The NHS has dismissed a record number of staff for poor performance, signalling a tougher approach to competence and accountability as the health service faces mounting pressure to improve standards.
Figures reported for 2024–25 show around 7,000 NHS employees were dismissed, the highest number since records began in 2011. This marks a sharp rise from roughly 4,000 dismissals two years earlier and reflects a significant shift in how performance issues are handled across the health service.
Capability dismissals surge
More than half of the dismissals were recorded under “capability” grounds, which apply when staff are unable to meet the essential requirements of their role despite support and intervention.
Under NHS guidelines, capability procedures are used when performance falls consistently below expected standards and improvement has not been achieved through training, supervision or redeployment. Other dismissals during the period were linked to misconduct or redundancy.
The rise comes as the NHS grapples with record waiting lists, staffing shortages and public concern over service quality, prompting ministers to push for stricter management of performance.
New performance league tables
The increase in dismissals follows the introduction of a new performance framework by NHS England last September. The system uses a quarterly, league table-style ranking to assess how trusts are performing against key measures including patient outcomes, finances and operational efficiency.
High-performing trusts are being given greater autonomy over spending and decision-making, while lower-ranked organisations are expected to learn from the strongest performers and accept targeted support from national NHS teams.
Officials say the rankings are designed to drive improvement and make accountability more transparent across the system.
Ministerial warning on standards
Health secretary Wes Streeting has previously warned that senior NHS managers who consistently fail to meet required standards could lose their jobs.
Streeting has made improving NHS performance a central plank of the government’s health agenda, arguing that reform must go hand in hand with increased funding if waiting times are to fall and patient care is to improve.
His comments marked a clear break from what critics have described as a culture of tolerance towards underperformance in parts of the NHS.
Think tank backs tougher approach
Gareth Lyon, head of health and social care at Policy Exchange, said the figures showed the NHS was finally taking performance management more seriously.
He said the health service needed to “significantly up its game” by applying consistent standards and ensuring that staff who cannot meet core expectations are supported early or, where necessary, moved out of roles they are not suited to.
Lyon added that clearer accountability was essential if the NHS is to deliver better outcomes with limited resources.
Government response
A Department of Health and Social Care spokesperson said effective performance management was vital to protecting patients and supporting staff.
The spokesperson said early intervention, proper training and clear expectations can prevent many performance issues from escalating, but added that action must be taken when standards are not met.
The department said the aim is not punitive but to ensure the NHS has the right people in the right roles as it works to recover services and rebuild public confidence.
