Who's Looking After the People Looking After You?

The NHS Staff Survey — the largest workforce survey in the world, covering approximately 600,000 respondents annually — reveals a service under profound strain. In 2023, 34% of staff reported feeling burnt out, up from 28% in 2019. The proportion of staff who would recommend the NHS as a place to work fell from 67% to 57% over the same period, with morale lowest among ambulance staff and mental health nurses.^[1] Behind these figures sits a workforce crisis that predates the pandemic but was dramatically accelerated by it: the NHS in England carries roughly 112,000 unfilled posts — a vacancy rate of approximately 8% — and spent £3 billion on agency staff in 2023/24 to cover the shortfall.^[2,3] Sickness absence runs at 5.2%, double the private sector average of 2.6%, with 44% of staff reporting work-related stress and 30% experiencing musculoskeletal problems. The junior doctor strikes of 2023 and 2024, driven by a 35% real-terms pay erosion since 2008, reflected a workforce that increasingly feels undervalued, overworked, and unable to deliver the standard of care it trained for.

The structural causes are well-documented but slow to address. The NHS Long Term Workforce Plan, published in July 2023, promised a doubling of medical school places and a 50% increase in GP training places — but the funding to deliver these commitments remains unfirmed.^[4] In the meantime, international recruitment accounts for approximately 25% of new nurse registrations, creating a dependency risk that workforce planners acknowledge but have not resolved. Nursing turnover has eased since the worst of the post-pandemic exodus, falling from 12.5% to 10.8% between 2022 and 2024 following improved pay settlements, but it remains above pre-pandemic levels. The danger is circular: burnt-out staff leave, vacancies rise, remaining staff carry heavier workloads, burnout deepens, and the cycle repeats. Agency spending — at £3 billion annually — is both a symptom and a cost: every pound spent on temporary cover is a pound not spent on the permanent workforce, training, or the infrastructure that might ease the pressure in the first place.^[3]