One in 11 workers in England will be NHS employees by 2036-37 if Rishi Sunak’s staffing plan for the health service goes ahead, new research by the Institute for Fiscal Studies (IFS) shows. The planned massive expansion of the NHS workforce also means that it would employ almost half (49%) of all public sector staff by then, the thinktank estimates. That compares with the 38% who did so in 2021-22. The NHS across the UK as a whole is already one of the world’s largest employers with about 1.5 million personnel. It has the fifth biggest workforce after the US Department of Defense (2.9 million), the People’s Liberation Army in China (2.3 million), the US supermarket group Walmart (2.2 million) and the McDonald’s fast-food chain (1.9 million). The long-term workforce plan that NHS England published in June envisages the number of health service staff growing significantly every year from 2027 until it reaches between 2.2 million and 2.3 million in 2036-37. That involves huge increases in the number of domestic doctors, nurses and other staff. The IFS’s research appears in its forthcoming Green Budget 2023, which was funded by the Nuffield Foundation. Max Warner, a research economist at the IFS and co-author of the research, said: “Our analysis suggests that if the NHS long-term workforce plan is achieved, one in 11 workers in England will work for the NHS in 2036-37, up from one in 17 (6%) in 2021-22. This is a striking number: it means that the NHS could employ almost 10% of all workers in England in the not-too-distant future.” The plan was drawn up in response to widespread concern that serious staff shortages have left the NHS in England struggling to provide timely and high-quality care, including in ambulance response times, A&E units, GP appointments and diagnostic services. However, the IFS warns that future governments will face tough choices about public spending, including the possibility of having to raise the basic rate of income tax by up to 6p over time, in order to give the NHS the money it needs to hire and pay the huge expected number of new personnel and extra drugs and equipment they will use. Delivering the plan will require the NHS’s budget to rise by an average of 3.6% every year until 2037, increasing it by £50bn by that year, the IFS estimates. That 3.6% was the average annual budget uplift every year from its creation in 1948 to 2009-10. “That [3.6%] is by no means outlandish by historical standards, but would nonetheless require difficult fiscal decisions in the current climate of sluggish growth,” said Warner. Hiba Sameen, the lead economist at the Health Foundation, said a much higher proportion of graduates would have to start working for the NHS if the plan is to work. “Our recent analysis found that the proportion of first-year higher education students in England training to be NHS clinical professionals would need to increase by 50%, from one in nine first-year students in 2022-23 to one in six in 2031-32,” she said. A Department of Health and Social Care spokesperson said: “As well as doubling medical school places and almost doubling the number of adult nurses and midwives in training, it [the plan] sets out how we will deliver long-term productivity improvements in the NHS workforce. “We will train new types of staff to free up doctors’ and nurses’ time so they can spend more time caring for patients, remove regulatory barriers facing healthcare professionals, and train doctors to work in more flexible ways.”