Lack of skilled staff is already impacting access and quality of care, and without a shift in workforce policy the situation will worsen over the next decade, warn Anita Charlesworth, Candace Imison and Richard Murray


This summer, IPSOS Mori asked almost 24,000 people across 28 countries about their healthcare system, and it emerged that people in the UK are the most satisfied with their healthcare.

But the same survey found that people are also worried, believing the NHS is overstretched and worried whether the required staff and services will be in place in the future. 

The NHS runs very hot, with fewer doctors and nurses per head of population than our European or G7 peers.

This is not a new problem, but things are now critical, with worsening retention, falling numbers of GPs and mental health staff, and learning disability and community nursing numbers not matching patient needs.

Worsening workforce gap

NHS Improvement and Health Education England estimate the gap between the staff needed and those available in the hospital and community sector in England has now reached more than 100,000. 

New analysis from the Health Foundation, King’s Fund and Nuffield Trust finds that if current trends continue, the gap could reach almost 250,000 by 2030.

If the pattern of people leaving the workforce before pension age continues, and the pipeline of newly trained domestic and international recruits doesn’t increase, there could be a shortage of more than 350,000 staff by 2030.   

Workforce shortages now present an even greater challenge to the NHS than funding. The lack of adequately skilled staff is already impacting on access and the quality of care patients receive, and without decisive and sustained action this will worsen over the next decade.

England has a poor track record of workforce planning, but in the past we had the safety valve of international recruitment

This is at a time when the health system will be focused on the workforce, delivering its road map to much needed improvement – the NHS long-term plan – but unless it is clearly linked to urgent and focused action by government and health system leaders, the plan can only ever be a wish list.

The shortages are also taking a significant toll on the health and wellbeing of staff. Beyond the numbers, the plan needs to support new ways of working and address the discrimination and inequalities which have no place in the health service. 

This is particularly evident in pay and career progression for both black, Asian, minority, ethnic and female staff. 

England has a poor track record of workforce planning, but in the past we had the safety valve of international recruitment.

The world has changed, and it would be a folly to think we can continue to muddle along. Brexit, alongside restrictions on migration, is already reducing the number of nurses trained abroad registered to practice in the UK.

Paradigm shift in workforce policy

England needs a paradigm shift in the approach to workforce policy. The equivalent of £2bn has been taken from the central NHS training budget, as spending fell from 5 per cent of health spending in 2006-07 to just 3 per cent this year.

We have already seen a fall in nurse training places in the early years of this decade, and with changes to student finance we are struggling to expand training numbers at precisely the time we need rapid growth.

A coherent and transparent national approach to workforce planning and strategy is essential. NHSI and HEE working together more closely on workforce is a helpful first step, but properly aligning workforce and service strategy – delivering the right number of staff with the right skills – will require more fundamental change.

Workforce planning for the future must span NHS acute, mental health, community and primary care, as well as social care. It must include all staff groups and those who provide education and training (higher and further education providers).

Workforce planning for the future must span NHS acute, mental health, community and primary care and social care, and include all staff groups and those who provide education and training

Social care is also experiencing substantial staff shortages, with high turnover and a lack of investment in skills and development. The service of the future clearly requires more integrated models of care.

The workforce strategy to implement those models needs to take a much wider view than the historically narrow prism of the health service.

Prioritising workforce in the long-term plan means difficult choices about how new funding is spent, and some of the solutions will be controversial. But this is an imperative – the public are right, workforce is the biggest threat to the NHS.

Urgent and sustained action is needed at all levels of the system, and across government.

In the short term, it is critical there is both concerted action to improve retention and support for international recruitment. Rapidly expanding training numbers, particularly in nursing, as well as investing in new ways of working is key. We will be exploring these issues in detail in a report in January.

Government and national and local NHS leaders need to grasp the nettle. In the NHS’s 70th year, we need a firm focus on the huge and vital responsibility to steward the health and social care system for years to come – it is make or break time.

Anita Charlesworth is director of research and economics at the the Health Foundation.

Candace Imison is director of policy at the Nuffield Trust. 

Richard Murray is director of policy at The King’s Fund.