Intended for healthcare professionals


NHS staff survey underlines need for national workforce strategy

BMJ 2022; 377 doi: (Published 01 April 2022) Cite this as: BMJ 2022;377:o871
  1. Adele Waters
  1. The BMJ

MPs have rejected a “once in a decade opportunity” to tackle longstanding failures in NHS workforce planning after voting against a proposed amendment to the Health and Social Care Bill1 that would require the health and social care secretary to publish an independently verified workforce assessment and plan at least every two years.

Amendment 29, which passed in the House of Lords last month, was backed by more than 100 healthcare organisations, including the BMA, the Academy of Medical Royal Colleges, and the Royal College of Physicians.2

Rejection of the proposal in the House of Commons came on 30 March, the same day as the publication of the latest NHS staff survey.3 Ironically, the survey’s findings had prompted universal calls for an NHS workforce strategy, from healthcare unions, health think tanks, and NHS organisations alike.

The 2021 survey ran in October and November last year and was completed by 628 475 staff at NHS trusts, a 48% response rate. It showed that almost three quarters of respondents worked in NHS organisations with too few colleagues to allow them to do their job properly. Only 27% of staff said that staffing was sufficient at their organisation, down 11 percentage points on last year (38%).

The survey found that 68% of staff were happy with the standard of care their organisation provided, down six percentage points since last year.

But it detected significant areas of concern around the health and wellbeing of staff, as a third of doctors and dentists reported feeling burnt out from work.

Universal disappointment

Before the amendment vote many organisations had appealed to MPs for support. NHS Providers released results of a survey showing that some 89% of trust leaders did not think that the NHS had robust plans in place to tackle workforce shortages. And almost all (98%) warned that shortages would slow down progress in tackling the growing care backlog.

Trust leaders overwhelmingly (88%) supported amendment 29, said NHS Providers, and had a loud and clear message for MPs: failing to back it would only compound staff shortages and workforce burnout.

Defeat of the amendment by 82 votes (249 v 167) was met with universal disappointment from unions and healthcare organisations.

The BMA said that, given the consistent pleas from the healthcare profession about the precarious state of the NHS workforce, the vote was “truly disappointing.”

The association’s deputy chair of council, David Wrigley, said, “The government’s decision to vote this down is a huge, missed opportunity and means we still won’t know how many healthcare staff the country needs—despite being all too clear that staff and services are dangerously overstretched.”

The Doctors’ Association UK agreed, saying that workforce planning failures were at the very root of all problems highlighted in the latest NHS staff survey, so parliament’s refusal to address this was “even more disappointing.”

Its chair, Jenny Vaughan, said, “‘Failing to plan, planning to fail’ was never more bitterly appropriate. How can doctors even hope to cope when the government remains hopelessly oblivious to the critical need to come up with a workforce plan that stands any chance of actually working for the NHS?”

Missed opportunity

The Hospital Consultant Specialist Association, the hospital doctors’ union, called the defeat a major blow to hopes that the NHS would get a strategic oversight to workforce planning.

The union’s president, Claudia Paoloni, said, “No one in leadership appears to have the bravery or will to compare the numbers we have against the number we need, acknowledge that we must pay and treat our people adequately, and then fund our NHS to deliver this.

“If the government doesn’t act on workforce, we will face increasing chaos and declining levels of care. Patients will pay the ultimate price for this neglect.”

The Royal College of General Practitioners condemned the vote as a “missed opportunity to redress historic poor workforce planning, which is desperately needed.”

Martin Marshall, the college’s chair, said that while the result was a “let-down” for all healthcare professionals working in general practice and the wider NHS, it would not stop the college and others from campaigning for a safe workforce strategy.

At a glance—some findings from the NHS staff survey

Care standards

  • 59% would recommend their organisation as a place to work, down from 67% last year

  • 68% are happy with the standard of care provided by their organisation, down from 74% in 2020

  • 68% would be happy with the standard of care provided by their organisation for a friend or relative, down from 74/% in 2020


  • 27% said that their organisation had enough staff for them to do their job properly, down from 38% last year

Enthusiasm for work

  • 67% feel enthusiastic about their job, down from 73% in 2020

  • 53% look forward to going to work, down from 59% last year

Feeling valued

  • 42% are satisfied with the extent to which their organisation values their work, down from 48% last year—the lowest rate in five years


  • 38% find their work emotionally exhausting

  • 34% feel burnt out because of their work (including 41% of nurses and 33% of doctors)


  • 33% of staff are satisfied with their level of pay, a drop of four percentage points on last year. Pay satisfaction among doctors—the staff group most satisfied with their pay—has dropped from 60% in 2020 to 50% in 2021


  • Correction: We amended this article on 5 April 2022 because it initially referred to “%” decreases in three instances that should have been described as percentage point decreases.