What's causing the healthcare recruitment crisis? 

Recruiting and retaining staff has become a significant struggle for the healthcare sector1. Surveys conducted by The Royal College of Nursing over 30,000 shifts, shows a shortfall in planned staffing levels exists across all clinical settings in both NHS and private healthcare organisations.2

However, there is no one direct cause for this struggle. Shortages can be put down to a number of factors, including poor workforce planning; cuts in funding for training places; restrictive immigration policies exacerbated by Brexit and worryingly high numbers of healthcare professionals leaving their jobs early.3

If substantial staff shortages continue, they could lead to growing waiting lists, deteriorating care quality and the risk that some of the £20.5bn secured for NHS front-line services will go unspent,4 placing even more pressure on independent healthcare businesses. Even where commissioners have the resources to commission additional activity, healthcare providers may not have the staff to deliver it.

So, what’s causing the healthcare recruitment crisis?

As a healthcare provider, it is important to understand the contributing factors surrounding the carer shortage. By identifying these factors, your business can begin to prepare for the future.

The impact of Brexit

Brexit is probably the biggest external challenge facing your workforce in recent years. The government’s proposal to put restrictions on net migration is set to cause disruption to the flow of low-skilled non-UK workforce.5

International recruitment plays a huge role in addressing vacancies in the NHS, with nearly 62,000 of the 1.2 million NHS workforce, along with an estimated 104,000 in the adult social care sector, currently recruited from outside the UK.6

Last year, an average of 55% of healthcare providers reported a shortfall of one or more registered nurses per shift (58% in NHS organisations and 25% for non-NHS providers).7

Staff Retention

High levels of turnover make replacing your healthcare staff a constant battle. And, with the pool of available workers becoming smaller and smaller, staff retention plays a crucial role in maintaining the healthcare workforce.

  • The problem with pay

    Local authority budgets have been shrinking and the care sector has been feeling the side effects. Across the healthcare sector, businesses are being forced to look at cost saving measures to meet operating costs and contract demands.

    In a survey of 30,000 nurses last year, 55% reported that they did not have the level of staff originally planned per shift, resulting in those on shift being overworked.8 However, this was not reflected in their pay.
  • Zero hour contracts

    Zero hour contract, which are attractive to some, are very undesirable to others. Uncertainty about working hours is a real issue for those who want to be able to ensure a regular and stable income. 25% of nurses working in adult social care are currently employed under zero hour contracts.

An Aging Workforce

The UK’s ageing population is growing. And with this demographic shift the average age of retirement is also increasing. Today, a fifth of all workers in the Adult Social Care Sector (320,000 jobs) are over the age of 55.9

New Recruits

Despite the government’s commitment to increasing the number of nurses in training, 2018 was the second year in a row where the number of applications and acceptances for pre-registration nursing degrees fell.10

There are a number of reasons fall in nursing student applications. These include recent changes to how funding works for NHS students in England, along with the dip in the population of 18-year-olds.11

Investments in Healthcare

Investments in education and training for the healthcare sector has dropped from 5% in 2006/2007 to 3% in 2018/19. This amounts to a loss of £2bn in investment funding.12

Investing in education and training is recognised as a major factor in developing and maintaining the healthcare workforce. NHS England’s funding is now planned to increase by an annual average of 3.4% over the next five years, increasing healthcare investments by £20.5bn in 2023/2024. This is higher than the 1.4% per year funding increases to the Department of Health and Social Care’s budget since the financial crisis, but lower than the average 3.7%.  

Gender Segregation

Figures released in April 2018, showed female NHS staff in England earn nearly a quarter less than men working in the same role.13

In NHS England, women make up over three quarters of all staff. However, they remain in the minority when it comes to senior roles. Today, only 36% of consultants in England are women.14

What this data reflects is that men in the healthcare sector, are more likely to make it into senior positions. But with over 75% of all healthcare staff being women15, it also raises the question of how much the sector is losing by failing to provide the same progression opportunities across all its staff.


  1. https://www.kingsfund.org.uk/publications/health-care-workforce-england
  2. https://www.rcn.org.uk/-/media/royal-college-of-nursing/documents/publications/2017/september/pdf-006415.pdf
  3. https://www.kingsfund.org.uk/publications/health-care-workforce-england
  4. https://www.health.org.uk/publications/the-health-care-workforce-in-england
  5. https://www.rcn.org.uk/-/media/royal-college-of-nursing/documents/publications/2017/september/pdf-006415.pdf
  6. https://www.skillsforcare.org.uk/NMDS-SC-intelligence/Workforce-intelligence/publications/The-state-of-the-adult-social-care-sector-and-workforce-in-England.aspx
  7. https://www.rcn.org.uk/-/media/royal-college-of-nursing/documents/publications/2017/september/pdf-006415.pdf
  8. https://www.thesun.co.uk/news/5361247/low-pay-years-of-funding-pressures-and-a-lack-of-staff-why-thousands-of-nurses-are-leaving-the-nhs-every-year/
  9. https://www.skillsforcare.org.uk/nmds-sc-intelligence/workforce-intelligence/publications/the-state-of-the-adult-social-care-sector-and-workforce-in-england.aspx
  10. https://www.health.org.uk/sites/default/files/upload/publications/2019/A Critical Moment_1.pdf
  11. https://www.health.org.uk/sites/default/files/upload/publications/2019/A Critical Moment_1.pdf
  12. https://www.kingsfund.org.uk/publications/health-care-workforce-england
  13. https://www.bbc.co.uk/news/health-43659119
  14. https://digital.nhs.uk/news-and-events/latest-news/narrowing-of-nhs-gender-divide-but-men-still-the-majority-in-senior-roles
  15. https://www.kingsfund.org.uk/sites/default/files/media/judy-taylor-gender-diversity-in-the-public-sector-nov13.pdf