The NHS has a talented and dedicated workforce, providing care to patients 24 hours a day, 7 days a week and 365 days a year. But it is struggling to cope with growing and changing pressures. We have now reached a tipping point: workforce concerns have become the single biggest risk facing services.   

We need clarity and honesty about who is responsible for delivering a sustainable workforce, how we achieve the right balance between national, regional and institutional roles, and how we can work to overcome the challenges we face. 

  • The gap between the workforce providers need and the staff they are able to recruit and retain is now unsustainable, putting at risk patient safety and quality of care. It may also undermine much-needed schemes to transform and modernise services. 

  • There are plans to increase domestic supply but it is far from clear this will be enough to meet current and future demand and new staff take several years to train. We will have to continue to recruit from the EU and the rest of the world. We need to be honest about the workforce supply gap we are facing. 

  • Trusts must continue do all that they can to recruit and retain staff, making their organisations great places to work, with positive and inclusive cultures where bullying is not tolerated and staff from diverse backgrounds are valued and empowered to succeed. Providers must also take opportunities to develop the workforce to deliver care in new ways and improve workforce productivity. 

  • Finally we must be clear that the existing workforce is under substantial pressure. Staff are feeling over stretched and undervalued. We need to look at all the factors which are contributing to staff leaving the NHS, from pay to working conditions. Trust leaders, performing difficult and complex roles in highly pressured and challenged organisations, need support from the national level to do this. 

NHS provider trusts can only go so far in tackling these challenges. A change of approach is urgently needed from the Department of Health and the NHS national bodies. Trusts do not have confidence in the current national approach, which lacks a coherent and credible strategy to support trusts in tackling the workforce challenges facing the NHS. 

While our focus has been on the provider sector we recognise that these challenges need to be seen in the context of the wider health and social care workforce, including primary care, third sector organisations, and, of course, the ‘informal workforce of family and friends who contribute so much to the care of loved ones. All these components of the health and social care workforce are interrelated. Sustainability and transformation partnerships and new care models offer an opportunity to take a more holistic approach to workforce strategy planning, and policy. But we must act now to address these challenges. 

This report is just the starting point and we look forward to working closely with trusts, the NHS national bodies, the Department of Health, and other stakeholders to ensure the provider sector has the workforce needed to deliver high-quality care.