modelling research/
modelling
Von Eitzen-Strassel, J. (The 2014 Skill mix analysis of Dutch general practitioners Database Empirical
Netherlands) research/
modelling
Welsh Parliament (Wales, United 2020 A Healthier Wales: Our Workforce Strategy for Health and Social Care Google Policy/Strategy
Kingdom)
West Yorkshire Health and Care 2022 People Plan, Workforce Strategy 2021–2025; regional strategy Reviewer’s Policy/Strategy
Partnership (England, United personal library
Kingdom)
Whitehouse, K. (United Kingdom) 2020 Supply/projections of neurosurgical workforce Google Empirical
research/
modelling
Whole Systems Partnership (United 2022 Population health led strategic workforce planning framework; Strategic Reviewer’s Modelling tool/s
Kingdom) Workforce Planning (SWiPe®) personal library
World Health Organization 2010 Models and tools for health workforce planning and projections; overview of Google Think-tank/
(International) supply-focused health workforce planning models and tools Academic report
World Health Organization 2010 Webpage with link to Workload Indicators of Staffing Need (WISN); supply- Google Modelling tool/s
(International) focused health workforce planning tool initial iteration Shipp (1998)
Wranik, D. (Canada) 2008 Typology of health human resourcing strategies by micro (individual) and Database Empirical
macro (regional/national) levels research
Yao, J. (China) 2016 Implementation of Birthrate Plus® in China for midwifery workforce Database Empirical
demand research/
modelling
Yasutake, J. (Hawaii, United States) 2012 Four-point plan to increased primary care workforce by 20% by 2020: early Database Empirical
warning system for impending workforce shortages, fill gaps in education research/
and training, strengthen pipeline into health careers, additional resourcing modelling
to maximise benefit of health care provision

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Theppanya et al. [93] highlighted the importance of provincial modelling at the level of the individual physician offered policy and
engagement of Bolikhamxay, Laos, to ensure health services can respond operational insights with an especial interest in modelling the
to increasing demand, despite diminished staffing supply in provincial geographical imbalance between urban and rural physician densities.
areas. Managing uncertainty within modelling is challenging and complex
Level of service standard and service targets are impacted by and [94]. The means by which uncertainty is managed within modelling is
impact on level of need. Smith et al. [61] utilised generic categories of often dependent on the nature of the uncertainty and outcomes sought
patient dependency-acuity (from acute hospital wards in the UK) and [94,59]. Stochastic, robust programming and sensitivity analysis model
staffing levels (aligned to patient dependency-acuity) to comment on uncertainty variably [94]. Stochastic programming, akin to robust
service quality. They called for additional patient dependency-acuity programming, processes unknown parameter values using random pa­
categories to better reflect specific needs of particular population rameters and/or uncertainty sets, usually from a probability function
groups such as those utilising primary care, mental health and learning and provide a worst-case guarantee. Vile et al. [70] utilised stochastic
disability services. Roberts and Hurst [62] similarly evaluated service modelling to forecast demand for emergency medical services and
quality by patient dependency and staff activity but also included cost generate efficient staffing estimates to match changeable demand. Lopes
considerations in their planning approach. Tomblin Murphy et al. [82] et al. [37] applied Monte Carlo simulation to ascertain the impact of
advised service-based health human resource planning, based on how input parameter variation in their agent-based modelling of physician
often a service is required against how often a service is performed, to supply in Portugal. Chung et al. [59] used fuzzy sets to substitute known
predict service level aids prediction of capacity. Birch et al. [85] advo­ values in a dynamic model to forecast nursing personnel requirements
cated for a needs-based approach to planning that incorporates service for cancer care over a ten-year planning horizon. Robust programming is
elements, such as skill mix or competency requirements, productivity criticised for its conservativeness, whilst stochastic approaches are
levels and task or provider substitution, to improve service efficiency criticised because it is difficult to understand how they generate optimal
notably cost savings as well as move to inter- and multi-disciplinary solutions [94]. Sensitivity analysis attempts to harness the contribution
models of care provision that align to service targets. of inputs to the variation of optimal solutions [86]. However, it does not
consider data uncertainty at the modelling stage [94]. Sensitivity anal­
3.2.3. Descriptive and predictive workforce modelling ysis does not capture inter-relationships between input parameters [94].
Modelling of the health and social care workforce is often utilised to Asamani et al. [24,88] advised sensitivity analyses utilised a full range of
provide a quantitative forecast of future staffing supply and demand as input values, as well as structural uncertainty or policy scenarios to
well as population needs [47,94]. Modelling is frequently mathematical capture key assumptions implicated in analyses.
to generate numerical predictions, given uncertainty within multiple Scenario generation, application and analysis are commonly utilised
input parameters for health and social workforce planning [94]. How­ within health workforce modelling both within supply/demand pro­
ever, frameworks [85] or toolkits [89] incorporating mathematical el­ jections [29,40,42,43,98] and within needs-based approaches [30,31,
ements may also be utilised. Increasingly it is noted supply/demand 34,56,88,89,94,99] to make predictions about challenging futures [4,5]
considerations must be considered alongside population needs if defined through changing one or more input parameters [94]. Whilst
comprehensive modelling approaches are to be designed and used [88, policy analysis has been categorised separately from scenario generation
95]. Dejaco et al. [47] advised workforce modelling needs to account for by the Centre for Workforce Intelligence [5], it can be seen in the
technological advancements and enhancements upon service supply and literature how policy closely impacts scenario generation, notably ef­
demand. fects on supply [49,55,100].
Simulation approaches to modelling may be defined as `useful … for Both qualitative and quantitative data are utilised in health and so­
assessing the potential impact of various changes on future health cial care workforce modelling [50,89] with qualitative data more often
workforce resources’ [76: 34]. Simulation approaches continue to be used to contextualise modelling approaches and outcomes [89]. Data
commonly applied within health and social care workforce modelling quality is commented on as a significant constraint on the accuracy of
approaches [50,54,56,86,96] and may be categorised into discrete event modelling [86,43,47,89]. McCarty and Fenech [86] noted the value of
simulation, system dynamics and agent-based modelling [94]. There are national data sets for national modelling in comparison with regional
multiple illustrations of system dynamics modelling within the literature datasets that may better reflect regional variation across both health
and several references to agent-based modelling. These are discussed in needs as well as workforce supply distribution. Simkin et al. [89: 4]
more detail below. evaluated the quality of the data sets they utilised in the production of
Vanderby et al.’s [42: 1325] modelling for future Canadian cardiac their primary care workforce planning toolkit. They categorised data
surgeons described system dynamics as `a continuous time modelling `quality’ by source, strengths and limitations, best `availability’ data
approach, which simulates the flow of cohorts through various stages.’ being those `readily’ available, for example, those data in the public
Koichubekov et al.’s [53] model to predict the general practitioner domain such as census data, whilst the most `comprehensive’ data are
workforce in Kazakhstan utilised mathematical statements that captured those that accommodate a broad range of scenario analyses. Simkin
supply as stock from inflow and outflow, and demand from population et al. [89] noted the most challenging data to harness being those that
size, health needs and level of use of general practice services. Leerapan illustrated productivity and practice activities.
et al. [97] used system dynamics modelling to inform policy Ranta et al. [43: 42] noted several limitations regarding the data
decision-making to plan the health workforce (for 2018–2037) to pro­ used in their projections for the neurologist workforce of New Zealand
vide UHC. Leerapan et al.’s [97] model included three sub-modules: advising `the neuro-epidemiological and neurologic case mix data in
population, healthcare delivery and education/labour market. All ex­ New Zealand are insufficient … the contribution of non-neurologists to
amples of system dynamics models cited used causal loops to demon­ neurological service provision could be greater than estimated.’ They
strate the interdependent nature of the models’ multiple parameters. add that the lack of data from private neurologists as well as lack of
Whilst system-based modelling focuses on the activity/behaviour of adjustment for ageing and ethnic variation within the population across
the system, agent-based modelling focuses on the activity of the indi­ the planning horizons may have increased the prevalence of some
vidual or agent [35,37]. Lopes et al. [37] utilised an agent-based neurological conditions. Dejaco et al.’s [47] recommendations on
modelling approach to forecast the physician workforce in Portugal modelling the rheumatology workforce from a European perspective
noting an agent-based approach enabled consideration of geographic encouraged the use of multiple data sources and uncertainty analyses.
distribution and migration of physicians and the interactions between Whilst projection horizons are variably represented within the
physicians across a range of medical specialities and other healthcare literature from five- to 45-year periods, extended projection horizons are
professionals. Thongsukdee and Weerat [35] also reported the benefit of noted as less accurate than those of shorter periods [51]. Dejaco et al.’s

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[47] points to consider in European rheumatology workforce studies professionals who have undertaken advanced training), to address
advocated for models that provide five- to 15-year projection periods. shortages within the medical workforce, as highlighted by Streeter
This chimes with for example the projection periods utilised in Van et al.’s [96] geography of primary care. However, there is limited stra­
Greuningen et al.’s [51] evaluation of the Dutch workforce projection tegic workforce planning literature, and an opportunity for further
model for the general practitioner workforce and the work of Russo et al. research, about the potential for task substitution by `new’ roles like
[45] modelling the hepatology workforce of the United States (US). these to address the supply/demand imbalance.
Dejaco et al. [47: 3] also noted the importance of regular `prediction Current and future deficits within the nursing and midwifery work­
validity’ work to evaluate accuracy of modelling performance. force are evident in the literature from analyses of service level [61,67,
Workforce modelling is undertaken and contributed to by a range of 68,63,82,69,59], patient outcomes [60] and safety [65]. The notable
health and social care workforce stakeholders including clinicians/ lack of literature within this review about the global social care work­
practitioners, administrators/managers, public and private partners/ force calls for additional research into workforce planning of social care.
providers, policy-makers, educators, representatives of regulatory There is also a minimal presence within the literature regarding lower
bodies and researchers. There is also an increasing market contribution paid, unregistered, and voluntary roles within health settings. In the UK,
by commercial modelling consultants [45,87,95]. given many social care roles are undertaken by the lower paid [75] the
lack of research from social care settings is not surprising from this
4. Discussion perspective but concerning.
Traditionally supply/demand approaches have been utilised for
The SDGs agreed in September 2015 highlighted a global emphasis strategic workforce planning [81]. Yet increasingly there is call for
on health care access for all [101]. The World Health Organisation’s needs-based approaches that better consider demography, epidemiology
[12] strategy is clear on the need to ameliorate the deficits of the global and service requirements [19,85]. Whilst life expectancy has increased
health workforce, notably in low-income countries [102], to resource over the past two decades, healthy life expectancy has not kept pace
resilient, sufficient health services that provide accessible, safe health [107]. Increasing demands for health personnel and health services, are
care. National Health Workforce Accounts (NHWA) of the WHO [103], a generated by increasingly aged populations living with chronic
system of online datasets pertaining to the health workforce, has facil­ co-morbidities. Whilst increased appreciation of needs-based health
itated the WHO’s commitment to develop data-driven health workforce workforce planning may aid its utility, this is within a context of limited
planning [12]. health expenditure [19,85]. Increasingly service configuration has been
This review has identified a growth in strategic workforce planning incorporated into needs-based health workforce planning approaches,
literature in health, particularly over the last five years (2017–2022), often based on patient dependency-acuity and service standards [61,62]
with a preceding peak in 2016 that may have been aided in part by the and safety [65]. Birch et al. [85] called for increased attention to pay,
World Health Organization’s global health policy and strategy publi­ productivity and practice variation in planning for efficient health ser­
cations of 2015 and 2016. Approximately half of the literature identified vices, where competency requirements rather than role/profession
by this review illustrates empirical research, much of which is focused defined demand and supply. Whilst Dejaco et al. [47] identified the
on descriptive and predictive health workforce modelling for quantifi­ importance of factoring in the contribution of technologies on workforce
able workforce projections. No literature explicated optimal periodicity demand and supply, this recommendation has limited representation
of strategic workforce planning in health and social care. However, all [63] within the health and social care workforce planning literature.
literature referenced the imperative requirement, globally, of the The World Health Organization [99] identified the importance of
workforce for health and care services for today and the future. As integration to transform services for people-centred care, provided by
workforce planning shifts internationally towards demographic and multi-disciplinary teams, that better met the increasing needs of the
needs-based approaches, there is increased consideration, albeit aged, chronically ill and those multimorbid. Braithwaite et al. [108]
implicitly, for services’ design and development in planning their have promulgated changing models of health care to accommodate
requisite workforce. population needs in more streamlined, flexible and digitised ways
Whilst there are notable authors, for example Asamani et al. [24,88, however strategic health and social care workforce planning to meet the
104] who provide African/Ghanian perspectives and advocate for objectives of health systems remains tacit within this narrative.
needs-based health workforce planning [24,104], most literature (86 of Health workforce modelling is commonly illustrated within the
101 references) of this review is from high-income countries notably literature of this review to describe and predict personnel supply and
North America, Australia, Europe and the UK. Workload Indicators of demand, population needs and service provision (66 of 101 items).
Staff Needs (WISN) is used worldwide to identify health workforce Workforce models are often mathematical to provide quantitative
staffing requirements notably in low and middle-income countries. forecasts of future staffing requirements. However conceptual frame­
Whilst the universality of WHO’s WISN commends its accessibility, works as illustrated by Tomblin Murphy et al. [60: 130], Organisation of
low-income countries particularly have struggled to implement it. Economic Cooperation and Development [19: 33] and Asamani et al.
Mabunda et al. [105] noted challenges in relation to lack of data to meet [88: 4] are also utilised to provide qualitative context to planning ap­
the model’s requirements, technology to run the software and the lack of proaches. Simulation modelling is often used [37] and may be cat­
workforce supply to meet the recommended number of staff needed that egorised by the level of focus: individual (agent-based), system (system
the model generate. Higher income countries have generated an addi­ dynamics) or event (discrete event) [94] or combination of foci such as
tional range of health workforce planning models and frameworks as in hybrid modelling [89]. Managing uncertainty within mathematical
bespoke solutions to health workforce planning challenges. Literature modelling is complex and variably illustrated within the health work­
from Europe has demonstrated multi-national collaborations for health force planning literature of this review. Stochastic approaches are noted
workforce planning [106,47,85]. within the work of Vile et al. [70] and Lopes et al. [37]. Amorim-Lopes
The supply of the medical workforce is predominant in the literature. et al. [94] compare the contribution of stochastic approaches, robust
Whilst pockets of over-supply are forecast by particular scenarios run in programming and sensitivity analyses to manage uncertainty. No one
the context of specific medical specialities, for example, Whitehouse approach is necessarily preferable although running uncertainty ana­
et al. [40] on the UK’s neurosurgical workforce, overall, the medical lyses is advised [47,94,88]. Scenario modelling in comparison with
workforce deficit is clearly communicated within the literature. The forecasting based on a single current set of circumstances, offers mul­
concern over the past decade and more for the supply/demand of gen­ tiple hypothetical projections and potentiates a range of solutions for
eral practitioners is noted globally [49,52,56,53]. There is increasing `wicked problems’ according to Amorim-Lopes et al. [94: 2]. Data
use of advanced practitioners, (registered non-medical health quality, availability and comprehensiveness are key in modelling

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accuracy [89]. workforce, the importance of which to the overall health and care sys­
There is a limited, dated, literature of backtesting/evaluation of tem has not been recognised.
health and social care workforce models and/or approaches [50,51,82]. Multiple frameworks and models are used for strategic workforce
The Organisation for Economic Cooperation and Development [81] planning in health and social care around the world. However, access
noted use and accuracy as key evaluative measures. Whilst these mea­ and use tend to be the privilege of high-income countries with middle
sures would recommend the strength of WISN, given its extensive use and low-income countries reliant on the World Health Organization’s
around the world, the need to evaluate health and social care workforce [110] WISN model. Increasingly, countries across Europe collaborate to
planning approaches and models remains. share resources and mutual knowledge. Supply/demand approaches to
health and social care workforce planning are often utilised within the
4.1. Limitations of the review literature of this review but needs-based frameworks and models,
considerate of demographic and epidemiological factors, are also
This review does not present an exhaustive literature on strategic adopted to plan for services with an appropriate skill mix and level of
workforce planning in health and social care, but it does strive to capture productivity to deliver for people’s health and social care requirements.
key characteristics of a reasonably comprehensive though limited Descriptive and predictive modelling dominates the review’s litera­
literature from around the world on strategic workforce planning in ture. Mathematical modelling proffers not only the possibility to predict
health and social care. Single reviewer screening of titles/abstracts and potential futures of the health and social care workforce but also to
the contribution of a large (nine) number of reviewers at this stage may provide quantifiable forecasts which are likely to have value in esti­
also have negatively impacted the consistency in the application of the mating health and social care expenditure. The accuracy of predictive
initial title/abstract screening algorithm. Only English language texts modelling is limited often by data quality and availability as well as the
were consulted. Literature was retrieved from 2005 to 2021 to include duration of planning horizon. Whilst conceptual frameworks and models
the policy document `Our health, our care, our way: a new direction for are common within the literature on strategic workforce planning in
community services’ [109], identified as one of the first policy docu­ health and social care, their evaluations are not. This remains an
ments to propose better health and social care integration in the UK; enduring limitation.
however, in essence an arbitrary date range. The paucity of literature The lack of integration within health services is noted, alongside the
retrieved and included within the review on social care workforce integration of health and social care services beyond policy ambitions. It
planning is noticeable. The reasons for this deficit are unclear. Finally, is essential that strategic workforce planning for sustainable, responsive,
the contribution of literature from reviewers’ personal libraries is by targeted health and social care moves from aggregations of health and
chance and for convenience, to compliment the majority literature of social care workforce projections for individual professions, or services
this review retrieved through systematised search means. towards whole-system approaches that consider the ecology of practi­
tioners, their patients, people and environments.
5. Conclusion
Funding
Strategic workforce planning in health and social care around the
world for the next five to 20 years is essential if the growing imbalance Claire Sutton and Julie Prowse are seconded (from February 2022 to
between the supply of the health and social care workforce and its de­ March 2023) to the Workforce Observatory, the University of Bradford,
mand is to be addressed adequately to ensure safe, accessible and uti­ West Yorkshire. Their research posts at the Workforce Observatory are
lised care services that meet the needs of the world’s populations. Whilst funded by Health Education England.
the World Health Organization’s SDGs are aspirational, meeting the
health and social care elements will rely on robust strategy and planning
for the workforce to deliver them. Declaration of Competing Interest
The current and future medical workforce is more commonly
considered within the literature than any other professional group with There are no conflicts of interest to be declared either in the un­
the supply/demand of a variety of specialty medical practitioners rep­ dertaking of this review or the submission of this manuscript of the re­
resented. The nursing and midwifery workforce is represented by liter­ view to `Health Policy’.
ature that examines the need for undifferentiated nursing care. Allied
health professionals are poorly represented with single references. Acknowledgments
Similarly lower paid, unregistered workers and volunteers within health
have minimal representation. The social care workforce is notable by its The contribution of the wider Workforce Observatory team is
sparse literature. Whilst this may be a limitation of the method of this acknowledged. Particular thanks are offered to Mat Andrews, Specialist
review, it may also point to a lack consideration for this undervalued Faculty and Subject Librarian, University of Bradford.

Appendix 1. Initial literature title and abstract screening algorithm

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C. Sutton et al. Health policy 132 (2023) 104827

Appendix 3. Named examples of strategic health and social care workforce planning models, methodologies and frameworks

Lead author/s and date/s of publication that make/s reference to Title (if available) and brief description of model, methodology or framework
named model, methodology, framework

Asamani, J. (2021) Population needs-based simulation model

Ball, J. (2010a); Ball, J. (2010b); Yao, J. (2016) Birthrate Plus®: number of midwives to provide all women with a minimum of one-to-one care during labour
Centre for Workforce Intelligence (2014) Robust workforce planning framework, An introduction; framework to include horizon scanning, scenario
generation, workforce modelling, policy analysis; supply and demand (workforce modelling) orientated
Health Education England (No date) HEE Star; solution-focused workforce planning framework
Health Education England (2018) WRaPT repository of health workforce planning tools sub-categorised into capabilities, trends and case
studies
Health Resources and Services Administration (2019) Technical Documentation for Health Resources Service; modelling approach for health workforce focus on
specific health professions
KPMG (2021) Bespoke software solutions according to commissioner requirements; utilised by Northern Care Alliance NHS
Foundation Trust (UK NHS Trust)
Organisation for Economic Cooperation and Development (2013) A range[26] health workforce projection models from 18 countries around the world
Organization for Economic Cooperation and Development (2016) Framework for the supply and demand of health workers
Shipp, P. (1998); World Health Organization (2010) Workload Indicators of Staffing Needs: international staff supply/demand approach
Skills for Health (2022) Six Steps Methodology to Integrated Workforce Planning; approach for `workforce of right size … right skills …
taking into account … demand … local demographic situation … to the budget …’
(continued on next page)

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(continued )
Lead author/s and date/s of publication that make/s reference to Title (if available) and brief description of model, methodology or framework
named model, methodology, framework

Tomblin Murphy, G. (2011) Health human resources conceptual framework: identifies key factors of health workforce planning and the
ways they relate; developed within Birch et al. (2007)
Van Greuningen (2012) Simulation model to estimate required and available capacity of health professionals in the Netherlands.
Initially developed in 2000
Whole Systems Partnership (2022) SWiPe®: Population health led strategic workforce planning frameworks and models; illustrative examples
of models commissioned by regional UK NHS Trusts
World Health Organization (2010) Western Pacific Workforce Projection Tool (WWPT): projecting workforce needs of a country or area
World Health Organization (2010) iHRIS: workforce planning toolkit based on health provider-to-population ratios

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