NHS staffing shortfall of 100,000 could reach quarter of a million by end of next decade
Shortages of staff risk longer waiting lists, declining care quality and new NHS money going unspent
Long-term plan must be linked to credible strategy to shore up healthcare workforce
Critical and lasting shortages in the healthcare workforce mean that the forthcoming NHS long-term plan risks becoming an unachievable ‘wish list’ of initiatives to improve the health service. If unaddressed, these shortages could lead to growing waiting lists, deteriorating care quality and the risk that some of the money for frontline services pledged at the Budget will go unspent, according to a new briefing published today by The King’s Fund, the Health Foundation and the Nuffield Trust.1
The briefing, entitled The health care workforce in England: make or break? draws on a new forecast of the staffing gaps emerging in the 1.2 million-strong NHS workforce. It predicts an increase in NHS staff shortages from over 100,000 at present to almost 250,000 by 2030, warning that this could mean that over one in six health service posts are short of an appropriate staff member by the end of the next decade. The three organisations warn that these shortages could be over 350,000 if the NHS continues to lose staff and cannot attract skilled workers from abroad.2
The briefing comes as NHS leaders are poised to publish their blueprint of how the health service can adapt to the next 10 years in response to the £20.5 billion funding boost confirmed by the Chancellor at the Budget last month. It warns that even before this funding increase was pledged, the NHS could not recruit the staff it needed because of an incoherent approach to workforce policy at a national level, poor workforce planning, restrictive immigration policies and inadequate funding for training places. Funding for education and training dropped from 5 per cent of health spending in 2006/7 to 3 per cent in 2018/19, the equivalent of a £2 billion drop.
Now, with worryingly high numbers of doctors and nurses leaving their jobs before retirement, and training budgets among those facing potential cuts following the Budget,3 the organisations say that the health service is reaching a tipping point. Unless new staff can quickly be recruited and trained, the NHS simply will not have the workers available to meet the demand for healthcare expected over the next decade, exacerbating recruitment and retention problems. This will mean that even with the extra money to commission frontline services, healthcare providers will not have the staff to deliver them.
The briefing sets out five tests for the NHS long-term plan. These tests would require a ‘funded and credible strategy’ to:
- Address the immediate workforce shortages. Urgent measures are needed to address shortages in certain jobs and locations, such as radically boosting international recruitment in the aftermath of Brexit and improving staff retention.
- Deliver a sustainable workforce over the next 10 years. This will involve expanding training places and apprenticeships and will require the government to look into financial incentives to attract more nurses.
- Support new ways of working across the health and social care workforce. Including making better use of the skills of some existing staff– such as a far greater role for nurses, pharmacists and physiotherapists in family doctors’ surgeries.
- Address inequalities in recruitment, pay and career progression. Tackling gender, race and other inequalities must be a key feature of national and local workforce strategies.
- Strengthen workforce and health service planning. This should involve a much more coherent and transparent approach to planning and strategy development.
The briefing also highlights the equally pressing problems in the social care workforce, which too is hampered by substantial staffing shortages and is especially vulnerable to plans to cut off so-called ‘low-skilled’ migration. The three organisations argue that the ‘critical interdependence’ of the two sectors means that any attempt to tackle one area must be accompanied by plans to address workforce problems in the other.
Commenting on the briefing, Candace Imison, Director of Policy at the Nuffield Trust said:
'The NHS has a woeful track record in ensuring that the health service has the right numbers of staff it needs in all the right places. This has now reached a critical juncture: unless the NHS Long Term Plan puts in place urgent and credible measures to shore up the workforce both in the short term and in the longer term, it risks being a major failure. Solving the acute and systemic problems affecting the healthcare workforce will not be easy, but we owe it to patients, staff and taxpayers to start now.'
Richard Murray, Director of Policy at The King’s Fund, said:
'The NHS cannot meet increasing demand from patients without the workforce to staff services. Unless the NHS long-term plan is linked to a credible strategy for recruiting and retaining staff, there is a real risk that some of the extra funding pledged by the government will go unspent and waiting lists for treatment will continue to grow.'
Anita Charlesworth, Director of Economics at the Health Foundation said:
'The NHS is overstretched and services are being compromised by serious staff shortages. As things stand, this problem will only get worse over the next decade, putting access and quality of care at risk.
'Unless the government and system leaders take radical action and prioritise the NHS workforce, staffing shortages will more than double to almost a quarter of a million by 2030. The NHS can’t sustain current services, let alone improve, with such a large and growing gap between the staff it needs and the people available to provide care.'
The briefing forms part of a longer research report on the health and social care workforce, exploring policy solutions to the problems identified. This will be published in the coming weeks.
- 1. The briefing 'The health care workforce in England: make or break?' is the first of two interventions from the three research organisations looking at the state of the health and social care workforce. The second output, due for publication in the coming weeks, will be an in-depth research report exploring potential policy solutions to the problems facing both the health and social care workforce.
- 2. The new projections show the gap between demand for staff and the supply of staff directly employed by NHS organisations up to 2030. Demand for staff is calculated by projecting forward current vacancies (over 100,000 in 2018/19) in line with healthcare activity projections derived from Health Foundation and Institute for Fiscal Studies modelling. The supply of staff is based either on long-run trends in staffing continuing (the 250,000 figure) or these trends slowing down due to problems in recruiting and retaining staff (the 350,000 figure). These figures do not include staff working in primary care, including GPs and practice nurses.
- 3. The £20.5 billion NHS funding increase announced at the October Budget applied to NHS England revenue spending and not to the overall Department for Health and Social Care Budget. Unless further changes are made, the overall DHSC budget, excluding the NHS England and capital budgets, will fall by £1bn in real terms in 2019/20. This would mean further squeezes on budgets like public health and training next year.
Notes to editors
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The King's Fund is an independent charity working to improve health and care in England. We help to shape policy and practice through research and analysis; develop individuals, teams and organisations; promote understanding of the health and social care system; and bring people together to learn, share knowledge and debate. Our vision is that the best possible health and care is available to all.