NHS workforce and demand over time

The NHS workforce has been growing both recently, over the last year, and in the long-term, over the last ten years. However, demand for NHS services has also been growing.

The number of full-time equivalent (FTE) non-primary care NHS staff has grown over the last year. Between November 2019 and November 2020:

  • the NHS workforce increased by 4.4%;
  • the number of professionally qualified clinical staff increased by 4.2%;
  • the number of doctors increased by 5.3%;
  • the number of nurses and health visitors increased by 3.6%; and
  • the number of midwives increased by 2.3%.

The number of FTE GPs also increased throughout 2020, and was 1.3% higher in December 2020 than in December 2019. There were 0.5% fewer primary care nurses in December 2020 than in December 2019.

Looking at longer-term trends, the number of FTE non-primary care NHS staff has also grown relative to ten years ago. Between November 2010 and November 2020:

  • the NHS workforce increased by 15.6%;
  • the number of professionally qualified clinical staff increased by 15.5%;
  • the number of doctors increased by 26.9%;
  • the number of nurses and health visitors increased by 9.1%; and
  • the number of midwives increased by 15%.

Demand for the NHS’s services has also been increasing. Between 2010/11 and 2018/19, the number of hospital admissions rose by 15%, and the number of people going to major accident and emergency departments rose 13%. The number of people receiving a first treatment for cancer rose by 27%. The number of urgent GP referrals for suspected cancer more than doubled.

The Government has attributed the rise in demand primarily to an increasingly elderly population, as well as high levels of obesity. The Institute for Fiscal Studies has also highlighted that there are more people living with chronic disease and multiple conditions.

Is the number of NHS staff sufficient?

A number of health organisations have argued that current NHS staffing levels are insufficient to meet demand, and that this was the case even before the pandemic. For example, the Health Foundation argues that there is a particular shortage of nurses, and that this is a result of a “failure to invest in training”. In addition, the Health Foundation highlights high numbers of vacancies in sub-sections of nursing, particularly in mental health nursing.

The King’s Fund also argues that the NHS is understaffed, pointing to high numbers of unfilled vacancies. It attributes this “workforce crisis” to “a prolonged funding squeeze combined with years of poor workforce planning, weak policy and fragmented responsibilities”. The King’s Fund argues that solving the crisis will require addressing issues including:

  • workforce planning;
  • pay;
  • training;
  • staff wellbeing; and
  • immigration policy.

The NHS People Plan 2020/21 states that “more people” are needed to ensure “services are appropriately staffed”.

In December 2020, Secretary of State for Health and Social Care Matt Hancock said he was “delighted” that “record numbers of doctors and nurses are working in our NHS”.

What is being done to increase staffing levels?

In the Conservative Party manifesto published ahead of the 2019 general election, the party said that it would deliver 50,000 more nurses and 6,000 more doctors in general practice. In November 2020 there were nearly 11,000 more nurses (FTE) than there were in November 2019. There were 438 more GPs (FTE) in December 2020 than in December 2019.

To encourage more people to train in nursing and midwifery, the Government has introduced a £5,000 per year maintenance grant for all nursing and midwifery students, with additional funds available for specialist disciplines which have struggled to recruit, such as mental health. Help with childcare costs is also available.

To aid recruitment of medical professionals from overseas, the Government has also introduced a health and care worker visa. This visa aims to make it “cheaper, quicker and easier” for healthcare professionals from other countries to come and work for the NHS, one of its suppliers or in adult social care.

In its People Plan for 2020/21, the NHS said it would address workloads and wellbeing in the organisation. The key elements in its plan to do this are: recruiting more people, adopting new ways of working, and creating a compassionate and inclusive culture to encourage fewer people to leave the organisation.

A report by the House of Commons Public Accounts Committee in September 2020 concluded that the necessary planning and funding to address the acknowledged shortage of nurses was not in place. It also argued that some measures being taken, such as increasing undergraduate nursing student numbers, would take too long to yield results.

The recent Government health and social care white paper proposes to introduce a statutory duty for the secretary of state for health and social care to publish a document setting out roles and responsibilities for healthcare workforce planning and supply in England.

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Cover image by Sasint on pixabay.