New analysis by a leading healthcare charity shows that the health service is increasingly having to rely on less-skilled clinical support staff to fill gaps in services when there are not enough nurses.

Falling short: the NHS workforce challenge, published by the Health Foundation and available at, shows that the UK has struggled to train enough nurses domestically.

As a result, in response to a severe drop-off in the supply of EU nurses since 2016, it has significantly increased its recruitment of nurses from countries elsewhere in the world over the last year.

Between March 2018 and March 2019, the NHS actually saw the biggest annual increase this decade in its overall workforce.

However, the Foundation warns that this growth masks an ongoing shift in the mix of clinical staff employed in the NHS as, while the number of doctors has increased, growth in the number of registered nurses has been outstripped by increases in clinical support staff, including healthcare assistants and nursing associates.

The report highlights that, while there were 4500 more full-time equivalent (FTE) nurses (an increase of just 1.5%), the NHS employed 6500 more FTE support staff for doctors, nurses and midwives — a 2.6% rise.

Director of Research and Economics at the Health Foundation, Anita Charlesworth, said: “Services are being forced to make do with shortfalls of increasingly pressurised nurses and rely on less-skilled support staff to pick up the slack. Clinical support staff play an incredibly valuable role in the NHS if they are supported in a well-planned way, but these trends appear to be largely unplanned, reflecting the failure to recruit enough nurses”.

Operating without a plan means there has not been enough consideration of the impact such changes might be having on patient care, she concluded.

Last reviewed 4 December 2019