Staffing Shortfall 'A Major Problem' for NHS, Study Finds

Peter Russell

November 28, 2019

The NHS holds up remarkably well despite major problems compared to other high-income countries, a study suggested.

Writing in the BMJ, researchers concluded that if the health service wanted to achieve comparable health outcomes with other high-income countries, spending needed to increase to improve staffing levels, long-term care, and other social services.

"I think if there's one overarching message that's coming out, is that we see an NHS that's stretched, lead researcher Prof Irene Papanicolas from the London School of Economics and Political Science said.

Staffing Issues

The team of UK and US researchers set out to compare the UK health system with nine other high income countries, across seven key areas including spending, structural capacity, accessibility, quality, and health outcomes.

The focus was on the most recent data available, typically 2017, as well as trends since 2010 when available and comparable.

The results showed that the UK spent the least per person on healthcare in 2017.

"What we felt was the most striking number was the staffing levels," Prof Papanicolas told Medscape News UK. "We found that the UK has about 7.8 nurses per 1000 of the population, and that was lower than both the study average of the countries that we compared it to, lower than the OECD average, and lower than the EU average.

"Similarly for doctors, we found that there were lower [numbers of] practising doctors per 1000 population as compared to study countries,"

Although the UK has comparable numbers of people over the age of 65, it spends less of its already low total healthcare expenditure on long-term care – and a greater proportion of this comes from private sources than it does in other healthcare systems.

When it came to the healthcare workforce, the UK had among the highest proportion of foreign trained doctors (28.6%) and nurses (15%).

Since 2015, the year before the UK voted to leave the EU, migration of healthcare professionals had decreased, the study found. The authors said this had contributed to existing staffing challenges.

"We saw that since 2015, on the nursing side, there's been quite a steep decline in the annual inflow of nurses," said Prof Papanicolas. "And if you look at the split between EU- and non-EU nurses, it's kind of driven by a decline of nurses coming in from the EU."

The researchers acknowledged that they carried out an observational study and it was therefore not possible to prove cause and effect.

However, the authors concluded: "Taken together, these results suggest that if the NHS wants to achieve comparable health outcomes at a time of growing demographic pressure, it may need to spend more to increase the supply of labour and long-term care and reduce the declining trend in social spending to match levels of comparator countries."

Performance of UK National Health Service compared with other high income countries: observational study
BMJ 2019; 367 doi: https://doi.org/10.1136/bmj.l6326 (Published 27 November 2019)

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