You can't get the staff these days: the shifting NHS workforce

From humble beginnings, the NHS workforce has grown from approximately 144,000 in 1948 to more than 1.03 million in May this year. The NHS is the largest employer in the United Kingdom and is often touted as one of the biggest employers in the world.

Between March and April 2013 however, the NHS hospital and community health service workforce in England decreased by more than 11,600 full-time posts. Were these reductions in line with previous seasonal patterns or is there something bigger at play in the 'new' health system, which continues to grapple with flat-funding and tough productivity challenges?

Index change in NHS full-time equivalent staff: September 2009–May 2013

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Change in NHS full-time equivalent staff graph

Index change in NHS full-time equivalent staff, September 2009-March 2013

Between March and April 2013, the number of managers decreased by 1,619 (4.6 per cent); scientific, therapeutic and technical staff by 2,258, consultants 570 and others (6,018) – the equivalent of more than 1 per cent – while nurses, midwives and health visitors decreased by 1,141 (0.4 per cent). All staff groups were down by 11,606 (1.1 per cent). These decreases in 2013 are larger than other recent years, but there are a number of factors that could begin to explain this.

The first is that some staff have taken voluntary or compulsory redundancy at the end of March. The latest redundancy figures show a clear increase in the latest period up to the end of March 2013 (see figure below).

Quarterly head counts of compulsory redundancies: 2007/08–2012/13

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NHS staff redundancies graph QMR blog

Quarterly head counts of compulsory redundancies graph

The second factor is that the NHS runs its accounting periods on financial years, which means that any fixed-term contracts for the financial year 2012/13 are likely to have ended on 31 March 2013. This has also affected workforce figures in the past – as the past three years' worth of data show – but certainly the scale of contracts ending this year is striking. There were 3,295 redundancies in the final quarter of 2012/13 – the equivalent of 0.3 per cent of the total NHS workforce.

Along with staff taking redundancy the re-organisation of the health system has affected workforce figures. For example, staff from the Health Protection Agency who were previously included in NHS staff data have now moved, administratively, to Public Health England, and are no longer included. The 4,700 staff involved in this move account for 40 per cent of the reduction in total full-time posts recorded between March and April this year.

A third factor is a reduction in staff number in the NHS, particularly among managers, whose numbers have fallen by 20 per cent since September 2009. This reflects the call in the coalition government's White Paper Equity and Excellence: Liberating the NHS (Department of Health 2010) to reduce management costs by more than 45 per cent over four years.

Getting the balance of staff right is key for running an effective NHS in the future. However, as we have previously said in our work on the NHS workforce, there is currently an imbalance between staff groups, with an oversupply in some and an undersupply in others. And if proposed minimum staffing levels become a reality, these balances may change again in the future.

With staff moving between new organisations and leaving those that are closing, it is clear why we have seen some decreases in overall staff numbers recently. What isn't clear however is if there are underlying pressures of efficiency or productivity that are also impacting on staff numbers.

Getting the balance right between having the right people in the right places at the right time, at the right cost, will be key for a healthy NHS in the future.

Find out more with the September 2013 quarterly monitoring report

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