Since the height of the COVID-19 pandemic, NHS workforce has grown by more than 20%. This expansion reflects the urgency and necessity of pandemic and post post-pandemic decisions reflecting the management of rising patient demand, increasing care complexity, and years of structural understaffing. On the surface, this appears to be a positive shift — a system investing in its people.
However, beneath the headline figures lies a growing concern. Despite an increase in headcount, the NHS is seeing declining productivity. Output per staff member is falling, while core performance targets — from elective recovery to emergency response — are being consistently missed. NHS productivity has also reduced by c.20%. Many NHS organisations now face the uncomfortable truth: more staff alone does not equal better outcomes and managing the double edge sword of increased payroll and reduced efficiency results in urgent transformation and restructuring
While the NHS workforce has grown significantly, so too have vacancies — a contradiction that lies at the heart of the current crisis. As of early 2025, there are more than 100,000 unfilled posts across the service, with nursing shortages accounting for over 30,000 of those unfilled posts. These gaps are not just statistics; they translate into heavier workloads for existing staff, longer waits for patients, and a growing sense of strain at every level of the system.
Absenteeism rates remain stubbornly high, often driven by stress, fatigue, and burnout. Many frontline staff are working beyond their contracted hours, covering for absent colleagues or navigating unpredictable rota changes, leaving them emotionally and physically depleted. Temporary staffing, while essential in some areas, adds further instability and cost pressure, often disrupting continuity of care and team cohesion.
Despite the overall rise in headcount, output per staff member has fallen. Fewer patients are being treated per clinician. Operating theatres are underutilised. Ambulance handover times remain excessive. Diagnostic backlogs are growing. In other words, the NHS is larger than ever — but less productive.
This is not a reflection on the commitment or capability of NHS staff. On the contrary, clinicians, nurses, support workers, and managers are showing exceptional resilience in the face of unprecedented demand. The issue lies not with the workforce, but with the systems in which they operate.
Systemic inefficiencies — including overly complex processes, duplication of effort, inconsistent digital adoption, and poor communication across departments — are draining time and resources. Role confusion, unclear lines of accountability, and constant organisational restructuring have left many staff uncertain about their responsibilities or decision-making authority. In some areas, highly qualified staff are spending more time on administrative tasks than on clinical work. Meanwhile, underinvestment in training and development means that the full potential of many roles goes untapped.
These challenges are further compounded by leadership gaps. When leaders lack the tools, authority, or support to make meaningful change, inertia sets in. Local improvements are often lost in wider system fragmentation. Targets are chased without context. Performance is measured but not managed. And all the while, frontline staff are left carrying the consequences.
The result is a productivity paradox: a service with more people, more pressure, and more cost — but less tangible impact. If left unaddressed, this imbalance will continue to erode both morale and service quality. The NHS cannot afford to simply grow; it must evolve. That evolution begins with a renewed focus on performance, role clarity, resource optimisation, and leadership that has the capability and capacity to translate effort into outcomes.
In recent years, compassionate leadership has become a core part of NHS strategic language — and rightly so. Empathy, respect, and psychological safety are essential in high-pressure healthcare environments. Staff who feel heard and supported are more likely to stay, contribute, and thrive.
But compassionate leadership cannot exist in a vacuum. Without accountability, performance clarity, and effective decision-making, compassion risks becoming hollow. Leaders must move beyond reassurance and provide structure, direction, and measurable progress. The ability to connect emotionally must be matched with the ability to deliver operationally.
Supporting staff isn’t just about showing empathy. It’s about removing the obstacles that prevent them from doing their jobs well — whether it’s excessive administrative burden, unclear priorities, or ineffective rostering. Compassionate leadership is not about softening expectations. It’s about ensuring those expectations are realistic, clearly communicated, and properly supported.
The future of NHS leadership lies in the integration of emotional intelligence and operational strength. Leaders must be both supportive and strategic. They must listen deeply — and act decisively. They must care for their teams — and hold them to meaningful standards. One without the other creates imbalance. Too much control without care drives burnout. Too much compassion without structure leads to underperformance.
Effective leadership in today’s NHS means being visible, accountable, and focused. It means engaging staff in decision-making while maintaining a grip on delivery. It means being able to have hard conversations when needed — and following them up with action and support. Above all, it means making choices that prioritise both patient outcomes and staff sustainability, within constrained financial envelopes
Linea works alongside NHS organisations to embed compassionate, high-performing leadership. Our focus is not on theoretical models, but on practical change. We help leaders understand the conditions that drive both staff satisfaction and service improvement — and then support them to create environments where both can thrive.
Through strategic workforce planning, performance coaching, operational redesign, and culture transformation, we support NHS teams to move from intention to impact. Our approach is to ensure that compassion and accountability are not in competition, but in partnership.
The NHS cannot afford to rely on sentiment. It must build systems that work — and leaders who can lead. More staff without better leadership will not deliver the care patients need. Compassion without clarity will not retain the people the system depends on.
This is a pivotal moment. Leaders must be empowered — and expected — to act with both empathy and efficiency. They must support their teams emotionally while managing them effectively. They must push for better outcomes while protecting staff wellbeing. This isn’t about choosing between kindness and competence. It’s about demanding both.
The future of the NHS will not be secured by numbers alone. It will be secured by leadership that sees the full picture — the pressures, the people, the purpose — and rises to meet it with courage, clarity, and compassion.
Not just more empathy. More impact.
Which is where Linea can help.
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