The NHS is in a ‘permacrisis’ – how did we get here, and how do we recover?

2023 proved to be a year of records – the NHS reached a historic vacancy rate, saw historic strikes and went through a record number of health secretaries in 12 months. The NHS is in a vicious cycle – the staffing crisis has resulted in a downward spiral in elective backlog; the pressures created by the backlog have created an increasingly difficult and demanding working environment, pushing more clinicians to leave. The only way to address the backlog is to increase staffing; the only way to stem the flow of clinicians leaving is to reduce the pressures created by the backlog and workforce crisis. We are stuck in a loop – and it is hard to see how we will begin recovery in the face of ever-increasingly expensive and disruptive strikes, clinicians moving to warmer climates with better pay, and a seemingly never-ending backlog. As a result, the NHS has recently been described as being locked in a ‘permacrisis’. So, how did we get here, and how can we begin recovery?

How did we get here?

It may seem logical to link the current staffing crisis and elective backlog with the Covid-19 pandemic, that saw elective care disrupted for the better part of three years throughout intermittent lockdowns and waves of critically ill Covid patients take clinical priority over other patients. The pandemic and lockdowns certainly did not help, and by the end of the last lockdown in early 2021 the elective care backlog had reached six million. Patients presenting with non-life threatening, or non-Covid, conditions in March of 2020 may have struggled to access medical care during this time; and following the pandemic they may well have progressed to more advanced and complex disease or injury. Patients whose ailments could have been resolved in a matter of appointments may now require increasingly invasive and involved care – not only did the NHS have to see patients it may have missed over the almost 6 months of lockdown, it also had to deal with a patient population with increasingly advanced conditions.

The UK has also seen an increasingly aging population since 2011. This means two things – a higher proportion of the senior clinical workforce of the NHS are reaching retirement age, and an increasingly aging population is presenting with increasingly complex care needs. There are, as a result, more patients with complex care needs, and less senior doctors to see these patients.

In addition, short-sighted usage of NHS resources has made significant dents in budgets. The use of agency and bank staff to fill rota gaps as a result of vacancies has significantly increased in the past 5 years, with a FOI request by the Labour Party in 2022 revealing a £3 billion spend on agency and locum fees. This is a massive drain on resource and has contributed to a stagnation of wages for NHS staff – which has triggered 12 months of continuous strike action, subsequently costing a further £1 billion in agency and locum cover and missed appointments. Though this is not an exhaustive history of the NHS crisis – there are several other factors, including a general economic downturn, changing demographics and nature of disease, and increasing pull from other countries, that have contributed to the current state of the service – these factors are not as easily addressed.

We now find the NHS with limited resource, a growing elective care backlog – despite the waiting list having dropped in October 2023, the most recent strikes have resulted in twice as many cancelled appointments as the waiting list reduced by, and a workforce that is undertaking record levels of industrial action. The NHS is in a ‘permacrisis’ – an unsustainable cycle of increasing waiting lists and a shrinking workforce and resource.

What will recovery take?

Though there is no ‘silver bullet’ to recovery, workforce is the key running theme in the issues the NHS is facing. The elective care waiting list is growing because of a lack of capacity to treat patients; the workforce is increasingly discontent because of the pressures of a large waiting list; both issues are not adequately addressed because of a lack of resources. Both issues have driven usage in agency and locum staff – which has further depleted resources.

Increasing the permanent workforce is the most effective solution to address the issues mentioned. Employing clinicians on permanent contracts and maintaining enough staff to adequately staff rotas is less costly than employing agency and locum staff to fill gaps in rotas; it also improves patient care. Maintaining an adequately staffed rota is crucial in addressing the elective care backlog and reducing workload and sharing burden across clinicians. Reducing stress and improving patient care is crucial in improving retention, according to the NHS Staff Survey 2022 results. Retaining senior clinicians ensures training opportunities are available for more junior clinicians, creating and maintaining a robust pipeline of clinicians and strong incentives for clinicians to stay in the NHS. Retention is cheaper, and more beneficial to patients and services, than recruitment; however, retention cannot be improved without recruitment.

Once services reach stable staffing levels, the elective backlog can be effectively addressed – and the NHS can begin recovery.

Remedium has been a recruitment partner to the NHS for the past 10 years, successfully sourcing, recruiting and onboarding 4,000 clinicians and saving over £400 million in agency and locum expenses. We offer a diverse range of recruitment support, from employer branding support to recruitment process outsourcing. If you are interested in finding out more about Remedium’s recruitment support, please get in touch with us today.  







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