The NHS has recorded an unprecedented surge in staff dismissals, with figures approaching 7,000 during 2024/25.
The number represents a dramatic rise from approximately 4,000 just two years earlier and the highest number since records began in 2011.
Capability-related terminations have been the primary driver behind this increase, accounting for more than half of all dismissals in the most recent period.
Under NHS guidelines, capability dismissals occur when employees cannot meet the fundamental requirements of their position.
The NHS has recorded an unprecedented surge in staff dismissals
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Other grounds for termination include misconduct and redundancy.
The sharp uptick reflects a broader effort to address underperformance across the health service, with ministers taking an increasingly firm stance on standards within the organisation’s 1.5 million-strong workforce.
Health Secretary Wes Streeting has championed this tougher approach, pledging in November 2024 to implement a “zero tolerance” policy towards inadequate performance.
He cautioned that there would be “no more rewards for failure” within the service.
In November 2024, Wes Streeting vowed to implement a ‘zero tolerance’ policy towards inadequate performance
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Mr Streeting had previously signalled that NHS managers failing to meet standards in newly published league tables would face dismissal.
The think tank Policy Exchange has welcomed the shift in approach.
Gareth Lyon, the organisation’s head of health and social care, said: “People who can’t or won’t do their job should be sacked.
“The NHS needs to significantly up its game, and that will only happen with a more rigorous approach to performance management including firing people not up to the job.”
NHS workforce data revealed that 1.8 per cent of staff who departed their roles in 2024/25 did so through dismissal (file photo)
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Analysis of NHS workforce data reveals that 1.8 per cent of staff who departed their roles in 2024/25 did so through dismissal, compared with roughly 1.2 per cent a decade ago.
Ministers have indicated this figure serves as the most reliable measure of performance-related terminations.
Research conducted by Skills for Health, based on freedom of information requests to every NHS trust and integrated care board in England, estimates that replacing each dismissed employee costs approximately £6,500.
Despite the record numbers, the NHS dismissal rate remains below 0.5 per cent of its workforce.
This stands in stark contrast to the private sector, where estimates suggest between 2 and 3 per cent of employees are typically dismissed.
Jon Freegard, director of Skills for Health’s consultancy and research division, described the sharp rise in dismissals as “regrettable” but noted it likely reflects prolonged periods of underperformance.
He advocated for earlier intervention, suggesting some employees could improve with appropriate support.
Mr Freegard added: “No one can argue against those who are not up to the job being dismissed, but there’s an additional factor to consider here: Why are underperformers so costly to replace?”
Former Health Secretary Steve Barclay criticised what he termed a “deeply ingrained culture” within the NHS, pointing to a “revolving door of managers who fail in one organisation only to end up transferred elsewhere”.
A spokesman for the Department of Health and Social Care spokesman said: “Performance management is essential in the NHS as we look to drive up standards and make sure patients are getting the care they deserve.
“As we work hard to fix our NHS, early intervention and proper support for staff will prevent performance issues arising in the first place.
“After years of damage, our 10 year health plan is making sure staff have access to the training and resources they need to thrive in their roles and deliver outstanding care.”