The National Health Service (NHS) in England is considering a drastic reduction in new hires to prevent economic collapse. This leaked strategy suggests substituting human staff with artificial intelligence to manage patient care through the mid-2030s.

The 380,000-person gap in the mid-2030s forecast

The National Health Service (NHS) is proposing to lower annual staffing increases to between 1.1 per cent and 2 per cent.. according to a draft of the plan seen by the FT, this represents a sharp decline from the 2.6 to 2.9 per cent growth rate targeted in the 2023 workforce plan. This shift implies that by the mid-2030s, the National Health Service (NHS) will employ up to 380,000 fewer people than previously anticipated.

The previous 2023 strategy aimed to expand the workforce from 1.4 million to 2.3 million staff to address chronic shortages. However, the current government argues that a 50 per cent increase in doctors over the last decade failed to improve patient outcomes or access, leading to a decline in overall productivity.

Autonomous AI as a substitute for clinical roles

To bridge the staffing void, the National Health Service (NHS) intends to integrate AI capable of making autonomous decisions during patient treatment. The leaked document suggests technology could be used to frame consultations, identify key patient information, and highlight risk levels. In some instances, the plan envisions technology completely substituting for a human role.

As the FT reports, the proposal includes incentives for the remaining workforce, suggesting that staff who deliver sustained productivity improvements through technology should be given a share of the benefit via bonuses or extra time off. This marks a fundamental shift toward a tech-first delivery model for public health.

The £50 billion cost of the 2023 staffing plan

The fiscal driver for this pivot is the staggering cost of previous expansion goals. The Institute for Fiscal Studies estimated that the 2023 plan would have seen the National Health Service (NHS) employ 9 per cent of all workers in England by 2036/37, up from 6 per cent. This expansion would have added approximately £50 billion in costs.

Officials warn that continuing on the previous path would lead to a vast increase in the pay bill as a proportion of GDP. the draft plan explicitly describes the previous recruitment trajectory as a path to "financial ruin" that would bankrupt both the health service and the United Kingdom.

Prioritizing 49,000 more GPs over hospital nurses

The revised strategy shifts the focus of human labor from hospitals to community-based care. The plan suggests a need for 49,000 more GPs by 2035 to facilitate treatment closer to home, which is a 23 per cent increase over the 2023 projections. This expansion of general practice comes at the direct expense of hospital staffing.

Recruitment for nurses is seeing the steepest decline. The new proposals envisage an increase of only about 50,000 nurses over the next decade, a massive drop from the 170,000 to 190,000 nurses proposed in the 2023 plan. To keep existing doctors from leaving, the National Health Service (NHS) may allow staff to exchange some pension contributions for higher immediate pay.

Paul Johnson's skepticism of 2005-era technology

Paul Johnson, the former head of the Institute for Fiscal Studies, has expressed doubt regarding the National Health Service's (NHS) ability to execute this digital transformation. Johnson noted that the organization often struggles to utilize technology from 2005, making the leap to autonomous AI highly ambitious.

This raises critical questions that the leaked document does not fully answer. Specifically, it remains unclear how the National Health Service (NHS) will ensure patient safety when AI makes autonomous decisions, and whether the current fragmented IT infrastructure can support such advanced tools. furthermore, the plan's reliance on "unproven tech," as described by Unison union deputy head Alan Lofthouse, suggests a high-risk strategy with no guaranteed safety net.