The future of the NHS depends on its workforce
BMJ 2024; 384 doi: https://doi.org/10.1136/bmj-2024-079474 (Published 27 March 2024) Cite this as: BMJ 2024;384:e079474Read the full series: The BMJ Commission on the Future of the NHS
- Mary Dixon-Woods, director1,
- Charlotte Summers, professor of intensive care medicine2,
- Matt Morgan, professor of intensive care medicine and columnist345,
- Kiran Patel, chief medical officer and consultant cardiologist6
- 1THIS Institute, Cambridge, UK
- 2University of Cambridge, Cambridge, UK
- 3University Hospital of Wales and Cardiff University, Cardiff, UK
- 4Curtin University, Australia
- 5The BMJ
- 6University Hospitals Birmingham and University of Warwick, UK
- Correspondence to: M Dixon-Woods mary.dixon-woods{at}thisinstitute.cam.ac.uk
Achieving a high quality, sustainable NHS is currently challenged by major workforce problems. Staff are the most significant element of NHS expenditure1 and its most important asset in providing care for NHS patients, but stewardship of the workforce is not optimised at policy or service level. Based on knowledge of the field, the literature, and listening to patients and staff, we identify three key interlinked areas in which action is urgently needed: configuring the workforce, improving conditions and working environments, and enhancing career and training pathways. We propose what might be done to tackle the current challenges, emphasising that workforce stewardship needs to be highly intentional about diversity, inclusion, and equity and needs to be done collaboratively with staff, patients, and the public.
Configuring the workforce for the future of the NHS
Staff shortages
The future of the NHS depends on having the right numbers of staff in the right roles, at the right times, and in the right locations. At present, the NHS simply does not have enough staff to deliver on its goals and commitments: it has fewer doctors, nurses, and managers than peer countries. By June 2023, there were over 125 500 vacancies in hospital and community health services in England.2 Over 1 in 10 nursing posts were unfilled, with mental health and community nursing especially affected.2 Although the overall number of doctors in hospital and community services has increased to 134 000, representing an additional 39 000 medical staff since 2010,2 the NHS is currently short of nearly 11 000 doctors (a 7.2% vacancy rate). The vacancy rate in clinical professional roles is compounded by difficulties in recruiting and retaining high quality staff in other roles, including administrative, managerial, scientific, and technical staff, as well as …