DOI: https://doi.org/10.58248/HS134
Overview
In England, the NHS[1],[2]and adult social care (ASC) sector[3] make up around 13% of the workforce.[4] The UK has fewer doctors and nurses per person on average than other OECD countries[5],[6],[7] Health and social care in the UK is devolved policy area but all nations of the UK have sought to improve the growth and capacity of the health and social care workforce.[8] Persistent issues affecting both workforces include:
- High vacancy[9],[10] and leaver rates[11] and use of temporary staff.[12] Though vacancy rates have decreased slightly by 21,000 vacancies since 2022/23, there were 100,658 NHS vacancies in March 2024[13] and 131,000 adult social care vacancies in 2023/24, not including posts filled by temporary staff. [14],[15],[16],[17]
- Reliance on international recruitment. In 2022/23, 21% of the NHS and 19% of the ASC workforce were from overseas, including 38% of doctors on the GMC register.[18],[19],[20],[21]
In June 2023, NHS England (NHSE) published its Long-Term Workforce Plan (LTWP) aiming to address an estimated shortfall of 150,000 NHS staff and reduce reliance on international recruitment over a 15-year period.[22] To achieve this the Institute for Fiscal Studies estimated that an annual increase in the NHS budget of approximately 3.6% in real-terms.[23]
In July 2024, Skills for Care published the ASC workforce strategy, highlighting the need for sector growth to meet rising demand and to address changes in care provision, workforce expectations, and education.[24]
This was followed in January 2025 by a government announcement detailing new investments and reforms to strengthen ACS and support the workforce. Initiatives proposed included an £86 million boost to the Disabled Facilities Grant, expansion of the national career structure for care staff, and development of a shared digital platform to improve NHS-care provider information sharing. The government also appointed Baroness Louise Casey to chair an independent commission into adult social care to build cross-party consensus towards delivering a national service for provision of care services.[25]
Challenges and opportunities
Various challenges and opportunities arise at the level of policy, service provision, leadership and management, and staff issues. The independent investigation of the NHS in England, the ‘Darzi report’ (2024), highlighted significant challenges in recruitment and retention, exacerbated by social determinants of health, such as poor housing and low income. The report recommended a multifaceted approach to address these issues including funding for training and specific policies aimed at improving staff wellbeing and experience.[26]
In March 2025, the UK Government announced plans to abolish NHS England as an independent entity, integrating its functions directly into the Department of Health and Social Care (DHSC). It said this would reduce bureaucracy, eliminate duplication, and empower NHS staff to deliver better care.[27]
The growth in NHS and ASC workforces[28],[29] has not kept pace with demand driven by the increasingly complex needs of an ageing population (HS71, PN745), growing waiting lists, and greater economic inactivity since the covid-19 pandemic.[30],[31],[32],[33],[34]
Research evidence suggests the support and need for further investment and emphasis on community care over hospital-centric models.[35],[36],[37] However, excluding Covid-19 funding, between 2015/16 and 2021/22, the proportion of Department of Health & Social Care (DHSC) spending allocated to primary care decreased from 8.9% to 8.1%.[38] Challenges to the improvement and expansion of services in the community include workforce shortages, limitations in physical and data infrastructure, and the structure of training, contracts and funding.[39],[40],[41],[42],[43],[44],[45],[46]
Introducing new roles and skill mixes may address some staffing shortfalls and provide the opportunity for more joined-up and multi-disciplinary care.[47],[48] In January 2024, the DHSC launched the care workforce pathway.[49] In April 2025, four more new roles were added such as the ‘enhanced care worker’.[50] However, some have raised concerns about new NHS roles including over regulation, competition for training opportunities,[51] and poorer outcomes compared with doctors and nurses.[52],[53]
In the adult social care workforce, approximately 25% of staff are from ethnic minority backgrounds and 19% are non-UK nationals.[54],[55] However, the Adult Principal Social Workers Network and NHS Confederation (NHSC) highlight that this diversity is not reflected in senior leadership.[56] Data indicates that staff from minority ethnic backgrounds are half as likely to be appointed from a shortlist or promoted compared to their white counterparts.[57] This lack of representation can hinder the sector’s ability to address the needs of the communities it serves effectively.[58],[59] NHSC reports suggests more equal and diverse representation in senior leadership can make leaders reflective and sensitive to the communities they serve.[60],[61],[62]
Research suggests that the NHS is under managed,[63] with a need for better support and accredited training for managers to enhance performance.[64] Contributing factors can include outdated infrastructure, reliance on less experienced staff, and strained primary care.62
Improving productivity will require strategic investment in capital (buildings and infrastructure), technology, innovation, and initiatives to boost staff morale.[65],[66],[67] Since 2022, some NHS workers have taken strike action due to pay and patient safety concerns,[68] impacting NHS performance and increasing expenditure.[69]
The House of Commons Health and Social Care Committee inquiry report Social care: changes to legal migration measures noted that better pay can increase satisfaction.[70] Though research suggests it is uncertain that pay or salary supplements alone can significantly improve retention or staff shortfalls.[71],[72] The Institute for Fiscal Studies has noted the importance of more flexibility in pay systems to address local variation in the cost of living.[73] Research indicates that non-monetary interventions—such as improved organisational culture and leadership, flexible working arrangements, support for career progression, wellbeing initiatives[74],[75], and professional development[76] can positively impact staff retention and patient care.[77]
Training and upskilling continue to be priority areas in health and social care. Return-to-practice schemes have seen limited uptake.[78] For instance, since its inception in 2014, the national return-to-practice programme for nurses has supported 7,978 returners, with the NHS suggesting more can be done for increased participation.[79],[80]
While NHS trusts recruit and employ staff locally, national arrangements are in place to cover pay and general terms and conditions. In contrast, adult social care has a different labour market, predominantly composed of private providers, particularly small companies, and a workforce requiring fewer formal qualifications.[81] This structure can lead to fee and wage fluctuations, high staff turnover, and a focus on time to do tasks rather than quality of care.[82]
Stakeholders, including local authorities and care sector organisations, have expressed concerns about reported exploitation associated with international recruitment drives for ASC work.[83] Reports highlight instances where migrant care workers faced illegal recruitment fees, substandard living conditions, and threats of deportation.80 To help tackle this the UK Government launched an international recruitment fund of £12.5 million in 2025-26 and guidance for regional partnerships.[84]
In December 2023, the government made changes to visa rules for workers to stop them bringing dependants, to require sponsorship by regulators Care Quality Commission (CQC), and to pay a higher health surcharge.[85] Stakeholders, including trade union UNISON, expressed concerns about how these would impact retention, in a workforce that is over 80% female, and includes roles that do not come under the remit of the CQC.[86],[87],[88]
Cross-sector stakeholders have suggested that integrated care systems[a] offer opportunities to standardise pay scales across HSC, and coordinate recruitment, development, performance and safety monitoring across local areas (HS97, PN532).[89],[90]
Key uncertainties
- Creating specific regulation for new roles and medical apprenticeships. [91]
- The opportunities and challenges of automation and AI on the workforce and upskilling health and social care workers in digital literacy and skills.
- The long-term impacts of workforce and education reform on retention, inequalities in access to training, careers, and patient outcomes.[92],[93]
- There is limited evidence and policy interventions on how to best support young and informal carers, to remain in education or employment without exacerbating health inequalities or social exclusion.[94],[95]
Key questions for Parliament
- How will the Government ensure sufficient capital investment to support the expansion of health and social care education and sustainable workforce quality, productivity and infrastructure?
- What are the most effective evidence-based approaches to improve recruitment and retention strategies across the health and social care sector? How can these approaches address identified root causes and prevent burn out and/or further strike action?
- How can the sector ensure the new roles and skills-mix in health and social care professions improve the current workforce structures?
- How will the government ensure adequate investment and funding in community-based care?
References
[a] Integrated Care System’s (ICS) aim to align actions between partners to improve outcomes, tackle inequalities, enhance productivity, and strengthen local communities.
[1] NHS England Digital, NHS Workforce Statistics – March 2024 (accessed 01 July 2024)
[2] NAO, NHS England’s modelling for the Long Term Workforce Plan, 22 March 2024, Figure 1, p12
[3] Commons Library research briefing CBP-9615, Adult social care workforce in England
[4] ONS, JOBS05: Workforce jobs by region and industry (accessed 01 July 2024)
[5] Nuffield Trust, The NHS workforce in numbers, 07 February 2024
[6] The Kings Fund, How does the NHS compare to the health care systems of other countries (PDF), June 2023, page 46-59
[7] The King’s Fund, Public satisfaction with the NHS and social care in 2023: Results of the British Social Attitudes survey, 27 March 2024
[8] UK Government, Build back better: Our plan for health and social care, Updated 12 September 2024
[9] Migration Observatory, Migration and the health and care workforce, 27 June 2023
[10] ONS, VACS02: Vacancies by industry (accessed 01 July 2024)
[11] Nuffield Trust, Waste not, want not: Strategies to improve the supply of clinical staff to the NHS, 28 September 2023
[12] NHS Pay Review Body, NHS Pay Review Body Thirty-Sixth Report 2023, 2023, p87
[13] NHS Digital, NHS Vacancy Statistics England, April 2015 – March 2024, Experimental Statistics (accessed 03 July 2024)
[14] Skills for Care, The state of the adult social care sector and workforce in England (accessed 01 April 2025)
[15] Nuffield Trust, The NHS workforce in numbers, 07 February 2024 (accessed 01 July 2024)
[16] NHS Pay Review Body, NHS Pay Review Body Thirty-Sixth Report 2023, 2023, p87
[17] Skills for Care, Turning point for social care as the sector launches a Workforce Strategy, 2024
[18] NAO, NHS England’s modelling for the Long Term Workforce Plan, 22 March 2024, p14
[19] Commons Library research briefing CBP-9615, Adult social care workforce in England
[20] Migration Observatory, Migration and the health and care workforce, 27 June 2023
[21] Nuffield Trust, Waste not, want not: Strategies to improve the supply of clinical staff to the NHS, 28 September 2023, p3
[22] NHSE, NHS Long Term Workforce Plan, 30 June 2023
[23] Warner, M and Zaranko, B. Implications of the NHS workforce plan. London: Institute for Fiscal Studies, 30 August 2023
[24] Skills for Care, A workforce strategy for adult social care (accessed 01 July 2024)
[25] Department of Health and Social Care, Guidance: Care workforce pathway for adult social care: overview, (accessed 16 April 2025)
[26] Department of Health and Social Care, Independent investigation of the NHS in England, Lords Darzi’s report, November 2024
[27] Department of Health and Social Care, NHS England, Press release World’s largest quango scraped under reforms to put patients first, 13 March 2025
[28] Office for National Statistics (ONS), The healthcare workforce across the UK, 6 March 2024
[29] The state of the adult social care sector and workforce in England, 2024 (skillsforcare.org.uk)
[30] Migration Observatory, Migration and the health and care workforce, 27 June 2023
[31] The Health Foundation, Health in 2040: projected patterns of illness in England, July 2023
[32] McKee M, Dunnell K, Anderson M, Brayne C, Charlesworth A, Johnston-Webber C, Knapp M, McGuire A, Newton JN, Taylor D, Watt RG. The changing health needs of the UK population, Lancet, May 2021, 22;397(10288):1979-1991.
[33] Commons library briefing, How is health affecting economic inactivity? 14 March 2023
[34] Shereen Hussein, The Impact of COVID-19 on social care workers’ workload, wellbeing and ability to provide care safely: Findings from the UK | PSSRU, 3 November 2020
[35] Reed S and Dodsworth E, Building community health and care capacity: Reflections from other countries. Briefing, Nuffield Trust, 2023
[36] Anderson M, O’Neill C, Macleod Clark J, Street A, Woods M, Johnston-Webber C, Charlesworth A, Whyte M, Foster M, Majeed A, Pitchforth E, Mossialos E, Asaria M, McGuire A. Securing a sustainable and fit-for-purpose UK health and care workforce. Lancet. 2021 May 22;397(10288):1992-2011.
[37] The Kings Fund, Primary And Community Care Needs To Be At The Core Of Health And Care, 13 February 2024
[38] Department for Health and Social Care, annual reports and accounts: 2021 to 2022, 2016/17
[39] House of Commons Health and Social Care Committee, The future of general practice, HC 113, 11 October 2022
[40] Committee of Public Accounts, Progress in improving NHS mental health services, 21 July 2023, Conclusions and recommendations para 1
[41] National Audit Office, Progress in improving mental health services in England, 9 Feb 2023
[42] Royal Pharmaceutical Society and The Kings Fund, A vision for pharmacy in England, 2024
[43] Health and Social Care Committee, Pharmacy, HC 140, 23 May 2024
[44] Health and Social Care Committee, NHS dentistry, HC 964, 11 July 2023
[45] Commons library research briefing CBP-9597, NHS dentistry in England, 29 May 2024
[46] Health and Social Care Committee, Government Response to the Committee’s Report on Workforce: recruitment, training and retention in health and social care, HC 1289, p48-61
[47] NHS England, Delivery plan for recovering access to primary care, 9 May 2023
[48] Rosen R and Palmer W, More staff in general practice, but is the emerging mix of roles what’s needed?, Nuffield Trust blog, 2023
[49] Department of Health and Social Care, Guidance: Care workforce pathway for adult social care: overview, Accessed 16 April 2025
[50] Department of Health and Social Care, Care workforce pathway for adult social care, 9 April 2025
[51] Una Geary, Martin McKee, Katie Petty-Saphon, Mind the implementation gap: a systems analysis of the NHS Long Term Workforce Plan to increase the number of doctors trained in the UK raises many questions, British Medical Bulletin, Volume 150, Issue 1, June 2024, Pages 1–10
[52] National Institute for Health and Care Research, Staffing on Wards: Making decisions about healthcare staffing, 26 March 2019
[53] National Institute for Health and Care Research, Scale, scope and impact of skill mix change in primary care in England: a mixed-methods study, May 2022
[54] The King’s Fund, The adult social care workforce in a nutshell, 2 May 2024
[55] Skills for Care, Headline social worker information, February 2024
[56] NHS Confederation, Diversifying the upper levels of the health service, 21 August 2024
[57] Nuffield Trust, Attracting, supporting and retaining a diverse NHS workforce, November 2021
[58] Department of Health and Social Care, Empowering diversity in social care: celebrating Black History Month, 1 October 2024
[59] Skills for Care, The social care workforce race equality standard – how representation supports retention, 11 September 2024
[60] Adult Principal Social Workers Network, Who Is Leading The Way? An introductory report on the world of social work leadership, October 2017
[61] NHS England, NHS Workforce Race Equality Standard (WRES) 2022 data analysis report for NHS trusts 22 February 2023
[62] NHS Confederation, Strengthening NHS board diversity summary (PDF), June 2021
[63] NHS Confederation, Are there too many NHS managers?, 16 February 2024
[64] Department of Health and Social Care, Health and social care review: leadership for a collaborative and inclusive future, Independent Report, 8 June 2022
[65] NHSE, NHS Long Term Workforce Plan, June 2023,
[66] The Kings Fund, Productivity in the NHS and health care sector, 14 June 2024
[67] The Kings Fund, How does the NHS compare to the health care systems of other countries (PDF), June 2023, page 39-45
[68] Commons Library research briefing CBP-9775, NHS strike action in England
[69] National Audit Office, NHS Financial Management and Sustainability 23 July 2024
[70] Health and Social Care Committee, Social care: changes to legal migration measures, 19 December 2023, p12-13
[71] Bimpong KAA, Khan A, Slight R, Tolley CL, Slight SP. Relationship between labour force satisfaction, wages and retention within the UK National Health Service: a systematic review of the literature. BMJ Open, Jul 2020
[72] Rolewicz L and Palmer W, Placed at a premium? The use of recruitment and retention pay supplements to address staffing shortfalls. Nuffield Trust, 2022
[73] Institute for Fiscal Studies, Cost of living and the impact on nursing labour outcomes in NHS acute trusts, February 2021
[74] Department of Health and Social Care, Health and wellbeing of the adult social care workforce, 19 May 2022
[75] NHS Employers, Evidence-based approaches to workforce wellbeing, 16 Feb 2024
[76] Department of Health and Social Care, Care workforce pathway for adult social care: overview, 4 April 2023
[77] Institute of Labour Economics, Non-monetary Interventions, Workforce Retention and Hospital Quality: Evidence from the English NHS(PDF), August 2023
[78] NHS England, Return to practice: healthcare professionals
[79] Anderson M, O’Neill C, Macleod Clark J, Street A, Woods M, Johnston-Webber C, Charlesworth A, Whyte M, Foster M, Majeed A, Pitchforth E, Mossialos E, Asaria M, McGuire A. Securing a sustainable and fit-for-purpose UK health and care workforce. Lancet. 2021 May 22;397(10288):1992-2011.
[80] NHS England, Return to practice: healthcare professionals
[81] Health and Social Care Committee, Government Response to the Committee’s Report on Workforce: recruitment, training and retention in health and social care, HC 1289p3
[82] The University of York and The Kings Fund, Understanding Domiciliary Care In England (PDF), 11 August 2017, p
[83] Commons library briefing, Visas for social care workers, 3 October 2024
[84] Department of Health and Social Care, International recruitment regional fund for the adult social care sector 2025-2026: guidance for regional partnerships, 10 April 2025
[85] McKinney, Gower, House of Commons Library, Changes to legal migration rules for family and work visas in 2024, 12 December 2024
[86] Commons Library research briefing CBP-9615, Adult social care workforce in England
[87] Health and Social Care Committee, Social care: changes to legal migration measures, 19 December 2023, paragraph 20.
[88] Migration Observatory, Migration and the health and care workforce, 27 June 2023
[89] Health and Social Care Committee, Workforce: recruitment, training and retention in health and social care, paras 182 and 235
[90] The University of York and The Kings Fund, Understanding Domiciliary Care In England (PDF), 11 August 2017, p25-26
[91] Department for education, Medical doctor apprenticeships: Everything you need to know, 5 February 2024
[92] Una Geary, Martin McKee, Katie Petty-Saphon, Mind the implementation gap: a systems analysis of the NHS Long Term Workforce Plan to increase the number of doctors trained in the UK raises many questions, British Medical Bulletin, Volume 150, Issue 1, June 2024, Pages 1–10
[93] Anderson M, O’Neill C, Macleod Clark J, Street A, Woods M, Johnston-Webber C, Charlesworth A, Whyte M, Foster M, Majeed A, Pitchforth E, Mossialos E, Asaria M, McGuire A. Securing a sustainable and fit-for-purpose UK health and care workforce. Lancet. 2021 May 22;397(10288):1992-2011.
[94] Department of Health and Social Care, Next steps to put People at the Heart of Care, 4 April 2023
[95] Department of Health and Social Care, People at the Heart of Care: adult social care reform, 18 March 2022
Photo by: New Africa via Adobe Stock
