What health and care need from the next government: #1 – NHS staffing

With a general election approaching, the Nuffield Trust is publishing a series of briefings that challenge the NHS and social care manifesto commitments of UK political parties ahead of the electorate heading to the polls. The first in our series looks at NHS staffing, setting out a series of policy ‘tests’ that the next government must meet to address some of the longstanding issues to attracting, training and retaining the mix of staff needed to meet the needs of the population.

The NHS and social care in England are struggling. A combination of the sudden shocks from the Covid-19 pandemic and high inflation, and the longer-term pressures of poor workforce planning, morale problems, failure to deliver promised efficiency savings, and decades of delay to social care reform are all taking their toll. Strain and dysfunction are deeply rooted and will not immediately improve, and the public sees this clearly: satisfaction with both services is at historic lows. Credible long-term plans to improve this situation are vital for any political leader who wants to gain the support of the British people.

Our series of general election briefings, produced with funding from the Nuffield Foundation, looks at a set of key issues where we believe a government taking or returning to office in the next year must act in order to meaningfully improve health and care. This, the first in that series, looks at the NHS's workforce – the indispensable 1.7 million-strong staff that are its primary asset and its largest cost.

If the next government wants an NHS workforce that achieves more for patients and the public while also enforcing a tight financial envelope, there are a number of tests it must meet to improve processes and policy direction. Meeting these tests would require clear direction to be provided for the health sector, and restraint in committing before the evidence is clear. But they would not be intrinsically expensive, and many would probably be popular. We hope these will feature prominently in election commitments from all parties, and we will review the extent to which these vital issues are being addressed just ahead of the next election.

Test 1: Improve the NHS pay review process to ensure it is fit for purpose

The NHS pay review process is in dire need of reform, and the next government must tackle this issue. It has not contained industrial strife and risks being abandoned by all sides. Pay review bodies need to publish their recommendations faster, be more able to address different financial realities, and be better informed by research so that they can actually try to deliver policy goals.

Test 2: Bring enough staff through domestic training to deliver a sustainable workforce

There are unacceptably high dropout rates at every stage of clinical education and early careers in the NHS. This risks wasting the large increases in training set out in the Long Term Workforce Plan. Student loans forgiveness and other rewards and incentives used in other countries should be adopted to target potential and new joiners at risk of rejecting the NHS and other public services. The next government must also make sure that opportunities to get placements where students and trainees learn from real work in NHS services keep up with the booming number of trainees.

Test 3: Make sure the deployment of different professional groups in the NHS is safe and efficient

New roles which take on some tasks traditionally done by doctors or by nurses, such as physician associates and nursing associates, must be rolled out safely and effectively. This requires an increase in the low level of public understanding; careful and appropriate regulation; and oversight to make sure NHS bodies are supervising them enough and using them for the right tasks, in a way that makes sense for local services.

Test 4: Eliminate the postcode lottery of NHS staff between services, settings and regions

The next government must tackle the postcode lottery in NHS staffing, and longstanding imbalances where some professions grow while equally vital ones stagnate. They should commit to precise goals to reduce staffing inequalities and make sure national and local decisions reflect these. They should find out which of the many policies in the UK and other countries aiming to pull staff to underserved areas actually work, expand these, and drop others.

Test 5: Retain as many as possible of the valuable staff currently working in the NHS

The rate of staff leaving the service in general has been elevated since the pandemic, wasting experience and training and suggesting poor morale. The next government should build on earlier schemes to reduce leavers from trusts, and task national bodies with working out what would make them stay. There should be funded local plans to reduce sickness absence, and requirements on the NHS to make working life easier for parents.

Read the briefing

View the summary slides


We are grateful to the Nuffield Foundation for contributing funding to this work through their General Election Analysis and Briefing Fund. 

The Nuffield Foundation is an independent charitable trust with a mission to advance social well-being. It funds research that informs social policy, primarily in education, welfare, and justice. The Nuffield Foundation is the founder and co-funder of the Nuffield Council on Bioethics, the Ada Lovelace Institute and the Nuffield Family Justice Observatory. The Foundation has funded this project, but the views expressed are those of the authors and not necessarily the Foundation. 

We are grateful to Richard Sloggett, Siva Anandaciva, and Anastasia Knox for their insightful comments as reviewers of this briefing.

Suggested citation

Rolewicz L and Palmer W (2024) What health and care need from the next government. #1: NHS staffing. General election briefing series, Nuffield Trust.