The NHS in England needs a massive injection of homegrown doctors, nurses, GPs and dentists to avert a recruitment crisis that could leave it short of 571,000 staff, according to an internal document seen by the Guardian.
A long-awaited workforce plan produced by NHS England says the health service is already operating with 154,000 fewer full-time staff than it needs, and that number could balloon to 571,000 staff by 2036 on current trends.
The 107-page blueprint, which is being examined by ministers, sets out detailed proposals to end the understaffing that has plagued the health service for years. It says that without radical action, the NHS in England will have 28,000 fewer GPs, 44,000 fewer community nurses and an even greater lack of paramedics within 15 years.
It suggests that the NHS will not be able to cope with the increasing demand for care that will arise in coming years as a result of the growing and ageing population. Services in rural areas, which already struggle to attract enough staff, will be left unable to give patients – especially older people – the help and treatment they need, it warns.
NHS England also makes clear in the blueprint its view, which is widely shared by health experts and staff groups, that the government must ditch its reliance on hiring more and more overseas health professionals and spending billions of pounds a year on temporary staff.
A recent draft of the plan revealed that the NHS was operating with 154,000 fewer full-time staff than it needs – far more than the official figure of 124,000.
In a thinly veiled plea to ministers to kickstart an ambitious programme to give the NHS enough personnel, it added: “Without any intervention or improvement in productivity, the workforce shortfall will grow to 571,000 full-time equivalents by 2036/37.” Those 571,000 staff are the equivalent of more than a third (37%) of the service’s existing 1.6 million-strong workforce.
However, the Guardian understands that the chancellor, Jeremy Hunt, is playing a key role in behind-the-scenes moves by the Treasury to water down NHS England’s proposals to double the number of doctors that the UK trains and increase the number of new nurses trained every year by 77% – because it would cost several billion pounds to do that.
His stance has led to a standoff with his cabinet colleague Steve Barclay, who is backing the plan. The health secretary believes that while NHS England’s projections are ambitious, they are also a realistic assessment of the dramatic scale of action needed to eradicate the severe staff shortages that are hampering the NHS’s ability to meet waiting time targets for A&E care, cancer treatment and surgery, and endangering the quality and safety of care that patients receive.
A senior NHS leader said: “Jeremy Hunt has been very resistant to the numbers in the workforce plan. The Treasury and Hunt don’t want numbers in it. They want it to be not very precise. They want the numbers to be projected in a different way that would be less expensive and to not commit to training specific numbers of doctors, nurses and others.
“While intellectually Hunt gets it, and emotionally he gets the patient safety argument, it seems that his priority, if the government has any financial headroom, is to use that for tax cuts or giving the army more money rather than training more doctors, nurses and speech and language therapists.
“The Department of Health and Social Care (DHSC) are flying the flag for the plan and what’s needed. Steve Barclay wants the plan to move forward. But there’s some significant pushback from the Treasury and from the chancellor himself.”
Hunt is balking at the cost of taking forward NHS England’s proposals. The document says that while the UK currently has 7,500 medical school places, double that – 15,000 – is required.
Similarly, the number of trainee GPs in England needs to jump from 4,000 to 6,000 and the annual supply of nurses to increase from 29,865 to 52,722 – a 77% uplift. The plan also says that the number of dentists needs to rise by 40%, and of physiotherapists and their allied health professionals by 20%.
The NHS needs to increase the overall number of all types of health professionals it trains from 66,032 to 102,484, a 55% rise, the document concludes.
It is due to be published shortly, once the disagreement over its contents has been resolved.
Hunt’s stance is in contrast to his enthusiastic backing, while chair of the Commons health select committee, for a massive expansion of the NHS workforce and publication of regular projections for how many staff of different types it needed to keep pace with the growing burden of illness.
The plan raises major concerns about the use of temporary staff to ensure safe staffing levels in hospitals. Spending on bank and agency staff has risen by 51% and 26% respectively since 2020, it says. “Use of agency staff is expensive and offers poor value for money for the taxpayer.” It also cites “increasing evidence that use of temporary staffing – particularly agency staff – can have a negative impact on patient and staff experience, and continuity of care.”
It also voices unease about the recent surge in the number of overseas workers in the NHS. They now account for one in six of the workforce – double the number in 2014. “International recruitment has supported necessary increases in some staff groups, such as doctors and nurses, but does not offer a universal solution to rising workforce demand,” the plan says.
Opposition parties accused the Conservatives of leaving the NHS unable to do its job properly by doing too little about NHS understaffing for years.
Wes Streeting, the shadow health secretary, said: “This is a national emergency. The NHS is experiencing the worst workforce crisis in its history and it is crying out for the government to act. Until the Conservatives admit they have failed to train enough staff, patients will continue to wait too long for the care they need.”
Daisy Cooper, the Liberal Democrats’ health spokesperson, said: “Our NHS is already struggling to recruit and retain the staff it desperately needs but these future projections should be a wake-up call to a Conservative government that continues to sit on its hands. Those dedicated NHS workers that turn up day in, day out need to know that the cavalry is coming.”
Anita Charlesworth, the director of research at the Health Foundation thinktank, said: “Around half of newly recruited NHS doctors and nurses are currently trained overseas – in the long term this is unsustainable and unethical in the context of a global shortage of medical staff.
“Relying on agency staff to plug gaps pushes up the cost of care, a prime example of the inefficiency resulting from the Treasury’s failure to spend on training new staff. The NHS workforce plan must set out comprehensive, long-term measures to recruit and retain the domestically trained staff needed by the NHS, and commit the funding to pay for this.”
A government spokesperson said: “We’re growing the healthcare workforce, recruiting 50,000 more nurses and we have almost hit our target of delivering 26,000 additional primary care staff.
“The NHS will soon publish a long-term workforce plan to support and grow the workforce.”
A DHSC source said: “We are driving forward progress to recruit more staff into the NHS to help treat patients more quickly, with more than 4,800 doctors and almost 10,900 more nurses compared to a year ago.”