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 2023, the health service has around 112,000 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 7.5 million in May 2023.
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 £3 billion being spent on locums in 2022, 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
For the first time in its 106-year history, the Royal College of Nursing chose to ballot its members for strike action in October 2022. Soon after, unions representing ambulance workers, junior doctors, and NHS consultants decided to join them in solidarity. By and large, the union members voted to strike.
As of October 2023, this industrial action is still ongoing, and the single biggest reason is due to uncompetitive wages in the NHS. In fact, when factoring in inflation, NHS workers have experienced a decline in their real-terms income for 15 years straight. So, when the UK’s cost-of-living crisis began to bite, it was the final straw for many.
Progress is being made in this regard—with talks ongoing and a permanent 5% pay rise being announced for all NHS pay points for 2023/24.
However, it’s impossible to ignore the differences in medical professionals’ salaries in the UK vs other similar countries. For instance, foundation (junior) doctors in the UK may be paid as little as £32,398 in their first year of practice. Compare that to another English-speaking country, Australia, where entry-level doctors typically start on a salary of AU$112,508 (£58,625). With such a large pay difference, and reports of a less demanding working environment, it’s no surprise that the UK to Australia pipeline is a popular choice for junior doctors. This has only added fuel to the fire of the NHS staffing crisis.
NHS staff retention issues
Staff retention is another huge issue for the NHS, with workers quitting their jobs in droves due to uncompetitive salaries and mounting stress. This problem is increasing year on year, with the NHS trusts reporting their staff leaver rate to have increased from 9.6% in 2020 to 12.5% in 2022.
Essentially, this means that the NHS now has to replace 12.5% of its workforce every year—which amounts to an extremely costly annual recruitment cycle. And because less money is left in the pot, it means it’s harder to afford current NHS workers a pay rise, leading to a vicious positive feedback cycle.
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.
Recruitment fallout from Covid-19
The Covid-19 pandemic placed extraordinary demands on the NHS, with new social-distancing rules, PPE requirements, and millions of extra hospitalisations and vaccinations. This only exacerbated the stress, anxiety, and diminished work/life balance felt by NHS employees.
It also contributed to the chronic staff shortages that we’re seeing in today’s health service, with burnout and loss of morale causing a ‘great resignation’ of NHS staff.
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. As of October 2023, all medical professionals are included, 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.
As we mentioned earlier, the NHS reached 7.5 million in May 2023. On top of that, ambulance wait times for category one ‘life threatening’ emergencies reached nine minutes and two seconds in 2022, far higher than the seven-minute national target. As for category two emergencies, such as a heart attack, wait times were over 51 minutes long.
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.
