NHS may employ one in eleven workers in England by 2036 – report

Almost half of public sector workers are set to be employed by the NHS by 2036 under NHS England’s long-term workforce plan, according to analysis by the Institute for Fiscal Studies (IFS) think tank. 

The IFS said the workforce plan implied annual NHS budget increases of around 3.6% per year in real terms (or 70% in total by 2036–37) – in line with the long-run average real-terms growth rate in UK health spending, but higher than the 2.4% per year seen since 2009/10. 

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By the NHS’s own estimates, though, returning to traditional health spending growth rates will only be enough to meet NHS demand if productivity can be increased by between 1.5% and 2% per year – well above what the NHS is estimated to have achieved in the past.

The IFS report said that if the recommended increase in the NHS workforce is delivered, almost half (49%) of public sector workers in England will work for the NHS in 2036/37, compared with 38% in 2021/22. By 2036–37, one in eleven (9%) of all workers in England will work for the NHS, compared with one in seventeen (6%) in 2021–22.

Among other findings by the IFS in its analysis of the workforce plan are:

  • The plan implies average growth in the size of the NHS workforce of between 3.1% and 3.4% per year, compared to around 1.1% per year between 2009/10 and 2019/20
  • Increasing the size of the workforce so rapidly will likely require NHS wages to become more generous in real terms, and potentially match or even exceed growth in wages in the rest of the economy. It will also likely require an increase in non-staffing inputs to healthcare, such as drugs and equipment
  • While the plan included £2.4bn of additional funding for training new staff, it did not consider the much larger medium-term implications of this large increase in staffing for the NHS pay bill, nor the required increase in other inputs if the NHS is to treat substantially more patients
  • The plan includes an expansion in all staff roles within the NHS, and a change in staff mix: it targets particularly large increases in the number employed in emerging roles – such as nursing associates and advanced practitioners – and in the number working in the mental health sector

Max Warner, research economist at the IFS and an author of the research, said: ‘The publication of the NHS workforce plan and its detailed workforce projections is an important and welcome milestone for the NHS. We estimate that the plan might imply average real-terms funding growth of around 3.6% per year for the NHS in England. That is by no means outlandish by historical standards, but would nonetheless require difficult fiscal decisions in the current climate of sluggish growth.

‘NHS modelling suggests that even these large staffing increases will only be ‘enough’ to meet future demand if staff productivity can be increased by a highly ambitious 1.5% to 2% per year. The risk of having a workforce plan but no similarly high-profile plan for capital, technology or management is that higher spending on staffing squeezes out other vital inputs, and makes those productivity gains all but impossible to achieve.’

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