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NHS staff: the issue explained 

How many people work in the NHS?

Around 970,000 people work in the NHS in England; with some of these part-time, this is equivalent to 782,000 full-time staff, according to Department of Health figures published in May 2000. 

Just over two thirds of these are staff providing direct health care to the public, while the remainder are management and support staff. There are 70,000 medical and dental staff, including 22,000 consultants. There are 340,000 nursing, midwifery and health visiting staff; 107,000 scientific, therapeutic and technical staff; and 21,000 healthcare assistants. Administration and estates and maintenance staff account for 173,000 of the English NHS workforce. Around 79% of the workforce in England are female; 7% of the workforce are from ethnic minority groups. There are 36,000 GPs in the UK, according to British Medical Association figures (October 2000). GPs are technically independent contractors; aside from some "salaried GPs", the majority are not employed directly by the NHS.

Isn't there a staff shortages problem?

By far and away the biggest shortfall is in nursing and midwifery. It is increasingly difficult to attract nurses specialising in acute, elderly and general care, paediatrics and psychiatry. Among medical consultants, there are shortfalls in numbers of psychiatrists, radiologists and accident and emergency specialists. Many family doctor (GP) vacancies also remain empty, especially in inner cities and remote rural areas. The NHS also faces a "retirement time bomb" around 2005, when the large cluster of Asian GPs who joined the NHS in the 1950s begin to retire. There are also serious recruitment and retention problems in physiotherapy.

Why is it so difficult to recruit and retain staff?

Poor pay is a key factor. An entry level nurse starts on £9,000, roughly equivalent to pay levels for supermarket shelf stackers; a newly qualified nurse earns £15,000. In NHS pathology laboratories, graduate trainees earn just £9,000; graduate laboratory technicians working for a pharmaceutical company could expect to start on £16,000. 

The high cost of living in many areas, especially the south-east, makes many NHS salaries uncompetitive. Non-pay issues are equally crucial: inflexible working conditions, low morale, stress, high workload (caused by staffing shortages), increasing violence and verbal abuse of staff by patients, poor management and lack of career development all combine to drive away NHS staff. Julia Neuberger, chief executive of the Kings Fund health policy institute, says: "Ambitious young people, leaving schools and universities, no longer see public service as the height of personal achievement. 

"Instead, it is associated with ponderous bureaucracy, political manipulation, poor opportunities and low pay."

How many more staff does the NHS want to hire?

The government has promised to hire 7,500 more consultants, 2,000 more GPs, 20,000 more nurses and over 6,500 more therapists and other professionals by 2004 .

How does the NHS propose to recruit and retain staff?

Ministers have launched high profile recruitment campaigns to persuade former nurses to join or return to the NHS. Nursing and doctor training places have been expanded. The NHS has promised to "invest in pay", especially in areas where living costs are high. It also plans to improve staff working conditions. The government has launched a scheme to offer "golden hello" bonuses to newly-qualified doctors who choose to become GPs, plus other financial incentives for older GPs and student nurses. In the short term at least the NHS is committed to plugging the gaps by hiring key staff from overseas. Nurses and doctors have been imported from China, the Philippines, Australia, New Zealand, South Africa and Europe. 

How will the NHS plan affect staff?

The NHS plan sets out a range of proposals to reform the professions. The medical consultants' contract will be updated - including a controversial ban on newly qualified consultants working in the private sector for seven years. There will be fewer self-employed GPs as more family doctors move to personal medical services' contracts or to employment on a salaried basis. All doctors will face more rigorous scrutiny of the quality of their work and nurses will be able to prescribe a greater range of drugs. The plan states: "The old hierarchical ways of working are giving way to more flexible team working between different clinical professionals."