Health Workforce 


Economics by Design has undertaken many projects related to workforce value in health systems.

Much of this work is unpublished and used by our clients to inform their investment and strategy decisions. Some studies, however, are in the public domain and these are showcased here.

For further reading check out our Workforce economic lens.

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Case Studies

Health Education England


Economic Evaluation of the Extended Surgical Team Pilots & Development of ROI Tool


Economics by Design was commissioned to undertake an economic evaluation of a new workforce model to support improvements to surgical training and service delivery. We developed the value proposition for the new models and evaluated pilots in Manchester and Chester.

Together with University of East Anglia, we developed a return-on-investment tool for NHS trusts to demonstrate the value of this workforce model in their local context. Further information on the findings, including the results of the evaluation, can be found here.

The traditional surgical care workforce model faces increasing pressure due to intense demands and the Covid-19 pandemic. NHS employers increasingly rely on temporary staff and locums to protect training time for surgical trainees and maintain safe staffing levels.

The Extended Surgical Team (EST) offers a multi-disciplinary and multi-professional approach that supports the entire surgical pathway.

According to the 2018 Future of Surgery report by the Royal College of Surgeons, the EST is predicted to play an increasingly important role in delivering high-quality care.

Compared to usual practice, the EST is expected to generate value by providing a cost-effective alternative, improving system efficiency, and enhancing workforce longevity and productivity. For surgeons in training, it allows more dedicated time for training and learning.

EST advanced care practitioners (ACPs) benefit from clinical career progression and skill enhancement. The EST is expected to deliver services that are as safe and effective as the traditional workforce model, with potential reductions in clinical risks.

The case studies included in the report showed significant return on investment resulting from the use of the EST in Same Day Emergency Surgical Services.

Other Publications


Here are a few examples of published studies:

In 2020, Health Education England commissioned Economics by Design to explore the value of the Library and Knowledge Service. The resulting report, Library and Knowledge Services Value Proposition: The Gift of Time.  highlighted the crucial benefits that library and knowledge services bring to NHS organizations, particularly by simplifying the process of gathering information for healthcare professionals.

By doing so, they alleviate the burden of searching for and synthesizing evidence, while also enabling NHS organizations to fulfil their statutory obligations of implementing evidence-based practices throughout the service.

In 2021, Health Education England commissioned Economics by Design, Anglia Ruskin University, and Rethink Partners to undertake an evaluation of the Allied Health Professionals Faculty Test Beds.

The resulting Formative Evaluation: report looked at the implementation, potential impact and value of faculties as an enabler of the recruitment, training, deployment and retention of AHPs by providers in the NHS in England.

It was too early to report on the success or otherwise of the Faculty in achieving its goals and having an impact on AHP vacancy levels. However, the team were able to use the value analysis to inform how the operation of the faculties would add value and to develop an associated maturity framework.

In 2021, Economics by Design was commissioned by Health Education England to undertake an economic analysis of the Breast Clinician Credential pilot.

The project involved the development of a value proposition for the Credential, and an economic model to measure the return on investment of the new training credential.

The investment made by Health Education England, and the return on investment that would be achieved if Integrated Care Systems were to fund these training posts going forward.

The final report included a cost-consequence analysis which provided information on the tangible and intangible benefits and costs which were not given a monetary value.

More details of the work and the final report are shown here.

In 2022, Economics By Design was commissioned by the National Breast Imaging Academy (NBIA) to undertake an Economic Evaluation of their collaborative national, multidisciplinary initiative to address the severe workforce issues faced in the delivery of breast imaging services across the country.

The report showed estimates of efficiency of the NBIA initiatives of a combined present-day value of just under £50m over a ten-year period.

Digital Health & Innovation

Our team has experience in enabling digital health innovators to demonstrate and communicate clear value propositions to the health and care system. We can also help develop pricing models and strategies.

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Health Workforce

Our team has experience of designing value in and evaluating the value of the health and care workforce and associated innovation and transformation strategies.

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Global Health Systems

Our team has international and national experience of designing value into health financing, health payer + insurance models, payment mechanisms, provider models, policy and regulation.

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Integrated Care

Our team has experience of designing value in and evaluating improvement focused, wellness programs and prevention-based integrated care pathways across different disease groups, client groups, and health conditions.

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