NHS leaders have called on the government to publicly recognise the scale of the NHS' current workforce problems as the first step to solving them.

As trust leaders prepare for what is already becoming the most difficult winter in NHS history, workforce issues are now, by far, trusts' biggest problem.

Trust leaders point to six different workforce challenges currently being faced across the health and care system:

• Difficulties in recruitment with nearly 100,000 NHS vacancies. This level of vacancy was occurring before COVID-19 hit.
  
  
• Recent loss of key staff to other sectors including retail, hospitality and logistics as these sectors pay significant sign on bonuses and higher comparative wages. This is a particularly acute problem in social care with an estimated 50-70,000 staff (3-4%) of staff having left the sector in the last six months.
  
  
• Growing numbers of staff choosing to retire early or return to their countries of origin. Trust leaders report "very worrying" retention problems amongst staff who have a greater level of discretion on whether they continue working for the NHS. There is particular concern at the loss of experience and leadership from senior staff who are close to retirement leaving the service.
  
  
• Growing levels of sickness absence due to the consistent, high, level of pressure staff are under. In our recent The State of the Provider Sector survey, 94% of trust leaders said they were concerned about staff burnout.
  
  
• Increasing difficulty in securing staff to work bank and agency shifts on which the NHS has become worryingly reliant. Trusts know they must prioritise the health and wellbeing off their staff who cannot be called upon to continually work extra hours. Trust leaders report that they are having to significantly increase temporary pay rates to try to staff these shifts with a consequent adverse impact on trust finances.
  
  
• Pressure on morale as staff say they are unable to give the quality of care they want to provide and that they believe patients need. Given the importance of working through growing care backlogs, staff are concerned that the current level of pressure will become 'normalised'.

Trust leaders say it is becoming increasingly difficult to maintain safe staffing levels, with some trusts reporting they are now having to close wards due to absence of staff, rather than risk patient safety. This is deeply worrying as the NHS heads into winter when the service needs as much capacity as possible.

Trust leaders also fear that if the push for mandatory vaccination is mishandled, potential further loss of additional frontline staff could jeopardise the safety and viability of 'pockets' of vital services. Some trust leaders were, for example, reporting concerns with maternity services, where substantial shortages of midwives and nurses existed prior to the pandemic and where there are higher proportionate numbers of staff still to be vaccinated.

The chief executive of NHS Providers, Chris Hopson, said:

"The single biggest message we are hearing from NHS staff is that they want the government to acknowledge the scale of workforce problems and to show how this level of pressure on them will not become the new normal.

"Staff have been working flat out since before COVID-19 and we are asking them, once more, to 'make an extraordinary effort this winter'. Staff will, of course, provide that extra effort. But they need to see a clear plan for how they get to a reasonable workload on a sustainable basis.

"The scale of the NHS' workforce problems are plain for all to see. Nearly 100,000 NHS staff vacancies. £6bn annual spend on temporary staff to fill these gaps. 55% of staff working unpaid extra hours each week. 44% saying they've felt ill with work related stress in the last year.

"All that frontline staff currently hear from government is constant repetition of the fact that there are record numbers of doctors and nurses in the NHS and that current pressures are sustainable.

"Thanks to the extraordinary effort of NHS frontline staff, the NHS won't break or fall over this winter. While the NHS does have more doctors and nurses than ever, growth in the NHS workforce has consistently failed to keep up with rising demand for care.

"This level of pressure on our workforce is totally unsustainable and it cannot go on much longer. It's now risking patient safety, quality of care and staff health and wellbeing. We can't keep trying to cover the mismatch between NHS capacity and demand for care by asking our staff to work harder and harder.

"Trust leaders therefore want the government to publicly acknowledge the scale of these problems. They recognise their role in solving them – it is as much their responsibility as it is government's to make the NHS a great place to work.

"But they want three clear government commitments:

• The government will amend the Health and Care Bill to provide a proper, robust, rigorous long term approach to workforce planning across health and care that, every two years, will set out future workforce needs for the following five, 10 and 20 years.
  
  
• In the first of these plans, within six months, the government will produce a fully funded plan to grow the health and care workforce over the next decade. The Health Foundation estimates that a million more health and care staff will be needed by 2030/31 to meet the estimated growth in need for health and care.
  
  
• The government will increase the NHS' education and training budget to match the required growth in workforce. Health Education England's £5bn budget has been cut by around half a billion pounds in real terms since the organisation's first budget was set in 2013.