Dr Minh Alexander retired consultant psychiatrist 20 December 2022
The NHS currently has a serious workforce shortage.
There are questions about the fairness of many NHS dismissals.
Dismissal of staff is a relatively rare event and usually represents some degree of management failure, whether in selection and recruitment, training, supervision, remediation or conflict management.
Dismissal is wasteful and also a traumatic organisational event.
High rates of dismissals raise questions about immature and harsh management culture.
NHS dismissal stats encompass dismissals under four categories: incapability, conduct, some other substantial reason and statutory reasons.
Redundancies are counted separately.
Across the whole NHS, about four to five thousand staff are dismissed every year, under the four categories above.
Almost twenty five thousand NHS staff have been dismissed in the past five years, with a decrease since the start of the pandemic.
| YEAR | Number of staff dismissed across all NHS organisations |
| 2017/18 | 5,585 |
| 2018/19 | 5,255 |
| 2019/20 | 4,905 |
| 2020/21 | 3,735 |
| 2021/22 | 4,025 |
| 2022/23 Q1 | 1,025 |
| TOTAL | 24530 |
FOI data from NHS digital shows that NHS trusts accounted for at least 24,010 of these dismissals (there is missing data for one NHS trust).
This is summary data on NHS trust dismissals in the same period, extracted from the NHS Digital data.
The data shows striking variation between NHS trusts in the rates of dismissals.
In the period 1 April 2017 to 31 March 2022, the range seen in NHS trusts was as follows.
Lowest
Chesterfield Royal Hospital NHS Foundation trust dismissed only fifteen staff.
At a current total workforce of 3448, this gives a rate of 4.3 staff dismissed per 1,000 staff during this period.
Highest
South East Coast Ambulance Service NHS Foundation Trust dismissed a staggering 440 staff.
At a current total workforce of 3833, this gives a rate of 114.7 staff dismissed per 1,000 staff during this period.
Ambulance trusts
Based on the NHS Digital data, NHS ambulance trusts are outliers and have the highest rate of dismissals.
Ambulance trusts account for 4% (48,831 of 1,208,079) of the NHS trust workforce, but they accounted for 9.3% (2,230 of 24,010) NHS trust staff dismissals in the five year period.
The numbers of dismissals for ambulance trusts across the period were as follows:
The rates of dismissal per 1,000 staff in the period, based on the most recent workforce headcounts, were as follows:
| NHS Ambulance Trust | Total number of dismissals during period 1 April 2017 to 31 March 2022 | Total workforce (NHS Digital August 2022) | Number of staff dismissed per 1,000 staff in the period 1 April 2017 to 31 March 2022 |
| South East Coast Ambulance Service NHS Foundation Trust | 440 | 3,833 | 114.7 |
| South Central Ambulance Service NHS Foundation Trust | 270 | 4,078 | 66.2 |
| South Western Ambulance Service NHS Foundation Trust | 220 | 4,443 | 49.5 |
| North East Ambulance Service NHS Foundation Trust | 130 | 2,765 | 47 |
| East Midlands Ambulance Service NHS Trust | 150 | 3,679 | 40.8 |
| Yorkshire Ambulance Service NHS Trust | 215 | 5,313 | 40.4 |
| West Midlands Ambulance Service University NHS Foundation Trust | 250 | 6,517 | 38.3 |
| East of England Ambulance Service NHS Trust | 185 | 5,284 | 35 |
| North West Ambulance Service NHS Trust | 185 | 6,345 | 29.1 |
| London Ambulance Service NHS Trust | 185 | 6,574 | 28.1 |
The average number of dismissals per 1,000 staff in the period, for ambulance trusts was 47.4.
The average number of dismissals per 1,000 staff in the period, for all NHS trusts was 19.9.
For additional context, this is a list of the “top” forty NHS trusts which dismissed disproportionately more staff.
All ten of the ambulance trusts feature in this list.
It is clear from many angles that NHS ambulance trusts have been neglected for many years and are highly stressed organisations.
They are also vital organisations, upon which we all depend.
Moreover ambulance trust performance is a barometer of other dysfunction in our health and social care system, as the current collapse of emergency care has shown.
There are two reviews underway on NHS ambulance trusts at present, neither of which command much confidence.
- A reluctant review by the NHS National Guardian which was left on the shelf since summer 2020 and only started after an enquiry on progress earlier this year.
- NHS England’s conflicted review of North East Ambulance Service NHS Foundation Trust, led by controversial NHS insider Marianne Griffiths, well known to Sussex NHS whistleblowers. Highly questionable terms of reference were leaked to the Health Service Journal, after which NHSE claimed they were not the final version.
The NEAS deaths and coronial scandal is an important proxy for the longstanding mismanagement and neglect of our ambulance services, and for capacity issues across the health and care system
It has national importance and deserves better than an NHS England whitewash.
A judge led inquiry with the power to ungag silenced whistleblowers, and the power to require participation by relevant non-NHS bodies, is needed.
| NHS England’s due diligence on Marianne Griffiths Concerns continue about whistleblowing governance at Griffith’s former NHS trust, University Hospitals Sussex NHS Foundation Trust. I asked NHS England CEO Amanda Pritchard if NHSE had undertaken due diligence and properly reviewed Griffith’s leadership at Sussex: “BY EMAIL Amanda Pritchard CEO NHS England 7 November 2022 Dear Amanda, Marianne Griffiths’ role in investigating North East Ambulance Service May I ask if NHS England has undertaken full due diligence into Marianne Griffiths’ past record on whistleblowing governance before appointing her to lead the NEAS investigation? Has it satisfied itself that she is a Fit and Proper Person to adjudicate on matters of whistleblowing governance, and that there are no outstanding serious matters of alleged whistleblower suppression, failure to protect whistleblowers or harm to whistleblowers, that relate to her role as CEO of University Hospitals Sussex NHS Foundation Trust and its predecessor organisations? For example, has NHSE satisfied itself that there are no formal, current internal trust processes such as grievances by whistleblowers or current litigation against the trust for whistleblower detriment, which relate to her tenure as trust CEO? I ask as this seems a critical issue given that NEAS is accused of harming and trying to silence whistleblowers, and is proven to have attempted to gag them with unlawful NDAs. I should mention that a question that I first put to NHS England on 26 June 2022, and have since repeated, about whether it had looked into allegations of poor whistleblowing governance at NEAS, remains unanswered. This is very troubling given that NHS England is in control of the current NEAS investigation. With best wishes, Minh Dr Minh Alexander Cc Tom Grimes NHS England Head of Whistleblowing” The response from NHS England, via its head of whistleblowing, on 8 December 2022 was as follows: “Hi Minh Thanks for your email and sorry for the delay in responding to this. Dame Marianne is a retired NHS Chief Executive. Having never worked in the region, but with extensive knowledge of the NHS, Dame Marianne has the relevant experience to Chair this independent investigation. Regarding the question of 26 June that you refer to, please can you let me know the details and I can see what happened to this. Best wishes Tom” The correspondence continues. |
Related items:
A Study in Delay: The National Guardian & Brighton and Sussex University Hospitals NHS Trust
Staff suicides at West Midlands Ambulance Service NHS Foundation Trust
The National Guardian’s Office does not put a blue light on for ambulance staff
The Dismissal of over Ten Thousand NHS Staff via ‘Some Other Substantial Reason’Waste Industry: The NHS disciplinary process & Dr John Bestley
Alexander's Excavations 