Intended for healthcare professionals


A long term workforce plan for the English NHS

BMJ 2022; 377 doi: (Published 26 April 2022) Cite this as: BMJ 2022;377:o1047
  1. Hugh Alderwick, director of policy,
  2. Anita Charlesworth, director of research and REAL Centre
  1. Health Foundation, London, UK
  1. Correspondence to: H Alderwick Hugh.Alderwick{at}

The health system desperately needs one, but—so far—government has failed to deliver

Pressures on the English NHS are extreme. In March 2022, 22 500 people waited more than 12 hours on trolleys in emergency departments for a hospital bed—32 times more than March last year and 68 times more than before the pandemic in 2019.1 More than six million people are waiting for routine hospital treatment, and 300 000 have waited more than a year.2 The healthcare system is buckling under the strain, and patients and staff are suffering as a result.

A mix of factors are to blame: a decade of underinvestment in the NHS, limited hospital capacity, massive disruption from covid-19, political neglect of social care, and more. But chronic workforce shortages are probably the biggest issue facing the NHS and its patients.

NHS staffing gaps currently stand at around 110 0003 and could grow substantially higher by 2030.4 The UK has fewer doctors and nurses per capita than most comparable countries.5

Covid-19 has made things worse. Around 70 000 hospital staff …

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