Hospital and community services

What are the trends in staff numbers working in hospital and community health services?

This section covers some of the key staff groups working in hospital and community health services, which includes hospital inpatient, outpatient and day case episodes and accounts for the majority of health expenditure. Over 1.2 million staff work across these settings. The data does not cover GPs and practice staff, other primary care providers (e.g. dentists), one trust that does not use electronic staff records, and staff from services which are now provided by non-NHS organisations.

These three staff groups (doctors, nurses and STT staff) account for 50% of all staff in hospital and community health services. The Government’s manifesto pledge to increase the number of nurses working in the NHS by 50,000 by 2024 was achieved in September 2023, with some 51,245 more nurses relative to September 2019 – but, as we have pointed out previously, there is some important nuance behind the headline figure.

In December 2023, the number of doctors had increased by 6,787 compared to the same point in 2022, and for STT staff (which includes occupational therapists, physiotherapists, pharmacists, radiographers, and healthcare scientists) there was an increase, from 160,904 to 169,640.

About the target: Recent NHS staffing commitments detailed in the Conservative Party Manifesto included delivering 50,000 more registered nurses by the end of the Parliament in 2024. This number includes 32,000 new nurses and retention of 18,000 existing nurses in the workforce. In March 2022, the Department of Health & Social Care published a policy paper detailing how progress against this commitment is being measured: using full-time equivalent nursing numbers working in general practice and hospital and community health services – but excluding health visitors.

Progress against targets on physiotherapist and paramedic numbers 

There are ambitious staffing targets for both ambulance paramedics and physiotherapists. In December 2023, there were 18,386 full-time equivalent ambulance paramedics in hospital and community health services, which has increased by 974 full-time equivalent staff compared to December the previous year. Over the same period, there has been an increase of 1,872 in physiotherapist numbers (including an estimate of those employed by primary care networks). Both of these groups, according to the definitions we have used to track them, have met their respective targets as of the end of 2023.

About the target: The targets for an additional 5,000 physiotherapists and 2,500 more paramedics by 2023 were detailed in the Interim NHS People Plan (2019). It is not clear whether these numbers relate to full-time equivalents or headcount, and whether these account for staff working in primary and/or secondary services.

Vacancy rates

Many posts in the NHS are vacant and, at best, filled by temporary staff. In the latest quarter (October to December 2023), 8.4% of nursing posts were not filled by a permanent or fixed-term member of staff, 2.3 percentage points lower relative to a year prior. For doctors, 5.7% were unfilled (a 0.2 percentage point decrease). It is still too early to determine whether the NHS is on course to meet the nurse vacancy target of 5% by 2028.

About the target: The target to improve the nursing vacancy rate to 5% by 2028 was in the NHS Long Term Plan (2019). However, the number of advertised vacancies is different to the proportion of posts not filled by permanent staff and it is not clear which method will be used to calculate success against the 5% target.

Sickness absence rates in the NHS 

While there will always be times when NHS staff become unwell and are unable to attend work, the relatively high rates in this sector suggest more could be done to address workplace issues that can lead to, cause and sustain absence. The sickness absence rate across all hospital and community health professions in Novemer 2023 was 5.3%, a decrease of 0.14 percentage points since the same time in 2022.

About the target: The target to reduce sickness absence rates in the NHS to that of the public sector average (2.9% in 2016) was cited in the NHS Long Term Plan (2019). It is not clear if this target includes staff working in primary care; however, robust data for primary care sickness absence is not available. The plan did not specify a time frame for achieving this reduction.

Why do hospital and community staff leave their role? 

Data on why staff leave their role is, unfortunately, limited. Although NHS Digital do capture some data on reasons for leaving, this includes staff moving between NHS organisations, rather than leaving the NHS entirely. On top of this, in the most recent reporting year 28% of reasons for leaving were unknown.

Despite this, over a 12-month rolling period, there were 17,507 fewer voluntary resignations in December 2023 than there were in the previous year. The number of staff retiring from hospital and community health services decreased from 28,456 in December 2022 to 23,207 in December 2023. Over the same period, 7,659 fewer staff left their role because of a better reward package, promotion or due to a lack of opportunities, while 4,897 fewer staff left due to work life balance, child dependants or adult dependants.

About the target: The NHS Long Term Plan (2019) set out an ambition to “improve staff retention by 2%; equivalent to 12,400 additional nurses”. However, there is no readily available, regularly updated data to monitor performance against this specific measure.