The health and social care workforce gap

There is a global shortage of healthcare workers. The World Health Organisation estimates there will be a healthcare workforce gap of around 14.5 million by 2030. The workforce crisis has been described as the worst problem currently facing the NHS, and the Care Quality Commission’s State of Care report for 2018/19 said it is having a direct impact on care.

As health and social care are devolved, this Insight sets out the numbers behind the workforce shortages in England and examines proposed plans to address them.

How big is the shortage of healthcare workers?

Around 1.2 million full-time equivalent (FTE) staff work in the NHS, and 1.1 million work in adult social care. Around 78% of social care jobs are in the independent sector. Providers across NHS England are reporting a shortage of over 100,000 FTE staff. Adult social care is facing even starker recruitment and retention challenges, with an estimated 122,000 FTE vacancies. This equates to a vacancy rate of around 8% for both the NHS and adult social care, compared with a vacancy rate of under 3% for jobs across the UK economy.

Analysis by the King’s Fund suggests the NHS workforce gap could reach almost 250,000 by 2030. Nursing is facing one of the greatest problems with one in eight posts vacant. The Interim NHS People Plan identified nursing shortages as “the single biggest and most urgent we need to address.” This is partly due to the integral role of nurses in delivering the NHS Long Term Plan, but also due to the absolute number of vacancies. There are significant shortages in learning disability, primary and community nursing, whilst the mental health nursing workforce dropped by 11% between 2009 and 2019.

In adult social care, around one in 10 social worker and one in 11 care worker roles are reportedly unfilled. The vacancy rate is highest in London. The demand for social care workers is expected to rise in line with the UK’s ageing population. Skills for Care have estimated a need for 650,000 to 950,000 new adult social care jobs by 2035.

The role of overseas nationals

12% of the healthcare workforce were non-British nationals in 2018, with similar numbers of EU and non-EU nationals. This trend varies by region: 23% of health workers in London were non-British, compared with 6% in Yorkshire and the Humber. The proportion also differs across staffing groups, with the NHS particularly reliant on overseas doctors. In 2018-19, for the first time, more non-UK graduates registered as new doctors than graduates trained in Britain. In response, the General Medical Council (GMC) stated:

“Overseas trained doctors are vital to the NHS and the role of the international recruitment is helping the service to tackle vacancies across trusts. We know that a longer-term approach to meeting our workforce needs for the future must encourage higher numbers of locally trained staff over the next 5 to 10 years.”

In June 2019, around 65,000 EU nationals were employed in NHS Hospital and Community Health Services (HCHS). Doctors and nurses were more likely to be EU nationals than some other staff groups (see Chart 1). In the adult social care sector, there were around 121,200 EU nationals, of which 78,000 were care workers. However, as a proportion, nurses were most likely to be EU nationals.

Addressing the shortage of workers

There is variation in the ability of services to recruit and retain staff. The Care Quality Commission’s State of Care 2018/19 report states:

“Areas in and next to London face specific issues linked to higher costs of living and pay disparities caused by the London weighting.

In primary care, there are areas of the country that have struggled to attract and retain GP staff, driven by their relative rurality or attractiveness as a place to work and live.

…In adult social care, staff are affected by the lack of value given to social care by society and disproportionate levels of pay.”

The Interim NHS People Plan, published in June 2019, set out the following broad commitments to tackle the workforce gap:

1. Make the NHS the best place to work
2. Improve our leadership culture
3. Prioritise urgent action on nursing shortages
4. Develop a workforce to deliver 21st-century care
5. Develop a new operating model for workforce
6. Take immediate action in 2019/20 while we develop a full five-year plan

The interim plan highlights an immediate need to improve retention, particularly in nursing. There is also a retention problem in social care, with a turnover rate of 40% for care workers in 2018/19. The GMC has warned that more doctors are choosing to cut their working hours in response to workload pressure. The number of FTE GPs has been rising more slowly than the total number of GPs, indicating that more are working part-time.

Labour, Conservative and Liberal Democrat manifestos addressed the NHS workforce crisis, with less detail provided on social care (see box for a summary). 

Further reading

• Falling short: the NHS workforce challenge, The Health Foundation
• The state of the adult social care sector and workforce in England, Skills for Care
• Legal duties of the Secretary of State for Health and Social Care for NHS workforce planning and supply in England, House of Commons Library
• Closing the gap: key areas for action on the health and care workforce, The King’s Fund

Image: Nurse carrying out a bed changeover / Adrian Wressell, Heart of England NHS FT / CC BY 4.0