Audit Wales warns of urgent need for national NHS workforce plan
The NHS in Wales is struggling with staff shortages, retention issues, and a reliance on agency staff, despite some improvements in workforce management, according to a new report from Audit Wales.
The report, published today by the Auditor General for Wales, warns that a lack of long-term workforce planning, gaps in data, and uncertainty over future healthcare services is hindering progress.
It calls for collective action from the Welsh Government and NHS leaders to address these challenges.
Thousands of vacancies and rising staff costs
There are currently 5,600 vacancies across NHS Wales, with more than 10% of medical and dental posts unfilled.
While the overall NHS workforce has grown in response to demand, recruitment and retention remain a challenge.
NHS staffing costs have risen by 62% since 2017-18, reaching £5.23 billion in 2023-24.
Despite efforts to reduce reliance on agency staff, the NHS still spent £262 million on agency workers last year.
The report acknowledges some progress in managing sickness absence and reducing agency staff use, but warns that staff turnover remains higher than before the pandemic, placing further strain on services.
Audit Wales is urging the Welsh Government to develop a national workforce plan to ensure that staffing models are sustainable.
The report highlights the need for a clear strategy that aligns with changing healthcare demands, including a shift towards community-based care and self-management of chronic conditions.
The lack of a coordinated plan is making it harder for NHS Wales to match staffing levels with future demand.
The report also highlights concerns over training and retention, with a significant number of medical graduates leaving Wales after qualification.
The report warns that workforce planning has become increasingly complex, with multiple organisations—including Health Education and Improvement Wales (HEIW), NHS Wales, and the Welsh Government—involved in decision-making.
Unclear leadership roles are making it difficult to implement effective workforce strategies.
A lack of comprehensive workforce data is also affecting planning efforts.
Gaps in information on primary care and specialist medical roles make it harder to predict future workforce needs.
Auditor General: ‘Action is crucial’
Adrian Crompton, Auditor General for Wales, said the challenges facing NHS Wales cannot be ignored.
“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 there is a need for urgent action, particularly in developing a stronger and more coherent national approach to workforce planning. This is crucial to building a motivated, resilient, and appropriately skilled workforce that can deliver sustainable, high-quality care.”
BMA Cymru Wales: ‘Service is not fit for purpose’
Responding to the report, Dr Iona Collins, Chair of BMA’s Welsh Council, said NHS workforce shortages are directly impacting patient care.
“BMA Cymru Wales welcomes this focus on significant NHS workforce gaps, which we have been highlighting for well over a decade. However, despite calls for an all-Wales workforce strategy, we have yet to see the necessary improvements in data collection to support a long-term plan.
“NHS workforce shortages contribute to delayed surgeries and longer waiting lists, leading to avoidable harm to patients, their dependents, and their employers.
“Wales has fewer doctors per head of population compared with the rest of mainland UK. Doctors did not expect to be placed in situations where the challenge isn’t applying their medical knowledge, but trying to deliver care in a system that is not fit for purpose.”
Audit Wales is urging the Welsh Government, NHS Wales, and key partners to work together to address these workforce challenges.
The report calls for improved workforce data, sustainable funding for training, and a clear long-term plan to prevent ongoing staffing shortages.
With rising costs, increasing demand, and thousands of unfilled positions, the report warns that delays in addressing these issues could put the future of NHS Wales at risk.
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