NHS staff numbers begin to fall as fears rise over effect of efficiency savings

BMJ 2010; 341 doi: (Published 23 July 2010) Cite this as: BMJ 2010;341:c4005
  1. Adrian O’Dowd
  1. 1London

    The number of NHS staff in England has started to fall for the first time in several years, prompting concerns that this may be the start of a trend of a shrinking NHS workforce.

    New figures on hospital and community health services from the NHS Information Centre show that the NHS’s workforce headcount fell by 3351 from March this year to April, from 1 219 500 to 1 216 149 (a 0.3% drop).

    The number in April was, however, 1% higher than in September last year, when it stood at 1 204 590, indicating that the downward trend may have just begun.

    The NHS employed 1151 fewer managers and senior managers in March this year than in April (a 2.8% fall), but the service has also seen a fall of 1229 (a 0.3% fall) in the number of doctors, nurses, midwifes, and health visitors.

    Doctors’ and nurses’ leaders have reacted cautiously to the figures, as they believe it is too soon to know whether this is the start of a definite trend. But they are concerned that the ongoing demand from the government for the NHS to make efficiency savings of £15bn (€18bn; $23bn) to £20bn by 2014 is already putting posts at risk.

    The provisional monthly NHS workforce data for England (which excludes GPs and practice staff), published on 21 July, have been calculated in a different way than previously.

    A spokeswoman for the NHS Information Centre said it was difficult to make a clear comparison between the new figures and older statistics but that since 1998 NHS staff numbers had been steadily increasing, apart from a blip in 2006-7.

    A BMA spokesman said, “These figures are always subject to small fluctuations, and it’s impossible to identify a long term drop in numbers of doctors at this stage.

    “However, a downward trend in future would be a cause for concern. Despite the pledge to protect the frontline services, many employers in the NHS are already freezing recruitment in response to financial pressures.”

    The Royal College of Nursing launched its “frontline first” campaign earlier this month, saying it had collected evidence from hundreds of NHS trust board papers that 10 000 posts were at risk. These posts are ones that have been lost or are expected to be cut as a result of recruitment freezes, not replacing retiring staff, and redundancies.

    The NHS Information Centre’s figures indicate a move towards the 45% reduction in management costs that England’s health secretary, Andrew Lansley, has promised as part of the Department of Health’s plans to shake up the NHS, outlined in the recent white paper (BMJ 2010;341:c3796, 14 Jul, doi:10.1136/bmj.c3796).

    Mr Lansley, taking part in a Number 10 website live question and answer session this week, defended the government’s plans to reorganise the NHS (

    One contributor asked Mr Lansley, “Do you think all GPs are ready to commission services on top of their day job?”

    Mr Lansley replied, “I know some of the GPs across the country are ready and able to go. I know there are others where they are not ready and are apprehensive about what it means.

    “This isn’t about turning individual GPs into managers. It is about involving GPs and the other professions in deciding what are the services they need, what are the choices for their referrals, what are the priorities for improvement.”


    Cite this as: BMJ 2010;341:c4005


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