Are there 100,000 vacancies in the NHS?

“We have 100,000 vacancies in our NHS yet Theresa May refuses to allow the very best international doctors to come here to care for our sick.”

Jonathan Ashworth, 1 May 2018

There were around 100,000 staff vacancies in NHS trusts in England between October and December 2017, according to information from NHS Improvement. It’s based on management information and is not an official statistic, so should be treated with some caution.

90-95% of doctor and nurse vacancies are being filled by temporary staff—so it’s not the case that nobody is doing these jobs. However, there is evidence that temporary staff cost the NHS more, and NHS Employers says that the vacancies are leading to some delays in treatment.

Restrictions on the number of “Tier 2” visas granted to people from outside the European Economic Area mean that some international doctors are not able to come to the UK to fill vacancies. NHS Employers says over 400 doctors have been refused a visa since December 2017.

Where does the 100,000 figure come from?

There were just over 97,000 vacancies in NHS trusts in England between October and December 2017, according to NHS Improvement (NHSI), which manages NHS trusts in England. That’s around 8% of the workforce. Around 10,000 of these vacancies were for doctors, and 35,000 were for nurses.

NHS trusts include all NHS services except GP surgeries—and there were 1.1 million people employed by NHS trusts in England in the same period.

This vacancy level is higher than the UK average for all jobs. From October to December 2017, there were 2.7 vacancies for every 100 filled employee jobs—the same level as for January to March 2018. In the NHSI data, there are around 9 vacancies for every 100 filled jobs.

These NHSI figures are whole-time equivalent (WTE), so if two half-time jobs were vacant for example, these would only count as one WTE vacancy.

The 100,000 figure should not be treated as certain

This is the first year in which this NHSI data on vacancies has been recorded, and there are still some things we don’t know about how it’s put together.

NHSI says that its vacancies data is “based on management information from the sector” so these aren’t official statistics. As we don’t know how this information was collected, it’s hard to know quite how reliable it is. For instance, we don’t know if the data was collected using a standardised data collection system, or if there was room for trusts to interpret “vacancy” in different ways. NHSI told us that they don’t have much information on this.

The Nuffield Trust think tank told us that there are lots of different ways a vacancy can be defined. For instance the classification may, or may not, include vacancies filled by temporary staff, or those where the post is not currently being advertised.

A minimum of 88,000 NHS jobs were advertised from July to September 2017

There are also official statistics on vacancies in the NHS in England, but these only look at the number of job adverts posted, rather than the number of empty jobs.

The latest figures on this are for September 2017, when there were around 28,000 advertised full-time equivalent (FTE) vacancies for permanent or fixed-term jobs. Across the three months from July to September 2017 there were around 88,000 vacancies advertised. 81% of these jobs were permanent ones.

But as these figures look at the number of adverts, rather than individual vacancies specifically, they can’t be used to say exactly how many empty posts there were in the NHS in England. One advert can be used to fill one vacancy or several, and NHS trusts don’t have to use the system that records these figures.

So this isn’t a complete figure for vacancies, only the minimum possible number.

Confusingly, a vacancy is not the same as nobody doing the job

According to the NHSI data, 95% of doctor vacancies, and 90-95% of nursing vacancies were being filled by temporary staff. These are either supplied by the NHS Staff Bank, or an agency.

So many of these vacancies are actually occupied by temporary staff. Is this a problem in itself?

One issue is cost. NHS Improvement notes that, while trusts underspent on agency staff by about £108 million compared to what was planned in October-December 2017, they overspent on bank staff by £664 million.

The National Audit Office noted in 2014/15 that “Previous reports suggest that agency doctors routinely earn 50% more than permanent staff, and hospitals might pay up to £3,500 for a doctor to work a single shift.”

There is also the question of whether the widespread use of temporary staff affects patient care. The Nuffield Trust, focusing on nurses in particular, says “relatively little” is known about this.

NHS Employers says that failing to recruit doctors leads to shortages on rotas, extra costs, delays in treatment, and clinics being cancelled.

Why are international doctors being turned away?

Despite these vacancies, there are numerous reports that doctors being recruited from abroad have been denied visas by the Home Office.

NHS Employers says it has heard that, since December 2017 “at least 400 doctors who we’ve being trying to recruit to come and work within the NHS in England haven’t been able to enter the country and take up posts.”

This is happening because of a cap on the number of Tier 2 visas being granted by the government. That’s the type of visa which doctors from countries outside the European Economic Area normally need in order to work here. Around 1,300 Tier 2 visas were granted in March 2018, and around 2,200 in April 2018. In January, the government estimated that a third of Tier 2 visas went to the NHS.

Priority is given to visa applicants for jobs where there is considered to be a “shortage” in the UK. Nurses, and some doctor roles, are on the “shortage occupation list”.

Because visa applications are oversubscribed, the minimum salary level needed to get a visa for non-shortage occupations is inflated. Without oversubscription it would be £30,000 (in most cases), but in March it was £60,000, and in April it was £50,000. Some, but not all, doctors earn that much. We’ve written more about how salary thresholds are calculated and set here.

NHS Employers says that the biggest NHS shortages are among nurses. Because nurses are a shortage occupation, they get Tier 2 visas as a priority—but that means the NHS has “fewer work permits available for doctors” who aren’t in a shortage role. NHS Employers argues that applicants for shortage occupations shouldn’t be included in the cap on Tier 2 visas, which would free up more visas for doctors in non-shortage roles.