Impact of Fiscal Policies on Recruitment, Retention and Conditions of NHS Staff

This briefing has been prepared in advance of Lord Clark of Windermere’s (Labour) debate scheduled to take place in the House of Lords on 30 November 2017, on the impact of Her Majesty’s Government’s fiscal policies on the recruitment, retention and conditions of NHS staff.

Data sourced from the NHS’s payroll and human resources system provides information on the size of the workforce for NHS Hospital and Community Health Service staff groups. This shows a varied picture across different roles. Both the average annual headcount and FTE figures for nurses and health visitors have remained relatively constant since 2010, with the average number of FTEs rising from 282,237 in 2015 to 284,845 in 2016. The number of FTE General Practitioners, however, has decreased from 34,592 in September 2015 to 33,302 in September 2017. Concern has been expressed by some organisations that recruitment and retention of staff has been placed under pressure by the Government’s public sector pay policy. The NHS Pay Review Body, which advises the Government on pay for Agenda for Change NHS staff (the national pay system for all NHS staff, with the exception of doctors, dentists and most senior managers), has said that the NHS is under significant affordability pressures with increased demand being accommodated within budgets that are “broadly flat in real terms”. The Royal College of Nursing has said that in its most recent biennial employment survey 24 percent of respondents said that they were thinking of leaving their job because of money worries.

The Government has argued that the cap on pay increases within the NHS has enabled it to recruit 30,000 more staff since May 2010. However, in the Autumn 2017 Budget, the Chancellor of the Exchequer, Philip Hammond, announced that the Government would fund a new pay award following negotiations with health unions on modernising the pay structure for Agenda for Change staff. This was in order to improve recruitment and retention.

This briefing provides background information on NHS staffing in England. It provides summary statistics on UK government expenditure on health in the UK and a discussion of the public sector pay policy as regards the NHS. The briefing also provides selected commentary on the issue of pay in the NHS as it relates to recruitment. Finally, selected statistics on the NHS workforce in England are presented.