Why are Record Numbers of ‘Incompetent’ NHS Staff being Sacked, and will it fix the Health Service?
Wes Streeting. Image Credit: Lucy North/PA Wire
Record numbers of NHS staff have been dismissed for poor performance, as the government intensifies its crackdown on incompetence in the health service following years of mounting pressure over patient safety, staffing shortages and declining public confidence.
New workforce data shows nearly 7,000 NHS employees were dismissed in 2024–25, up sharply from around 4,000 just two years earlier. It is the highest figure since national records began in 2011 and comes after Health Secretary Wes Streeting pledged a “zero tolerance” approach to underperformance.
What the NHS Dismissal Figures Show
According to NHS workforce statistics, 1.8 per cent of staff who left their roles in 2024–25 did so through dismissal, compared with roughly 1.2 per cent a decade ago. Ministers have described this measure as the best proxy for staff being fired due to poor performance.
More than half of recent dismissals were classed as “capability” terminations, which occur when an employee is unable to meet the basic requirements of their role. Other grounds include misconduct and redundancy, while resignations on health or retirement grounds are recorded separately.
Despite the record numbers, dismissals still account for less than 0.5 per cent of the NHS’s 1.5 million-strong workforce, far below rates typically seen in the private sector.
Wes Streeting’s ‘Zero Tolerance’ Approach Explained
The sharp rise follows repeated warnings from Wes Streeting that poor performance would no longer be tolerated within the NHS. In November 2024, he vowed there would be “no more rewards for failure”, signalling that underperforming staff, including senior managers, could face dismissal.
The Health Secretary also warned that NHS managers who fail to meet standards in newly published league tables would be held accountable, marking a significant shift in how performance is measured and enforced across the service.
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Why Capability Dismissals Are Rising
Experts say the increase reflects long-standing underperformance finally being addressed, rather than a sudden deterioration in staff quality.
Gareth Lyon, head of health and social care at think tank Policy Exchange, said tougher action was overdue, arguing that organisations cannot improve without proper accountability.
However, previous research by the group found that four in five NHS bodies had not dismissed a single manager for performance reasons in the previous year, including some trusts placed in special measures, a pattern critics describe as “unsustainable”.
The Cost of Replacing Dismissed NHS Staff
Research by Skills for Health, based on freedom of information requests to every NHS trust and integrated care board in England, estimates the average cost of replacing a dismissed NHS worker at £6,500 per person.
Jon Freegard, director of Skills for Health’s consultancy and research division, described the spike in dismissals as “regrettable” but warned it likely reflects months or even years of unresolved problems.
He said earlier intervention and targeted support could help some staff improve before dismissal becomes necessary, adding that the high cost of replacement raises serious questions about workforce planning.
Criticism of NHS Culture and Accountability
Former Health Secretary Steve Barclay has criticised what he called a “deeply ingrained culture” within the NHS, where complaints are seen as a problem rather than an opportunity for improvement.
He pointed to a “revolving door of managers” who move between NHS organisations despite past failures, and warned that insufficient accountability can allow problems to persist while patients remain at risk.
How the Government Is Responding
Responding to the figures, a spokesperson for the Department of Health and Social Care said performance management is essential to improving standards and patient care.
The department said its 10-year health plan aims to ensure NHS staff have better access to training, support and resources, with the goal of preventing performance issues before they escalate to dismissal.
A Difficult Winter for the NHS
The dismissal figures come amid a challenging winter for the health service, marked by junior doctors’ strikes, a severe flu outbreak, and warnings that staff shortages could leave vulnerable patients stuck in hospital over Christmas.
While ministers argue that firmer performance management is necessary, unions and workforce groups continue to warn that retention and morale remain fragile.
FAQ
Why are record numbers of NHS staff being sacked?
Dismissals have risen following tougher performance management and a government push to address long-standing underperformance.
What does ‘capability dismissal’ mean in the NHS?
It refers to staff being dismissed because they cannot meet the essential requirements of their role, rather than misconduct.
How many NHS staff were dismissed in 2024–25?
Nearly 7,000 staff were dismissed, the highest figure since records began in 2011.
Is the NHS sacking more staff than other sectors?
No. Less than 0.5% of NHS staff are dismissed annually, compared with 2–3% in the private sector.
Who is responsible for the zero-tolerance policy?
Health Secretary Wes Streeting, who has pledged tougher action on poor performance.
Does dismissing staff improve NHS performance?
Supporters argue it improves accountability, while critics warn it must be paired with training and early intervention.
How much does it cost to replace a dismissed NHS worker?
On average, around £6,500 per staff member, according to Skills for Health.
Are NHS managers included in the crackdown?
Yes. Ministers have warned that underperforming managers could face dismissal under new league tables.
What is the government doing to prevent poor performance?
The Department of Health says its long-term plan focuses on training, support and earlier intervention.