Years of poor planning and fragmented responsibilities for the health and care workforce mean that staff shortages are widespread. The workforce crisis is at the heart of many of the challenges facing NHS and social care services in England. In some areas, the number of staff is increasing, but the health and care needs of the population are also growing and the number of vacancies continues to outstrip the number of staff to fill them. Addressing chronic staff shortages and stemming the flow of staff leaving the sector is essential to enable services to better meet people’s needs and to provide a higher quality of care, so that waiting times come down, and outcomes and public satisfaction improve. To solve this crisis, there is a need for action to make working in health and social care a more attractive career.
What’s the problem?
- As at October 2023, there are more than 125,000 vacancies across the NHS workforce in England, excluding primary care vacancies such as GPs, and there are 152,000 vacant posts in the adult social care workforce. The figures equate to just under 9% of the required NHS workforce and just under 10% of the required social care workforce.
- The public recognise the problem. According to the most recent British Social Attitudes survey, public satisfaction with the NHS has fallen to its lowest level in the 40-year history of the survey. Of those who said they were dissatisfied with the NHS, 55% cited staff shortages as a reason.
- The most recent NHS Staff Survey found that 32% of staff often think about leaving their job, and less than half said their organisation is committed to helping them balance their work and home life. Health and care staff experience a demoralising cycle, with high vacancy rates adding to stress and pressures on staff, which then results in rising levels of sickness absence and many leaving the profession.
- The NHS and the adult social care sector is heavily reliant on recruiting staff from other countries. With a worsening global shortage of health care staff, continued over-reliance on international recruitment to plug the gaps in England’s health and care workforce may be unsustainable.
- NHS hospitals continue to spend billions on agency and bank staff to plug rota gaps. Temporary staff play an important role in ensuring safe staffing levels, but over-reliance on their use to offset shortages of permanent staff has an impact on staff morale and patient experience.
- Managers make up approximately 2% of the NHS workforce compared to 9.5% of the UK workforce. Since 2011, the number of managers in the NHS has stayed broadly the same, while overall staff numbers, demand for care, and the scale of activity has increased. With known exceptions, managerial roles have long compared unfavourably to clinical careers in the way staff are trained, structured and perceived. Evidence suggests that poor NHS administration can place a heavy burden on staff, as well as patients, but when done well can contribute to a better working environment and better care.
- In June 2023, the government published its NHS Long Term Workforce Plan. The plan is a welcome step in long-term planning for the NHS workforce. It sets out how to boost staff numbers through increases in training and education, and improve efficiency through ambitious reform plans. However, the plan is weaker on retention measures, and fails to address the issues that contribute to high attrition rates across the NHS workforce.
- As at October 2023, there is no national long-term social care workforce plan.
What should national government do?
The plan should:
improve pay and conditions, such as guaranteed hours and more generous sick leave
Social care staff are leaving the sector due to low pay, stress, and poor working terms and conditions. Low pay is a significant barrier to filling social care vacancies. Estimates suggest that 50% of care workers are paid the National Living Wage or just £0.50 over it.
reduce the pay gap between social care and NHS staff who do similar roles
Social care staff working in similar roles to those in the NHS receive a lower starting salary, and the gap grows over time as many NHS staff receive incremental pay increases within their pay band. NHS staff can expect to receive meaningful pay progression each year, with opportunities to progress to more senior roles and higher pay bands, whereas a typical care worker can expect to be earning just £0.06 more an hour after five years in the sector. Nationally negotiated pay deals for NHS staff do not apply to social care staff.
provide better training and skills for social care staff
Overall, better training for social care staff not only benefits the individuals receiving care but also leads to a more effective, compassionate and professional workforce.
ring-fence funding for NHS staff mental health and wellbeing hubs
Taking care of the health and wellbeing of NHS staff will help prevent burnout and reduce the number of staff taking sick leave. Mental health hubs were a lifeline for many staff during the Covid-19 pandemic and continue to be needed given the high levels of burnout being reported.
The outreach model of the hubs aimed to end a cycle of staff waiting until reaching breaking point to seek support, and staff reported positive experiences of hubs, saying they were a valuable source of support.
ask the NHS to make the expansion of flexible working a priority for its workforce
Flexible working leads to higher levels of job satisfaction, attracts people to an organisation, and allows people to fit work alongside other commitments. We already know that trainees in some clinical professions intend to work more flexibly when they qualify. A survey by The King’s Fund that asked GP trainees about their career plans one year after qualifying found that 41% intend to work five to six clinical sessions a week, out of a possible 10.
Legislation came into force in 2023 to make it easier for staff to discuss more flexible working with an employer. The NHS must look to adopt this and modernise its approach or risk long-term vacancies becoming a permanent fixture, as the number of UK workers expecting flexible working options continues to grow.
improve management, administration and leadership in the health and care sector
The UK has a track record of low spending on the administration and governance of its health system, less than comparable countries such as Germany and France. However, this perceived efficiency can breed inefficiency if taken too far. Increased administration capacity and improved processes could take the administrative burden away from clinical staff so that they can focus on delivering care.
Similarly, having sufficient management capacity can enable services to innovate more quickly and adopt new technologies. Data scientists, project managers and administrators can all drive improvements to services. Not only would this be good for patients and the public, it would also be good for staff. A 2023 survey of NHS staff found that 83% of respondents believe that greater technology investment can help to attract a younger workforce.
Good leadership of health and care services is critical to improving the workplace culture. While much of the responsibility for this sits within the health and care system, national government has an important role to play by recognising, valuing and supporting the development of high-quality leaders in health and care.