The NHS is facing recruitment challenges. That could be the understatement of the century as the UK’s national health service is in the grips of the worst staffing crisis in its history.
Not only does this threaten our health services’ ability to deliver care, but it’s also extremely costly, with HSJ reporting that recruitment consumes two-thirds of NHS trusts’ spending.
But how did we get to this point? What challenges are facing NHS recruitment? And perhaps most importantly, what action must be taken in the long road ahead to dig ourselves out of this hole?
On this page, we’ll tackle this complex topic and explain the root causes of the NHS workforce crisis. We’ll also talk about the software being used by recruiters that makes hiring healthcare staff a faster and cheaper process.
What is The Current NHS Staffing Crisis?
As of March 2024, the health service has around 100,658 unfilled NHS job vacancies.
Labour market conditions have made it harder for NHS recruiters to keep up with demand, and as a result, our current workforce is bearing the brunt of being stretched thin. It means today’s doctors are working longer hours, experiencing worsening stress, and suffering from low workforce morale.
All the while, the NHS waiting list is growing-reaching a staggering 6.39 million June 2024.
As a result of the staffing crisis, NHS trusts are being forced to bring in more and more locum staff – i.e. temporary replacements to permanent doctors. This recruitment model comes with higher costs, with almost £3 billion being spent on locums, making it an unsustainable long-term option.
So, that’s the position we’re in today. If current trends continue, the NHS will be short of 571,000 staff by 2036. Action must be taken sooner rather than later if we are to avoid the worst effects of this workforce crisis.
NHS Workforce Crisis: 5 Biggest Challenges Faced by The Healthcare Industry
The NHS workforce crisis has been aggravated by the intersection of many factors, some of which have been brewing for years. We’ll try to uncover the real picture of what’s happening here.
Uncompetitive salaries
Uncompetitive salaries within the NHS remain a persistent challenge in 2024, casting a long shadow over the healthcare sector. Despite a 5.5% pay rise in 2023/24, the cumulative effect of years of real-terms pay decline has left many healthcare professionals feeling undervalued and financially strained. This has fueled ongoing industrial action, with strikes disrupting patient care and adding further strain to an already overburdened system.
The stark pay disparity between UK healthcare workers and their counterparts in other countries, particularly Australia, has created a ‘brain drain’ effect. Junior doctors, in particular, are increasingly seeking better pay and working conditions abroad, exacerbating the NHS staffing crisis. This loss of talent not only impacts patient care but also places additional pressure on those who remain, leading to burnout and further attrition.
Addressing the issue of uncompetitive salaries is crucial for the future of the NHS. It requires a long-term commitment to fair pay that keeps pace with inflation and reflects the dedication and expertise of healthcare professionals. Failure to do so will only perpetuate the cycle of strikes, staff shortages, and declining patient care, undermining the very foundations of the NHS.
NHS staff retention issues
The end of the pandemic triggered a wave of turnover, particularly among experienced staff. Pre-pandemic turnover rates, which hovered between 7% and 8%, surged to 11% by September 2023.
This exodus of seasoned professionals carries significant implications for productivity. Their wealth of experience and skills is crucial for delivering high-quality, efficient patient care. Furthermore, their departure places additional strain on existing clinical staff who must now shoulder the responsibility of training and developing newer recruits. While this impacts productivity in the short term, it can lead to longer-term benefits as new staff gain experience and expertise.
Between 2010 and 2019, managerial ranks thinned, and integrated care boards are now facing a mandate to slash running costs by 30% in real terms in 2025/26, with at least 20% of those cuts due in 2024/25. This inevitably means further reductions in managerial staff.
The pandemic and its aftermath have left a deep imprint of burnout on NHS staff. Sickness absence rates remain elevated compared to 2019, with mental health conditions such as anxiety and stress accounting for nearly a quarter of all absences in January 2024.
The plain answer to this problem is to inject new funding into the NHS budget. However, until these wishes become a political reality, NHS trusts must find other ways to save money, such as cutting the cost of recruitment processes.
Regional imbalance
Like many countries, the UK experiences a high degree of regional imbalance.
In particular, our population, capital, and public infrastructure is mostly concentrated in large cities, especially London. Consequently, most young people (including junior doctors and nurses) choose to live in cities to find high-paying jobs and a reasonable commute to work. The NHS workforce, which is composed of a younger cohort than the average cross-section of society, is therefore mostly found in cities.
In contrast, older folk tend to prefer countryside life when they retire. Since our bodies suffer from worsening health conditions as we age, the result is that rural NHS services face higher influxes of patients as a proportion of their local populations. And, with fewer people to fill job positions in these areas, it only aggravates the staffing problems felt across the NHS.
The NHS recruitment and inclusion framework has listed several strategies for boosting talent acquisition in these areas, such as removing barriers to the workforce, or better advertising these positions to the public.
Visa/immigration issues
The NHS is a diverse workforce, with 16.5% of its staff being foreign nationals. This means that any changes to visa rules have a knock-on effect on how easily the NHS can source staff.
A prime example of this was when the UK officially left the EU bloc on the 31st January 2020, which effectively ended free movement to and from the continent. Since EU nationals no longer have the automatic right to live or work in the UK, it has restricted the talent pool that NHS recruiters can hire from.
Shortly after, the UK adopted a new ‘points based’ immigration system from 1st January 2021, which restructured eligibility criteria for work visas. While this has created a new administrative loophole for foreign nationals to come to the UK, it has increased the likelihood of so-called ‘skilled workers’ being granted a work visa.
It’s expected that these rules will make it easier for the NHS to source its employees from foreign countries outside of the EU. However, it’s also worth noting that the BMJ has expressed concerns about the legislation’s effect on social care in particular. Namely, that the law requires all applicants to have a job offer in place before they can be accepted into the country. NHS recruiters are in uncharted territory and will need all the expertise they can get to navigate the road ahead.
Are There Specific Areas Within the NHS That Face More Severe Recruitment Challenges?
The NHS is massive. It’s not just the biggest employer in Europe, but it’s also the biggest employer of skilled professionals in the world. It’s not surprising that there are some areas that are suffering from worse recruitment challenges than others.
For starters, there is the geographic disparity, with healthcare workers being predominantly located in the UK’s big cities. Naturally, this has placed extra recruitment burdens on NHS trusts in rural areas, in particular in Wales, Scotland, and Northern Ireland.
Then there are the recruitment gaps in particular NHS sectors, which can be found on the UK government’s ‘shortage occupations’ list. All medical professions were added in October 2023, meaning foreign nationals have an easier route to obtaining a work visa. Among the list, professions such as physiotherapists, radiographers, and paramedics are highlighted as being in high demand.
How Is the NHS Dealing With the Recruitment Crisis?
NHS trusts have been forced to rely on agency staff to plug the holes of its workforce crisis. However, this is more of a sticking plaster than it is a genuine solution—being both expensive and unsustainable. As such, trusts are increasingly adopting new techniques to Hire NHS top talent:
- Apprenticeship schemes: The NHS has recently placed more of an emphasis on offering apprenticeships to young people, in the hopes that it will grow a pool of home-grown talent. It offers an alternate route in the healthcare industry that especially benefits disadvantaged students who are put off by the cost of university tuition fees.
- Retire and re-join: The great resignation saw hundreds of thousands of doctors and nurses leave the NHS, but it doesn’t mean that they’re gone for good. The retire and re-join scheme launched in April 2023, allowing NHS employees to take their pension and top it up with a continued salary on as many hours as they wish.
- Flexible working hours: In recent years, NHS trusts have embraced the concept of ‘flexi time’, recognising its advantages for staff morale and work/life balance. This trend is expected to continue not just in the NHS, but also in other areas of the workforce.
What Impact Do Recruitment Challenges Have on Patient Care in the NHS?
The NHS staffing crisis has had severe repercussions for patient wellbeing. Whether it’s an accident requiring urgent medical care, or a long-term condition in need of a check-up, there simply aren’t enough healthcare professionals to keep up with demand.
The latest Referral to Treatment (RTT) figures for June 2024 show:
- The waiting list stood at 7.62 million cases, consisting of approximately 6.39 million individual patients waiting for treatment
- Around 3.13 million of these patients have been waiting over 18 weeks;
almost 302,700 of these patients have been waiting over a year for treatment – a slight decrease from around 307,500 the previous month (May 2024) - A median waiting time for treatment of 14.3 weeks – almost double the pre-COVID median wait of 7.5 weeks in June 2019.
For those who can’t afford private treatment, wait times could be putting their lives at risk.
Are There Initiatives to Recruit Healthcare Professionals from Abroad to Fill Vacancies in the NHS?
Yes. The NHS has multiple initiatives to attract diverse talent from around the globe. In fact, ethical international recruitment is listed as a workforce priority in the NHS Long Term Plan.
Currently, the points-based immigration system is intended to make it easier for qualified overseas professionals to come to work in the UK. Additionally, the Department of Health and Social Care is piloting a scheme for refugee nurses to come to the UK for the opportunity to rebuild their lives. And if you’re an EU national who worked in the UK before Brexit, you can apply for a visa under the EU settlement scheme.
How Can Individuals Interested in Working for the NHS Navigate the Recruitment Process?
The NHS recruitment process is notoriously labyrinthine—and rightly so, given that these workers are on the frontlines of our nation’s hospitals and clinics. Not just anyone can become a healthcare professional; it requires extensive education, background checks, and a process of onboarding.
Doctors have a relatively clear-cut route to working in the NHS, following the standard Foundation Programme application after completing a medicine degree at university. Likewise, nurses have a standardised pathway through the GPN Foundation Programme, which requires a nursing degree.
However, there are also many other roles within the NHS, such as healthcare assistants and non-clinical staff, that don’t require a degree. Applicants should research the relevant schemes in their local authority or get in touch with an NHS recruiter for advice.
Hire the Top Talent You Need With Software Specifically Built to Support NHS Recruitment
The NHS recruitment crisis has highlighted the need for long-term planning and restructuring of the workforce. It’s more important now than ever to make the switch from agency workers to permanent doctors and nurses.
Everything starts with recruitment. Without a tried-and-tested hiring cycle, and the tools to support it, the UK’s health service has no chance of attracting the top talent it deserves. That’s why we built Oleeo’s NHS recruitment platform. Our software integrates with NHS Jobs and Electronic Staff Record, and automates manual workloads like pre-employment screening.
Join the 145 NHS hospitals and 216 private hospitals (each with 2,000+ full-time equivalent job roles) that use Oleeo to assemble their diverse and competitive workforces.
