General Debate on the future of the NHS, its funding and staffing

Background

The Government has committed to publishing an NHS workforce plan, including independently verified forecasts for the number of doctors, nurses and other professionals needed to maintain the workforce over the next five to fifteen years. It has also commissioned Health Education England to review trends in the health and regulated social care workforce.

The Government says it is on track to meet its target for 50,000 more nurses by the end of March 2024 but think tanks and the Health and Social Care Committee have expressed concern that the demand for nurses is increasing faster than supply.

Over the past decade, NHS figures for England tend to show more people joining that leaving the NHS. Despite this, the number of vacancies has increased in recent years. In September 2022, 133,450 vacancies were recorded across the NHS in England and of these 47,500 were for nurses.

The NHS uses internal “banks” of staff and external agencies to fill vacancies. Staff supplied by agencies cost on average 20% more than NHS bank staff. The NHS England spend on agency staff was £2.44 billion in 2020/21.

The Government has said 2021/22 figures are yet to be finalised, though there are reports of a 20% increase in agency spending based on responses to freedom of information requests.

Consistently, more students apply to nursing and medicine courses than there are places available. The number of medical school places is capped. Stakeholders have called on the Government to increase the number of training places to boost domestic workforce numbers, but the Government has said this would have a “significant financial implication”.

International recruitment into the NHS workforce is growing and there has been a shift in international recruitment trends from EU to non-EU countries, raising concerns about the recruitment from ‘red-list countries’, where active recruitment is not permitted. In the context of a global shortage of healthcare workers, some stakeholders have said the UK has become overly reliant on international recruitment.

A number of issues have been highlighted as factors affecting the attractiveness of joining, and remaining in, the NHS, including work related stress, sickness and burnout and bullying, harassment and discrimination.

The Government’s 2022/23 pay offer was widely rejected by healthcare worker unions, who are now taking industrial action across the sector. Members of the Royal College of Nursing will go on a 48 hour strike in March 2023.

Junior doctors in England have also voted for strike action, which will involve a 72-hour walk out across all services.

The following Library products provide background information on the future of the NHS, its funding and staffing:

• Commons Library briefing paper CBP-9731 The NHS workforce in England, 21 February 2023
• Commons Library briefing paper CBP-7281NHS Key Statistics: England 18 November 2022
• Commons Library debate pack CDP-0209NHS staffing levels

Funding statistics

The table below gives details of the Department of Health and Social Care resource budget from 2010/11 to 2024/25. The figures up to 2021/22 are outturn expenditure, while those from 2022/23 onwards show spending plans.

Figures are shown in cash prices and real terms (ie taking inflation into account), with the annual real terms percentage change also shown.

With the exception of 2020/21, a real terms increase in expenditure is observed in each year shown. The highest annual increase of +11.3% is associated with the spending plans for 2022/23.

Sources: HM Treasury Public Expenditure Statistical Analyses, Table 1.5 Autumn Statement 2022, Tables 2.1 and 2.2 HMT GDP deflator, December 2022

Parliamentary questions

• Health Services: Finance |15 Feb 2023 | Written questions | Answered | House of Commons | 136769
• Accident and Emergency Departments: Finance |09 Feb 2023 | Written questions | Answered | House of Commons | 138417
• NHSand Social Services: Staff |08 Feb 2023 | Written questions | Answered | House of Lords | HL5274
• NHS: Finance | 07 Feb 2023 | Written questions | Answered | House of Commons | 138317
• NHS: Finance | 24 Jan 2023 | Written questions | Answered | House of Commons | 903230
• NHS: Finance | 16 Jan 2023 | Written questions | Answered | House of Commons | 120183

News articles 

• ICSs which ‘play the game’ offered extra funding 
  20 February 2023
  Health Services Journal
• NHS’ ‘slapdash’ cost-cutting leaving thousands without vital treatment
  19 February 2023
  Independent
• The NHS crisis - decades in the making
  7 February 2023
  BBC
• Thousands rally to demand action on NHS funding crisis
  29 January 2023
  Morning Star 
• The real reason for the NHS crisis
  15 December 2022
  Financial Times