The NHS has seen a dramatic spike in staff dismissals, with nearly 7,000 employees let go during 2024/25, marking the highest number on record since data collection began in 2011. The sharp rise signals a tough new stance on performance standards across the UK’s largest public sector employer.
Capability at the Core
Over half of these terminations were due to capability issues, meaning staff were dismissed because they were unable to meet the basic requirements of their roles. While capability has always been part of NHS performance management, the current volume reflects a more forceful push to address underperformance within the 1.5 million-strong workforce.
Health Secretary Wes Streeting has been at the forefront of this shift, promising a “zero tolerance” policy on subpar performance. In recent statements, he made it clear that the days of “rewards for failure” are over, emphasizing that NHS managers falling short in newly introduced league tables could face dismissal.
Tougher Standards, Rising Costs
According to analysis by Skills for Health, each dismissal costs the NHS an estimated £6,500 in recruitment and replacement expenses. This adds up to tens of millions in additional costs during a time when the system is already under financial and operational strain.
Jon Freegard, director of Skills for Health’s research division, acknowledged the need to remove staff who can’t meet the mark, but urged more early intervention and support, noting that many underperformers could improve with the right resources and guidance.
Still Below Private Sector Levels
Despite the headlines, NHS dismissal rates remain relatively low. Just under 0.5% of the workforce was dismissed last year—significantly below private sector figures, where annual dismissal rates typically range from 2% to 3%. Still, the jump from around 4,000 dismissals two years ago to nearly 7,000 this year marks a striking shift in NHS culture.
A Culture Shift in Motion
Former Health Secretary Steve Barclay criticized the long-standing NHS tendency to reassign underperforming managers rather than hold them accountable. His comments on the “revolving door” culture echo a growing public demand for transparency and higher standards across healthcare leadership.
The Department of Health and Social Care defended the firmer approach but stressed that long-term solutions require proper staff support. A spokesperson reaffirmed the government’s 10-year health plan, aimed at equipping staff with the skills, training, and resources to succeed—before performance becomes a problem.
