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18th February 2025

Audit Wales Calls for Collective Action on NHS Workforce Challenges

The NHS in Wales is still experiencing challenges with recruitment and retention and a reliance on expensive agency staff to plug gaps in the workforce.

 

Progress is being hampered by the absence of a national workforce plan, gaps in data and uncertainty over the future shape of healthcare services, according to a report by the Auditor General for Wales.

The report provides a summary of Audit Wales’ reviews of workforce planning arrangements at individual NHS bodies. It also sets out opportunities to strengthen workforce development and planning at a national level.

The report highlights positive developments in key areas such as sickness absence management and reducing agency staff use. It also shows how the NHS workforce has continued to grow to help cope with increasing demand.

However, significant challenges remain, the report warns. Staff turnover is still higher than it was prior to the pandemic, and staffing gaps continue to present real challenges for NHS Wales. There are more than 5,600 vacancies in NHS Wales overall, with more than 10% of medical and dental posts currently vacant. Whilst expenditure on agency staff has reduced in the last year, it still cost the NHS £262 million in 2023-24.

Growth in the NHS workforce is welcome in the context of increasing demand, said the Auditor General, but this comes at a price. NHS staffing costs have grown by 62% since 2017-18 and stood at £5.23 billion in 2023-24.

In the current financial climate, there is a question over whether continued growth at the same rate is sustainable, the report says. NHS Wales needs to adapt to the changing demand that it is facing, but it currently does not have a workforce plan linked to new and sustainable models of care. Workforce planning can’t be undertaken in isolation, the report warns.

The Auditor General says that the Welsh Government needs to work with senior leaders in NHS Wales and key partners to address these issues by developing a longer-term workforce plan that sets out:

  • how it expects to transition its workforce and service model to one shaped around population health improvement, self-management, and community-based management of multi-morbidities;
  • how it expects to match and plan for future demand and supply of specialist care, supported by a sustainable acute staffing model;
  • what a sustainable workforce model for social care looks like as part of a more integrated approach to workforce planning;
  • how it could ensure more of the staff who are trained in Wales remain in Wales; and
  • detailed medium to long-term educational needs and the necessary funding.

Addressing the need for a national workforce plan is only part of the solution, according to the report. There needs to be clear leadership to develop and implement it, it says.

The report found the current workforce planning arrangements are increasingly complex, which is complicated further by uncertainty over system leadership arrangements. Health Education and Improvement Wales (HEIW) clearly has an important position, says the report, but there are other organisations that have complementary roles. The role of the NHS Executive in relation to workforce and service modernisation needs to be clearer, it says.

The report also pointed out that workforce planning is made more difficult by a lack of clarity on the shape of future health and care services, by gaps in workforce data and by insufficient capacity and expertise within NHS bodies. In addition, whilst the numbers of education and training places commissioned by HEIW has increased in recent years, factors such as affordability, capacity within the system to place students and numbers of applications are combining to place constraints on important training “pipelines”.

Auditor General Adrian Crompton said:

“The NHS in Wales is continuing to face significant workforce challenges. The pandemic placed huge pressure on the NHS and that pressure has not gone away. Service demand remains high and is expected to grow further. This means the NHS and its partners must adapt the way they work and shape the workforce to meet these changing needs.

 

“The report points to some positive developments but also for a need for important action in a number of areas, not least in the development of a stronger and more coherent national approach to workforce planning. I see this as crucial in developing a health and care workforce that is motivated, resilient and appropriately skilled to ensure it is delivering sustainable care of the highest possible quality.”