Hospital 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. As at June 2020, there were 302,471 full-time equivalent nurses in hospital and community health services, an increase of nearly 14,000 nurses since June 2019. Over this period, the number of doctors has increased by 9,200 from the same point last year, and for STT staff (which includes occupational therapists, physiotherapists, pharmacists, radiographers, and healthcare scientists) an increase from 141,000 to over 147,500. These increases may be partly attributable to the call for recently retired health care professionals to return to service to help the NHS manage the Covid-19 outbreak or postponement in recruitment efforts.
About the target: Recent NHS staffing commitments detailed in the Conservative Party Manifesto included delivering 50,000 more registered nurses by 2024/25. This number includes 32,000 new nurses and retention of 18,000 existing nurses in the workforce. It is unclear whether the target of 50,000 more nurses by 2024/25 refers to headcount or full-time equivalent, and whether the commitment refers to nurses working in hospital and community services only, or if it also includes nurses working in general practice.
There are ambitious staffing targets for both ambulance paramedics and physiotherapists. As at June 2020, there were just over 15,000 full-time equivalent ambulance paramedics in hospital and community health services, which has remained fairly stagnant compared to June last year.. Over the same period, there has been an increase of 1,250 in physiotherapist numbers (and up to a 2,400 increase when including our estimate of staffing working in PCNs). Progress in numbers for both these groups seems to be moving at about the right rate to meet the respective targets.
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.
Many posts in the NHS are vacant and, at best, filled by temporary staff. In the latest quarter (April to June 2020), 10.3% of nursing posts were not filled by a permanent or fixed-term member of staff, a decrease of 2 percentage points in a year. For doctors, 6.1% were unfilled (a 1.2 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. Decreased vacancies in the latest quarter may be due to the additional staff working in the NHS during the Covid-19 pandemic.
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.
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 as at May 2020 was 4.72%. In the previous month, sickness absence was at its highest level ever recorded, at 6.2% - this was largely due to Covid-19 and staff having to self-isolate and take sick leave if they were experiencing symptoms of the virus.
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.
Between March and June 2020, there was a 30.1% drop in the total number of staff leaving hospital and community services, which is likely to be due to staff staying on to help manage the surge of patients in hospitals (as a result of the coronavirus outbreak). Over a 12-month rolling period, one of the only increases in the number of staff leaving hospital and community health services was due to retirement, and this increase was marginal (from 19,651 to 20,318). There were 8,000 fewer voluntary resignations in June 2020 than there were in the previous year.
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.