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The Progressive Policy Think Tank

NHS staff desperate for new managers so they have more time to care for patients

  • Triple threat of soaring demand, staff sickness and low pay undermining healthcare staff recruitment and retention 

  • Any increase in NHS staff over the last decade has been far outstripped by a soaring rise in need, says report 

  • Research highlights emergence of up to 10,000 ‘missing managers’ in hospitals and community settings since 2010 

An assembly of healthcare professionals has demanded more and better managers as part of a 10-point plan to solve the workforce crisis. 

IPPR held 240 hours of discussion with an assembly of doctors, nurses, midwives, pharmacists, carers and other health workers, with participants desperate for new managers to do the ‘managing’ to free up their time to do the ‘caring’. 

The findings from the assembly come with new analysis from IPPR which show that since 2010, England has had up to 10,000 ‘missing managers’ within frontline NHS hospital and community care services. 

Previous research shows that the UK spends far less on health system managers than many comparable countries. The UK only spends 2p in the pound on healthcare administration, compared to 5p in Germany and 6p in France. 

The report also highlights the triple threat of soaring demand, sick staff and low pay facing the healthcare workforce. 

Soaring demand 

While the number of people working in the NHS has increased by just over 1 per cent on average per year between 2010 and 2019, patient need for NHS services has risen much faster. The number of outpatient appointments has risen by nearly 4 per cent on average per year, and the number of diagnostic tests has risen around 5 per cent. Additionally, the number of fully trained and qualified GP’s has fallen by over 1 per cent per year (2015-2019), resulting in lower care for patients and greater workload for staff. 

At the same time, doctors have less time to deal directly with patients as they are burdened with administrative duties, project management and paperwork. Despite rising health need and a growing population, the number of managers in frontline hospital and community settings has fallen

There is a similar mismatch between capacity and demand in adult social care; the number of adults being denied social care by local authorities is now at an all-time high, with 544,605 people asking for help being rejected in 2020/21. 

Staff sickness 

Health and care workers are more likely than most to leave work due to long-term illness. Workers in these industries have a long-term sickness rate of 7.8 per 1,000, higher than workers in construction, manufacturing and most other sectors.  

Had the rate of people leaving health and care work due to long-term sickness been the same as a comparable frontline sector such as education, in just the period since Covid-19, IPPR estimate that around 14,000 extra qualified, predominantly frontline staff to be in work today. If it had been the same as the best performing industry – information and communications – that figure would rise to nearly 22,000 extra workers. 

Additionally, the number of staff voluntarily resigning from the NHS because of sickness rose by 43 per cent between the last quarter of 2019/20 and the 2nd quarter of 2022/23 (latest data). 

Low pay 

The increasing workload for healthcare staff combined with austerity-era reduction in pay has undermined recruitment and retention. This has created a vicious cycle as staff leaving the NHS leads to higher workload for remaining staff, which in turn leads to burnout and more leaving.  

In addition to the fall in real-terms pay, workers are facing increased dissatisfaction with poor working conditions. Members of the assembly demanded more flexible working, better return to work mechanisms for mothers and more say over innovation. 

Furthermore, the mismatch between capacity and demand in adult social care has put more pressure on unpaid carers, with one in five UK adults now providing care. These carers are more likely to suffer poor health, financial hardship, unemployment, and inequality – suggesting the burden of informal care is well beyond a sustainable level. 


The case for fixing this crisis is clear, the workforce assembly concludes. Having enough of the right people, in the right roles, with the right skills will lead to better health and care services. This in turn will halt and reverse the increasing number of people who are economically inactive due to sickness, resulting in more people in work and greater national prosperity. 

The assembly produced a 10-point plan to solve the health and care workforce crisis in England, which includes: 

  1. Recruit more and better managers to increase capacity to adopt, adapt and spread innovation and new technology. 

  2. Create a ‘return to health’ scheme that matches people with long-term health conditions, who would like to return to work, with suitable health and social care jobs. 

  3. Introduce a ‘comply or explain’ right to flexible working to increase support for women returning to work after maternity leave. 

Chris Thomas, head of the Commission on Health and Prosperity, said: 

“The NHS is facing a triple threat of soaring demand, staff sickness and low pay, and NHS staff are crying out for a long-term solution, and less short-term politics.  

“There is no one quick fix to solving the healthcare workforce crisis, but more managers are crucial to freeing up the time of doctors, nurses and other professionals to do the caring. 

“If nothing is done soon, demand will continue to outstrip capacity and England will only get sicker, and as a result poorer. We urgently need an ambitious, modern and sustainable workforce strategy.” 

Clare McNeil, associate fellow at IPPR, said: 

“England is prone to a healthcare workforce crisis and has often dealt with it by increasing international recruitment. However, this sticking plaster approach is no longer a viable solution as the UK becomes a less attractive place to work and a global shortage of health professionals emerges. 

“Further delays to a much-needed workforce strategy is only going to exacerbate ongoing issues. Issues which are seeing early career health professionals burnt out and considering leaving just when we need them most.” 


Case studies are available upon request 

Chris Thomas, the report’s author, is available for interview  


David Wastell, Director of News and Communications: 07921 403651 [email protected]  

Liam Evans, Senior Digital and Media Officer: 07419 365334 [email protected]  


  1. The IPPR paper, Finding Hope: The final report of the IPPR Health and Care Workforce Assembly by Chris Thomas, Clare McNeil and Amy Gandon, will be available under embargo on request. 

  2. IPPR held 240 hours of deliberation with the workforce assembly which was formed of 16 members, including doctors, nurses, midwives, pharmacists, psychotherapists, carers, mental health social workers and other healthcare professionals. 

  3. Rates of growth in both workforce numbers and diagnostic activity are calculated using Compound Annual Growth Rates (which smooth variance over time). The years used are 2010 – 19 wherever possible, subject to data availability. Workforce figures use September data in each year. GP data is only available from 2015.  

  4. A mismatch between workforce numbers and growth rate of activity can be explained in three ways. Productivity can close the gap - however, in the last decade NHS productivity has grown at under one per cent per year, making this highly unlikely. A decline in quality (as staff work faster) is also possible. Finally, it could indicate a far greater workload on each individual member of staff. NHS data on burnout, stress and exhaustion indicate the latter as the most plausible explanation. 

  5. To come to the 10,000 ‘missing managers’ figure, IPPR compared the rate of growth of managers in hospital and community healthcare settings to the rate of growth of all clinical professionals, doctors, and to health foundation estimates of the workforce growth needed to deliver sustainability in the next decade. This suggests manager numbers in these settings are 10,000 lower (FTE) than had growth been at a sustainable level. 




  9. IPPR is the UK’s pre-eminent progressive think tank. With more than 40 staff in offices in London, Manchester, Newcastle and Edinburgh, IPPR is Britain’s only national think tank with a truly national presence.