The NHS workforce: is it on track?

Covid-19 has exposed many of the pressures that the NHS was facing before the pandemic hit, not least the very real challenge of having sufficient staff in place to deliver high-quality health services.

As the virus spread, former NHS staff were urged to come out of retirement to boost frontline services and help tackle the outbreak. By mid-April, nearly 11,000 former and overseas nurses and midwives had joined the emergency staffing register, with twice that number of students able to extend clinical placements.

The need for such reinforcements reiterated what was already clear before the crisis, which is that despite the 1.5 million staff already working for the NHS, workforce levels haven’t been keeping up with rising demand.

Without understanding the trends in the numbers of different NHS professions, policy-makers are less able to identify areas of success (or for improvement), which makes workforce planning all the more challenging. We have therefore developed a tracker to monitor key workforce trends in the NHS.

NHS staffing pressures before the pandemic

The growth of the nursing workforce has been slow over nine years (the period for which comparable data is available), despite the ever-growing demand for care. While the number of hospital admissions has typically increased by around 2% annually, the number of nurses has increased by only 0.3% a year.*

One of the pledges by the Conservative Party before the 2019 general election was the addition of 50,000 more nurses by 2024/25. Given the pandemic, we already have to question the viability of that target, with indications that the planned growth for nursing this year will be scrapped. The recent boost to nursing numbers during the crisis has been very welcome, but will only provide a temporary spike.

As a result of the outbreak, more short and long-term challenges for the workforce are likely to confront the NHS. Retaining nurses is an example, with one report suggesting that Covid-19 has made 29% of nurses and midwives more likely to want to leave the service than to stay. International recruitment is another issue for this group, and it was reported that registrations from overseas nurses fell sharply from 1,300 in March this year to just 35 in April.

Sickness absence is another example of a target that may be put aside due to Covid-19. The NHS Long Term Plan committed to reducing the average NHS sickness absence rate to that of the public sector average (2.7%), from 4.5% just before the pandemic. But it doesn’t look like it will get better soon, with concerns that many stressed and traumatised NHS staff will need adequate psychological support as a result of the past few months (and possibly time off from work due to burnout).

The NHS staffing tracker

Our tracker aims to monitor progress against such key commitments. Generally, we have chosen indicators that have national ambitions against them, which can be measured using frequently published data. We have focused on four significant areas for the workforce, namely hospital and community health services, general practice, mental health and learning disability workforce, and training.

We recognise that the tracker will not capture all workforce-related plans (nor does it capture social care staffing, which is covered elsewhere), but we intend to draw out additional context, where possible, in a series of regular commentaries on the NHS workforce.

Challenges in monitoring progress

Though there is a great deal of detailed data for certain health settings and professions, many of the targets are opaque in ascertaining what the baselines are and what specific set of staff they cover. Conflicting statements from politicians about whether there has been any progress at all against the previous pledge to deliver 5,000 more GPs by 2020 are symptomatic of this.

In the event, it appears that the latest data (which itself is thought to suffer from data completeness issues) suggest that:

• while the total number (headcount) of doctors in general practice has risen – from 42,129 in March 2017 to 44,905 in March 2020,
• the number of full-time, permanent, fully-qualified GPs (that is, excluding locums and registrars) has decreased – from 28,172 in 2017 to 26,783 in 2020.

Vague ambitions of increasing the workforce by an arbitrary value make it very difficult to monitor progress – we need enough detail to be able to follow progress accurately and be able to hold the government to account.

For example, knowing the start and end month and year of each target, whether they refer to headcount or full-time equivalent, and which available data intends to be used to demonstrate success or shortfall. Ideally, NHS Digital (along with other arm’s-length bodies) would regularly publish progress against specific targets, meaning our tracker wouldn’t be necessary.

In the absence of such information, we have made a few assumptions in our tracker, and welcome feedback and suggestions so that it is as accurate and informative as possible. Given the history of shifting goalposts and delivery dates, it is likely that many aspects of the tracker will have to be updated over time. More than ever, Covid-19 has highlighted and accentuated the importance of NHS staff, which makes tracking and commenting on these numbers essential.

As the NHS learns how to live with the coronavirus, we must recognise that some of the workforce ambitions set out in preceding years will likely need to be reassessed once the pandemic eventually passes.

If you want to give feedback and suggestions on the tracker itself, please see the Feedback facility down the side of that page.

*This was calculated using compound interest, using finished hospital episodes from 2009/10 to 2018/19 and hospital and community health nurse numbers from September 2009 to September 2018. Please note the slight disparity in the reporting periods.