Intended for healthcare professionals

Opinion Acute Perspective

David Oliver: “If you don’t like it, just leave!” won’t solve the NHS workforce crisis

BMJ 2023; 380 doi: (Published 04 January 2023) Cite this as: BMJ 2023;380:p4
  1. David Oliver, consultant in geriatrics and acute general medicine
  1. Berkshire
  1. davidoliver372{at}
    Follow David on Twitter @mancunianmedic

After a series of strikes by nurses and paramedics in December, with more planned this month12 and an upcoming ballot of junior doctors on industrial action,3 we’re no closer to solving the NHS’s increasingly urgent clinical workforce crisis.4

YouGov surveys have shown that clinical staff retain high levels of public support for the action they’re taking.5 Similarly, public trust in doctors and nurses remains very high.6 Even though satisfaction with health services has fallen sharply, people are concerned about access, waiting times, and staffing shortages rather than blaming clinical staff.7

Meanwhile, anyone listening to radio phone-ins, reading public comments on news websites, or hearing certain “talking head” media guests will encounter a depressing set of unhelpful and hostile responses along these lines: “They knew what they were getting into and what the salary was when they took the job”; “Healthcare is a vocation”; “If they don’t like it, they can just leave”; “They should never be allowed to strike.” The problem with this narrative is that such resentment—and a “who has it worse” debate on terms, conditions, and hours—won’t solve the workforce crisis or help the NHS.

Regarding staff “knowing what they were getting into,” the Nuffield Trust has shown that since 2010 all clinical professions have experienced a major decrease in income in real terms, and their incomes have fallen well behind the private sector.8 Rapidly rising inflation will further erode them. Meanwhile, pressures on the service have grown inexorably. It’s ridiculous to claim that people who enter a profession in good faith, and then find that it changes around them, shouldn’t be allowed to complain or campaign about it. And such empty rhetoric won’t help to retain staff.

As for “if you don’t like it, just leave”—people are doing just that. We’re seeing a growing exodus of nurses,9 and a Royal College of Nursing survey10 has shown that half are thinking of leaving. A recent BMA survey found that four in 10 junior doctors would like to leave the NHS, and two thirds have researched alternative careers.11 Senior doctors are retiring early, and there are serious gaps in other workforce groups including paramedics.4 The UK is already near the bottom of the OECD table showing doctors and nurses per 1000 population.12 One in nine nursing vacancies is unfilled.13 Remaining staff are increasingly demoralised, burnt out, or unwell.14 And there’s a global labour market and labour shortage for trained health professionals.15

Healthcare as a vocation? Well, it’s a vocation for some and a rewarding, skilled job for others. But, short of being a nun or a monk, having a “vocation” doesn’t pay the bills or put food on the table. It’s not incompatible with wanting adequate remuneration or reasonable treatment at work, and it shouldn’t be used as a stick to beat staff with.16 The right to withdraw labour is a fundamental tool in protecting organised labour and workers’ rights. Introducing a ban on striking would be a very authoritarian move and would further alienate the clinical staff the government is supposed to be motivating and engaging with.

Finally, when people compare their own hours or pay with those in the NHS, they’re often not comparing like with like. Paramedics, nurses, and doctors have spent years studying, have professional registration, and in the case of doctors face many more years of postgraduate training and exams. They carry serious responsibility for people’s health and lives and are exposed to all manner of distressing situations. These occupations are more than just a job. What’s their direct equivalent in the private sector?

Ultimately, there’s no stampede of people from the private or self-employed sectors towards these key clinical roles. Brexit and new immigration rules have further harmed recruitment.1718 And ranting soundbites, amplified by right wing sections of the media or MPs, will solve nothing.