NHS staffing: explained

NHS staffing is often a subject that crops up in political debate and we’ve fact checked the topic extensively.

For instance, former Prime Minister Rishi Sunak told Question Time viewers during the 2024 general election campaign that the NHS has “more doctors and nurses working” in it “than ever before”. And the Liberal Democrats’ 2024 election manifesto points to “more than a hundred thousand staff vacancies in England alone”.

Even though these claims are true, they don’t quite tell you everything you need to know. So we’ve explained the basics here.

This explainer is part of a series of ‘prebunking’ articles Full Fact is publishing ahead of the next general election, exploring a range of topics which are likely to feature in the campaign. We’ll be updating these articles on a regular basis—this article was last updated on 24 October 2024 and the information in it is correct as of then.

How many vacancies are there in the NHS?

NHS England employs around 1.3 million full-time equivalent (FTE) staff, the latest data from July 2024 shows, including 141,018 doctors and 357,138 nurses and health visitors—the highest number since comparable figures began in 2009. 

But these figures don’t account for changing demand for NHS services or changes in NHS activity, so employing a record number of doctors or nurses doesn’t necessarily indicate the public’s health needs are being better met. 

We also have to consider the impact on NHS delivery caused by staff who aren’t there. Because by the end of June 2024, there were also  112,846  FTE vacancies across the NHS in England. That’s a vacancy rate of 7.7%.

It’s important to remember that just because a position is unfilled, it doesn’t mean the job is going undone. Many vacancies are filled by temporary staff.

The King’s Fund health think tank notes that “the NHS workforce is growing, but not rapidly enough to keep pace with demand. This means that urgent action is needed to ensure that the NHS has enough staff in place to deliver high-quality care and to develop the service for the future.”

What about the NHS Long Term Workforce Plan?

The last Conservative government took steps to address these vacancies.

In June 2023, NHS England published its long-awaited workforce plan highlighting the more than 100,000 vacancies as a “case for change”, adding that “the UK sits below the average numbers of nurses and medics per size of population” compared to other OECD countries.

NHS England’s plan outlined several key pledges and targets, including increasing GP training places by 50%, adult nurse training places by over 90% and doubling medical school places by 2031/32. The plan was based on detailed modelling and backed by £2.4 billion funding.

The plan modelled “NHS workforce demand and supply over a 15-year period and the resulting shortfall”. But an independent assessment conducted by the National Audit Office’s (NAO), found that it had “significant weaknesses”, including that the use of “manual processing” in the model meant the NAO could not replicate the results.

“Some of the assumptions used in the modelling may be optimistic and the model outputs were weakened by the limited extent to which future uncertainties were communicated,” the NAO said.

It said that these issues must be addressed before the Long Term Workforce Plan can be considered “a reasonable basis for regular strategic workforce planning”.

Anita Charlesworth, director of the REAL Centre at the Health Foundation, said the plan relies on “optimistic assumptions about improving NHS productivity”, adding that doing so is a “pipedream without significant investment in capital and technology”.

Has Brexit had an impact on NHS staff numbers?

Did Brexit drive doctors and nurses out of the NHS? It’s a common question and something plenty of people have suggested over the course of the election. There’s quite a bit of data to help us answer this.

Since the Brexit vote in 2016, the number of NHS staff hired from the EU and EEA has fallen significantly across some professions, but has remained steady among others. The number of hires from beyond the EU has also risen at the same time.

Full Fact’s analysis of Nursing and Midwifery Council (NMC) data shows that the number of EU/EEA trained nurses registering to practise in the UK dropped by 88% between September 2016 and March 2017. It has remained at roughly the same low level ever since.

This is a notable drop in numbers. There was no immediate Brexit-related policy change following the referendum, but as the Nuffield Trust health think tank explains, “the number of EU staff began to fall immediately following the Brexit vote and a simultaneous tightening of language requirements.”

According to the Nuffield Trust’s research, between April 2021 and March 2023, the number of nurses joining the UK register from outside Europe (47,057) was very similar to the number who registered from within the UK (52,171). But far fewer joined from EU and EEA countries (1,339).

At the same time more UK nurses left the register (49,847) than EU and EEA nurses (3,889) and nurses from outside the EU (3,645) combined.

Commenting on these numbers, the Nuffield Trust says: “Nurses trained outside the UK therefore entirely drove the sizable net increase in the total number registered, even as the domestically trained workforce shrank.”

But this pattern wasn’t repeated among doctors.

In a 2021 report, the General Medical Council (GMC) noted that the number of licensed EEA graduates has “grown steadily over the last five years”.

In fact, there were more EEA graduates joining and fewer leaving UK medical practice in almost every year since 2016. The total number of EEA graduates rose during the pandemic despite a fall in the number joining, which the GMC says may mean fewer graduates left during 2020 too.

When the UK left the single market at the end of 2020, EU and EEA staff fell under the same immigration rules as those from the rest of the world.

However, the Department of Health and Social Care (DHSC) introduced the Health and Care Visa to retain and recruit global health staff. It was a “fast-track visa route” which amongst other things involved waiving some charges. This scheme was extended several times and broadened to encompass other—but not all—healthcare roles.

These included, generalist medical practitioners, nurses, occupational therapists, pharmacists, dentists, and paramedics, among others.

Photo courtesy of Akram Huseyn