Incompetent NHS Staff Sacked – Why Are Dismissals at Record Numbers?
• December 26, 2025
Has the NHS finally drawn the line on underperformance? With nearly 7,000 staff dismissals recorded in 2024–25, up from around 4,000 just two years prior, the answer appears to be yes.
These record-breaking figures mark a pivotal shift in the way the health service approaches accountability, performance, and professional standards across its 1.5 million-strong workforce.
The surge follows the implementation of a controversial “zero tolerance” policy introduced by Health Secretary Wes Streeting. The crackdown, aimed at improving patient care and restoring public confidence, has sparked debate across the UK.
But what exactly is behind the spike in sackings? And what does it mean for the future of the NHS?
What’s Driving the Record Number of NHS Staff Dismissals?
Data obtained from NHS England reveals a dramatic increase in staff dismissals, reaching nearly 7,000 cases in the 2024–25 period, a sharp rise from the approximately 4,000 dismissals recorded in 2022–23. This represents the highest level since records began in 2011, signalling a systemic overhaul in performance expectations.
The majority of dismissals fall under “capability” grounds, which refer to an employee’s inability to meet the fundamental requirements of their role. While misconduct and redundancy remain valid reasons for termination, it is capability-related dismissals that have become the most prevalent.
According to official figures, 1.8% of NHS leavers in 2024–25 were dismissed, compared to 1.2% a decade earlier. While this proportion may seem modest, the implications are significant when scaled across the entire NHS workforce.
Why Are Capability-Related Dismissals on the Rise in the NHS?
The rise in capability-related dismissals highlights a shift in how the NHS addresses persistent underperformance, particularly in roles that directly affect patient care.
A Focus on Performance Over Tenure
Capability-based dismissals target individuals whose performance consistently fails to meet minimum job standards, despite training or managerial intervention. This includes clinical errors, failure to follow procedures, and general professional incompetence.
NHS Dismissal Grounds: A Quick Breakdown
| Grounds for Dismissal | Definition |
|---|---|
| Capability | Inability to perform job duties effectively or safely |
| Misconduct | Breach of professional conduct or behavioural standards |
| Redundancy | Job no longer required due to restructuring or funding |
In 2024–25, more than half of the recorded dismissals were linked to capability, suggesting that the NHS is no longer tolerating sustained underperformance, especially in frontline services.
Industry Expert Insight
Jon Freegard, Director of Skills for Health’s consultancy division, remarked:
“The sharp rise in dismissals is regrettable, but likely reflects months or even years of underperformance being rooted out. More needs to be done to intervene earlier; some staff can improve if given the right support.”
What Is the “Zero Tolerance” Policy Introduced by Wes Streeting?
In November 2024, Health Secretary Wes Streeting announced a firm policy shift intended to boost trust performance and eliminate systemic underperformance. At the heart of this reform is a clear message: “No more rewards for failure.”
The League Table Mechanism
One of the cornerstones of this reform is the introduction of league tables, quarterly rankings of NHS trusts based on patient outcomes, staff engagement, and efficiency metrics. Trusts falling in the bottom tiers risk direct intervention, including management dismissals.
Streeting’s policy is not solely focused on punitive action but on creating transparency, enhancing standards, and driving improvement. NHS managers who fail to meet performance benchmarks are now subject to dismissal, something rarely enforced prior to 2024.
“People who can’t or won’t do their job should be sacked. The NHS needs to significantly up its game.”
— Gareth Lyon, Head of Health & Social Care, Policy Exchange
This approach has been praised by think tanks like Policy Exchange, who have long called for tougher performance management within the NHS.
How Is NHS Performance Management Being Reformed?
The current approach to performance management marks a departure from the past, where underperforming staff, particularly managers, often moved between trusts without consequences. This “revolving door” culture has now come under direct scrutiny.
Former Health Secretary Steve Barclay highlighted this issue by stating:
“There is a deeply ingrained culture within the NHS where complaints are seen as a problem rather than an opportunity for improvement. Alongside that, there is a reluctance to hold individuals to account.”
The league tables and Streeting’s policy have begun disrupting this cycle, encouraging data-driven decision-making and fostering a performance-first culture across the NHS system.
How Much Does It Cost to Replace Dismissed NHS Staff?
The financial implications of rising dismissals are considerable. According to research by Skills for Health, the average cost of replacing one dismissed NHS employee is around £6,500.
This includes:
- Recruitment and onboarding costs
- Temporary staffing cover during vacancy
- Training and supervision for new hires
- Administrative and legal expenses linked to termination
| Cost Factor | Estimated Value |
|---|---|
| Recruitment & Advertising | £1,000–£1,500 |
| Induction & Training | £2,000 |
| Interim Staffing Cover | £2,500–£3,000 |
| Legal/HR Termination Processes | £500–£1,000 |
The cumulative impact of thousands of dismissals puts additional strain on an already stretched NHS budget, particularly when paired with staffing shortages and ongoing industrial action from junior doctors and nurses.
Is the NHS Falling Behind the Private Sector in Accountability?
One of the most striking contrasts lies in dismissal rates between sectors. In 2024–25, NHS dismissals represented less than 0.5% of the total workforce. By comparison, private sector dismissal rates typically range between 2% and 3%, according to various employment studies.
While the private sector often employs performance-based contract renewals, the NHS historically leaned towards retention and internal movement rather than outright dismissal. This gap in approach has raised questions about the public sector’s reluctance to enforce accountability.
Some argue that lower NHS dismissal rates reflect a more supportive environment, while others see it as a systemic failure to prioritise quality and public safety over institutional loyalty.
What Are the Wider Implications for Patient Safety and Trust?
As dismissal numbers rise, a critical question remains: Does this improve patient care, or does it risk destabilising NHS staffing?
Advocates of the zero-tolerance approach argue that removing underperforming staff is essential for restoring public trust, improving patient outcomes, and eliminating risk from clinical environments.
However, concerns have emerged about how such measures may affect staff morale, especially in high-pressure departments already under-resourced and overstretched. Moreover, without timely replacement plans, patient services may experience disruptions.
The Department of Health and Social Care (DHSC) has responded to these concerns by reiterating its commitment to:
- Supporting early interventions
- Providing ongoing staff training
- Delivering on its 10-year health workforce plan
Can Early Intervention Prevent Staff Dismissals?
One recurring theme from stakeholders is the need for proactive performance management rather than reactive terminations. Skills for Health’s findings suggest that many underperforming employees could improve with appropriate support, training, and structured intervention plans.
Effective early intervention could include:
- Regular performance appraisals
- Enhanced mentorship programmes
- Better mental health and wellbeing support
- Prompt access to skills development resources
By addressing gaps before they escalate, the NHS could reduce the number of capability-related dismissals, saving costs and maintaining continuity of care.
What’s the Government’s Stance on NHS Dismissals and Reform?
The government has thrown its weight behind reforms aimed at making the NHS more accountable, transparent, and performance-driven.
The 10-year workforce strategy focuses on:
- Upskilling healthcare professionals
- Introducing robust appraisal systems
- Modernising recruitment and retention practices
- Funding leadership development across NHS trusts
While the rising dismissal numbers indicate short-term turbulence, ministers are confident that these reforms will yield long-term stability and excellence in care delivery.
Conclusion
The record number of NHS staff dismissals reflects a complex and evolving landscape. On one hand, it showcases a serious commitment to high standards and zero tolerance for incompetence. On the other, it raises questions about training gaps, managerial oversight, and the broader support structures available to frontline staff.
The real challenge lies in striking the balance, enforcing accountability while nurturing improvement. Dismissals alone won’t fix systemic issues, but they may serve as a catalyst for necessary transformation across the UK’s most vital public institution.
Frequently Asked Questions
How does the NHS define capability-related dismissals?
Capability-related dismissals occur when a staff member consistently fails to meet the essential duties of their role, even after support and performance reviews.
Are NHS managers held accountable under the new policies?
Yes. With the introduction of league tables and performance metrics, NHS managers are now under closer scrutiny and can be dismissed for underperformance.
How does the NHS’s dismissal rate compare to the private sector?
NHS dismissal rates are under 0.5%, while the private sector typically sees dismissal rates between 2–3%, highlighting a more lenient historical approach in the NHS.
Is Wes Streeting’s zero tolerance approach widely supported?
It has been welcomed by think tanks like Policy Exchange but criticised by some who believe it may harm staff morale and retention if not balanced with support systems.
What is the role of league tables in NHS performance management?
League tables assess trust performance quarterly. Those underperforming face interventions, including potential leadership changes.
Can dismissed NHS staff reapply or appeal their termination?
Yes, like other public sector employees, dismissed NHS staff may appeal through internal procedures or employment tribunals depending on the circumstances.
How does staff dismissal impact NHS finances and staffing levels?
Each dismissal can cost up to £6,500 to replace, putting pressure on budgets and potentially leading to service delays if replacements are not promptly secured.
