Tessa Quinn
The NHS is one of the largest employers in the world, with approximately 1,257 hospitals in the UK and over 1.2 million full-time equivalent staff working in NHS trusts and clinical commissioning groups in England. The NHS in England is not a single organisation; it is made up of hundreds of different organisations of varying sizes, at central, national, regional, and local levels. The English NHS is controlled by the UK government through the Department of Health and Social Care (DHSC), which takes political responsibility for the service. While the NHS has been praised for its role in protecting people from heavy financial costs when ill, it has also faced criticism for long waiting times and inadequate capital funding.
| Characteristics | Values |
|---|---|
| Number of hospitals | Approximately 1,257 |
| Number of trusts | 219 (2021) |
| Number of staff | 1.2 million full-time equivalent staff (England only); 1.7 million across the UK (2012) |
| Number of doctors | 123,727 (England only, June 2021) |
| Number of nurses | 332,341 (England only, June 2021) |
| Number of managers | 33,907 (England only, June 2021) |
| Number of finance staff | 16,211 (England only, 2012) |
| Number of non-clinical staff | 587,647 (England only, 2012) |
| Number of student doctor places | 8,000 per year (England only) |
| Number of sight tests | 13.1 million (UK, 2024) |
| Waiting times | One in four patients wait over 3 months to see a mental health professional; 29 out of 157 hospital trusts missed all waiting time targets in 2017-2018 |
| Performance assessment | Conducted separately for England, Wales, Scotland, and Northern Ireland |
| Regulatory bodies | Department of Health and Social Care, General Medical Council, Nursing and Midwifery Council, Care Quality Commission |
| Funding | £4 million for homeopathic medicines in 2010; £10 billion for medical technology per year |
| Patient satisfaction | Overall satisfaction fell in 2021, mainly due to dissatisfaction with waiting times |
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What You'll Learn
NHS hospitals and their performance ratings
The NHS is one of the largest employers in the world, with approximately 1,257 hospitals in the UK and over 1.2 million full-time equivalent staff working in NHS trusts and clinical commissioning groups in England. In June 2021, there were 123,727 doctors, 332,341 nursing staff (including midwives and health visitors), and 33,907 managers in the NHS.
The NHS's performance is assessed separately for England, Wales, Scotland, and Northern Ireland. The Care Quality Commission (CQC) is the regulator of health and social care in England, and its ratings of NHS hospitals are based on five core categories: safe, effective, caring, responsive, and well-led. According to the CQC, 44% of NHS hospitals in England are rated 'Good', meaning they are "performing well and meeting expectations". Only 8% are rated 'Outstanding', defined as "performing exceptionally well". Meanwhile, 49% are rated 'Requires Improvement' or 'Inadequate'.
The latest health performance data reveals that fewer hospitals are rated as "excellent", and more operations are being cancelled despite an overall improvement in standards. The NHS Performance Ratings produced by the CQC assess a broad category of "core" medical standards relating to patient safety, hygiene, the safeguarding of children, infection control, and patient confidentiality. The assessment covers all 392 NHS trusts in England and also measures 86 other indicators such as waiting times for patients and ambulance response times.
The NHS has faced challenges in recent years, including long waiting times and staff shortages. In 2025, the average patient in England had been waiting just under 13 weeks for their appointment, and the backlog of hospital appointments has increased significantly since January 2020. There has also been a surge in "trolley waits", where patients require further treatment but a hospital bed is not immediately available. In addition, one in four patients in the UK wait over three months to see an NHS mental health professional, with 6% waiting at least a year.
Despite these challenges, the NHS has also achieved successes. In 2021, Queen Elizabeth II awarded the NHS the George Cross, the highest award for gallantry available to civilians, in recognition of their "courage, compassion and dedication" throughout the pandemic. The NHS has also partnered with Israeli tech company Taliaz to improve mental health services using AI-powered software.
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NHS staffing numbers and employment status
The NHS is one of the largest employers in the world, and the biggest in Europe, with approximately 1,257 hospitals in the UK. The NHS in England directly employs 1.7 million people (equivalent to 1.5 million full-time staff), with employee costs accounting for around two-thirds of NHS providers' expenditure. The NHS is the country's biggest employer, and it is estimated that by 2036/37, the projected demand for staff will be between 2.3 and 2.4 million. This would mean that one in eleven workers in England will work for the NHS, compared to one in seventeen currently.
The NHS is heavily reliant on professionally qualified clinical staff, who account for around half of all employees. Other key staff groups include those working in central functions, dealing with the NHS's property and estates, and supporting clinical staff. The vast majority of NHS staff (1.4 million people) work in 'hospital and community services' as direct employees of NHS trusts, providing ambulance, mental health, and community and hospital services. This group includes the 25,000 staff who work as local planners and commissioners of health services (known as integrated care boards). In addition, around 190,000 people (154,000 full-time equivalents) work in general practice services. Across NHS hospitals, community and general practice settings, there are 188,000 doctors in total and around 423,000 nurses and midwives.
In June 2021, there were 123,727 doctors, 332,341 nursing staff (including midwives and health visitors), and 33,907 managers in the NHS. The number of NHS staff has increased by more than 30% since 2009, although this growth has not been evenly spread across the years or staff groups. While the number of nurses has been increasing, some specialties, such as learning disability and community nursing, have seen a decline in numbers. The number of consultants and scientific, therapeutic, and technical staff has also increased, although there are variations within these groups. For example, the number of operating theatre staff and radiography staff has increased, while the number of chiropody/podiatry staff has fallen.
The NHS also employs indirectly, for example, through paying companies to provide services such as laundry, catering, and cleaning. Some NHS services are delivered by non-NHS organisations, with 68,000 full-time equivalent staff directly employed in independent healthcare providers in England. The NHS is heavily reliant on its international workforce, with nearly one in five people working in the health service coming from outside the UK. The proportion of international staff has grown in recent years, particularly from non-EEA countries, while the proportion of staff from EEA nations has remained static.
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NHS funding and allocation
The NHS is one of the largest employers in the world, with approximately 1,257 hospitals in the UK and over 1.2 million full-time equivalent staff working in NHS trusts and clinical commissioning groups (CCGs) in England. The NHS strives to uphold its goal of providing equal access to healthcare based on need. To achieve this, it's essential to divide its overall budget fairly so that local health economies can implement local services that cater to the specific needs of their populations.
In England, about 90% of Department of Health and Social Care funding is funnelled through NHS England, with just over 60% of this funding allocated to CCGs. CCGs are responsible for planning most primary, community, and hospital care services, including emergency care in their respective areas. The allocation of funding is influenced by various factors, including population size, age, additional needs, and the cost of providing services due to geographical differences.
The allocation of funding to NHS boards and territorial boards is also crucial. In 2017, NHS boards received an additional investment of £327 million. Out of this, £186 million was allocated to territorial boards, ensuring that all boards were within 1% of parity under the NHS funding formula, known as NRAC. £128 million was dedicated to supporting the delivery of service reform and improvement, addressing the challenges posed by an ageing population.
Despite these efforts, the NHS has faced criticism and concerns about its performance. A 2018 study by the King's Fund, Health Foundation, Nuffield Trust, and the Institute for Fiscal Studies concluded that the main weakness of the NHS was healthcare outcomes, with higher-than-average mortality rates for cancer, heart attacks, and strokes compared to other similar countries. Additionally, dissatisfaction with hospital and GP waiting times has negatively impacted overall satisfaction with the NHS.
To address these challenges, the Labour Government elected in 2024 announced the development of a new "10-year plan" for the NHS, aiming to tackle the issues and ensure proper funding and staffing for improved health and social care.
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NHS waiting times
The situation in Accident and Emergency (A&E) departments has been particularly challenging. While A&E attendance decreased significantly at the pandemic's onset, leading to improved performance, demand has since risen steadily, outstripping capacity and resulting in longer waits for patients. In May 2025, approximately 2.4 million people attended A&E, with 75.4% of patients being admitted, transferred, or discharged within four hours. This figure represents an improvement over the previous month (74.8%) and the previous year (74%), but it falls short of the 78% NHS operational target.
The pandemic has also impacted waiting times for non-urgent, consultant-led treatments. The maximum waiting time for these treatments is 18 weeks from the booking of an appointment or receipt of a referral letter. However, this right to timely treatment may be superseded by clinical interests, such as lifestyle changes that could improve treatment outcomes. Patients have the legal right to request alternative providers if they face longer waiting times than specified for their treatment.
Cancer care has also been affected, with services operating below operational standards. Changes to cancer waiting time standards were implemented in October 2023, aiming to improve patient care. Despite these adjustments, the percentage of patients informed of their cancer diagnosis within four weeks of an urgent referral decreased from 78.9% in March 2025 to 76.7% in April 2025, just above the 75% operational target.
Mental health services have also struggled to keep up with demand, with one in four patients across the UK waiting over three months to see an NHS mental health professional, and 6% waiting at least a year.
Despite these challenges, there are signs of improvement. In June 2025, the NHS waiting list fell to 7.39 million, a decrease of 0.03 million. This reduction was attributed to the dedication of NHS staff, who delivered a record number of tests and checks during one of the busiest months ever recorded in A&E. The average time patients waited for planned treatment also dropped to 13.3 weeks, despite increased demand.
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NHS structure and management
The NHS is one of the largest organisations in the UK and the biggest employer in Europe. It is made up of multiple organisations, each with its own recruitment team and list of vacancies. The structure of these organisations varies between England, Wales, Scotland, and Northern Ireland.
In England, the organisations making up the NHS include national bodies that oversee and regulate NHS services, Integrated Care Systems (ICSs) that plan and commission care for local populations, primary care organisations (including GP practices, dental practices, and opticians), acute (hospital) trusts, and mental health trusts. The NHS is constantly evolving, with recent major structural changes including the abolition of CCGs, the move to ICSs, and ICBs for commissioning regional services. These changes impact digital-first primary care and are in response to challenges such as increasing levels of obesity, diabetes, and antibiotic resistance, as well as the need to adopt new medical advancements.
The NHS in England is not a single organisation, but hundreds of different organisations of varying sizes and roles at central, national, regional, and local levels. Staff can be directly employed by the NHS, employed by a service provider, self-employed, or provide services under a contract with a non-NHS organisation. The NHS is also supported by charities and social enterprises, which provide additional services.
The Department for Health is the government department responsible for funding and creating policies for healthcare in the UK. Sustainability and Transformation Partnerships (STPs) were introduced in 2016 to bring together various stakeholders to plan services based on the long-term needs of local populations. The NHS also set out a Long Term Plan in 2019, with key ambitions including giving people more control over their health and care, encouraging Integrated Care Systems, and preventing/tackling health inequalities.
The performance of the NHS is assessed separately in England, Wales, Scotland, and Northern Ireland. Waiting times and dissatisfaction with hospital and GP access are significant issues affecting overall satisfaction with the NHS.
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Frequently asked questions
No, not all hospitals in the UK are part of the NHS. The NHS is the largest employer in Europe, with approximately 1,257 hospitals in the UK. There are over 1.2 million full-time equivalent staff working in NHS trusts and clinical commissioning groups.
The NHS was formed to ensure that all UK residents have access to free medical, dental, and nursing care. The NHS is constantly evolving to meet the challenges it faces, and it has been praised for its protection of people from heavy financial costs when ill.
The NHS has faced criticism for its long waiting times, with one in four patients throughout the UK waiting over three months to see an NHS mental health professional. The NHS has also been criticized for funding homeopathic medicines, which are not supported by scientific research.
