Does the NHS have enough staff?

The NHS in England carried more than 112,000 vacancies in 2023 — an 8.4% vacancy rate, up from around 64,000 unfilled posts in 2015. Nursing accounts for the largest single shortfall: 47,500 vacancies, meaning roughly one in nine nursing posts is empty. The departure of EU workers after Brexit removed a ready source of trained staff, and the NHS now recruits heavily from India, Nigeria, and the Philippines. Around one in three new nursing registrants trained abroad — a dependency that raises ethical questions about drawing healthcare workers from countries with their own acute shortages.

The vacancy problem is as much about retention as recruitment. Around 65,000 NHS staff leave every year; the NHS Staff Survey consistently identifies burnout, weak line management, and pay as the primary reasons. Nurse pay fell roughly 12% in real terms between 2010 and 2023. Junior doctors took industrial action in 2022–23 — the first such strikes in NHS history — citing pay erosion of over 26% since 2008. The disputes were settled with rises of 5–8%, restoring some ground but leaving total remuneration well below the levels that attracted staff a decade ago.

The government's response is the NHS Long Term Workforce Plan, published in June 2023, which commits to doubling medical school places and increasing nursing training by 92% over 15 years at a cost of £2.4bn. The ambition is real, but the timescale is not. Training a doctor takes more than ten years from undergraduate entry to independent practice; the doubled cohort will not be fully qualified until the mid-2030s. For the rest of this decade, the NHS will remain heavily reliant on international recruitment to fill the gap that domestic underinvestment created.

The vacancy crisis is shaped by a decade of policy choices. Between 2010 and 2018, the number of funded nursing training places in England was cut by approximately 25%, and the replacement of NHS bursaries with student loans in 2017 led to a 32% drop in nursing degree applications the following year. Medical school places were capped well below projected demand throughout the 2010s. The result is a domestic training deficit that international recruitment has been asked to fill: around 34% of new NMC registrants in 2023 trained overseas, primarily in the Philippines, India, and Nigeria — countries on the WHO's Health Workforce Support and Safeguards List. Meanwhile, the cost of covering vacancies with agency and bank staff reached £3 billion in 2022/23, roughly equivalent to the entire 15-year budget of the Long Term Workforce Plan. The poorest-performing trusts spend the most on agency cover, creating a cycle in which the areas most in need have the least funding available for permanent recruitment.

Workforce data understates the scale of the problem in several ways. The headline vacancy figure counts only posts that trusts are actively advertising; roles that have been frozen, downgraded, or abandoned do not appear. NHS Digital does not publish a unified, trust-level dataset linking vacancies, agency spend, and patient outcomes — making it impossible to assess directly whether staffing levels in a given hospital are safe. Attrition data tracks leavers from the NMC register but does not distinguish between nurses who emigrate, those who retire, and those who move to non-clinical roles within the NHS. The Long Term Workforce Plan's projections rely on demand modelling that NHS England acknowledges carries “significant uncertainty,” particularly around the future role of technology and the shifting burden of disease. There is no published methodology for how the £2.4 billion costing was derived, and independent analysts have questioned whether it accounts for inflation or capital costs.