Record Number of NHS Staff, Including Keralites, Dismissed for Poor Performance: Key Reasons

LONDON Dec 27: Record numbers of NHS staff, including Keralites, have been dismissed under Health Secretary Wes Streeting’s new “zero tolerance” policy on incompetence. According to NHS data, nearly 7,000 staff were dismissed in 2024–25—almost double the figure from two years earlier, when around 4,000 staff were let go.

This is the highest number of dismissals since records began in 2011. More than half of those dismissed were removed on “capability” grounds, meaning they were deemed unable to perform their roles to the required standard.

Reports indicate that the 7,000 dismissals include scores of Malayalee nurses found to be incompetent or unfit to practise. Various offences led to suspensions or dismissals. In several cases, the Royal College of Nursing (RCN) panel concluded that a nurse’s “fitness to practise was impaired” based on the following examples:

Failure to safely administer a subcutaneous injection by applying excessive pressure, causing the needle to bend

Failure to remove all surgical clips from a patient’s wound

Dishonesty during recruitment, including falsely claiming to have two or more years of nursing experience when this was not the case

Deliberately misleading a prospective employer about meeting minimum experience requirements

Working shifts for one or more agencies while signed off as medically unfit and/or while receiving sick pay from a substantive NHS employer

Dishonestly working elsewhere while knowingly on sick leave (proved by admission)

Inappropriate communication with dementia patients, including the use of condescending or patronising language such as “Well done” and “Good girl”

Waving an insulin injection in front of a patient’s face and shouting, “I give, I give”

Demonstrated lack of competence, including failure to meet required standards of knowledge, skills, and judgment as a Band 4 nurse in areas such as: Moving and handling patients, Managing workload, Communication

Incompetent Medication assessment and administration

Not recognising and escalating deteriorating patients

Being charged with two counts of attempted murder and two counts of administering poison with intent to endanger life or cause grievous bodily harm

Engaging in sexually motivated communications with individuals believed to be children

Dishonesty in falsely claiming to be qualified to administer IV medication without having passed the required test

Convictions for the attempted murder of two children

The rise in dismissals follows warnings from Wes Streeting, who said NHS managers would themselves be fired if they failed to perform in newly introduced league tables, published for the first time in autumn 2024. In November 2024, he pledged a “zero tolerance” approach to poor performance, stating there would be “no more rewards for failure.”

Gareth Lyon, head of health and social care at the think tank Policy Exchange, told The Telegraph:
“People who can’t—or won’t—do their job should be sacked. The NHS needs to significantly up its game, and that will only happen with a more rigorous approach to performance management, including firing people not up to the job.”

NHS data show that 1.8 per cent of staff who left NHS jobs in 2024–25 were dismissed, up from 1.2 per cent a decade earlier. Replacing an NHS staff member costs an average of £6,500 per person, according to FOI requests analysed by the not-for-profit organisation Skills for Health.

Jon Freegard, director of consultancy and research at Skills for Health, described the sharp rise in dismissals as “regrettable” but supported the new policy, noting that it reflects months or even years of underperformance finally being addressed. He said more should be done to tackle incompetence and that, with proper support, some employees could improve.

“No one can argue against those who are not up to the job being dismissed,” Mr Freegard said. “But there’s an additional factor to consider: why are underperformers so costly to replace?”

Former health secretary Steve Barclay said there is a “deeply ingrained culture” within the NHS where complaints are viewed as problems rather than opportunities for improvement, alongside a reluctance to hold individuals accountable. He highlighted the “revolving door” of managers and clinicians who, despite failures, have continued working and placing patients at risk long after warning signs were evident.

Despite the rise, NHS dismissal rates remain low compared to the private sector. With around 1.5 million staff employed by the NHS, the 7,000 dismissals account for less than 0.5 per cent of the workforce in 2024–25. By contrast, average private-sector dismissal rates are estimated at between 2 and 3 per cent.

The figures come during a difficult year for the NHS, marked by junior doctors’ strikes earlier this month and hospitals under pressure from a severe flu outbreak. Strikers were warned that their absence could force patients to remain in hospital over Christmas due to staff shortages, but the strikes proceeded regardless.

Responding to the dismissal figures, a Department of Health and Social Care spokesperson said: “Performance management is essential in the NHS as we work to raise standards and ensure patients receive the care they deserve. Early intervention and proper support for staff can prevent performance issues arising in the first place. After years of damage, our 10-year health plan is ensuring staff have access to the training and resources they need to thrive and deliver outstanding care.”