The NHS in England employs around 1.2m people (NHS Digital). They fulfil a wide variety of roles and are working hard day in, day out to deliver safe and high-quality care for patients and service users in the face of mounting pressure.
Rapidly rising demand and constrained funding are leading to increasing pressure across health and social care services.
In the NHS provider sector this is visible as trusts struggle to achieve performance targets such as the four-hour waiting target for A&E and the 18-week referral-to-treatment target, and in the continuing challenge of achieving financial balance. This is apparent across hospital, mental health, community and ambulance services.
Beyond the provider sector mounting pressure can be seen as GPs struggle to maintain patient access (NHS England) and as the Care Quality Commission warns that adult social care is “approaching tipping point”. Tied up with these performance and finance challenges, the NHS provider sector faces a set of growing workforce challenges.
There is a gap between the workforce provider trusts need to deliver high-quality services and the workforce they have. In 2014 Health Education England reported a staffing shortfall of 5.9% or 50,000 clinical staff. This has almost certainly widened since then. The workforce gap is most obvious in respect of clinical staff, resulting in closures of some services, for example A&E (BBC) and children’s services (Guardian), restricted opening hours for others, and pressure on staff (BBC) required to put in extra hours as they seek to maintain quality of care[8].
Figure 1 illustrates the role composition of the NHS workforce. Around 54% (564,000) of NHS staff in England today are clinically qualified – nurses /health visitors, scientific, therapeutic, and technical staff, doctors, midwives, and ambulance staff.
Figure 1
The number of clinical staff has increased over the last seven years (The King's Fund) – with a growth of 26.2% for doctors, 1.8% for nurses and health visitors, 13.3% for ambulance staff, and 10.1% for scientific, therapeutic and technical staff.
Yet this growth in staff has not kept pace with rising demand for services, greater patient acuity, and increased demand for staff generated by the push for and regulatory focus on higher staffing levels and care quality. A workforce gap has developed.