One of the biggest challenges facing the NHS is its human capital. The NHS is the country’s biggest employer but it is also beset by chronic skills shortages. The NHS is increasingly understaffed, with 100,000 vacancies adding to the pressure the health service faces. Frontline care is being affected by a shortage of clinicians, with waiting lists growing because NHS trusts are simply unable to treat patients in a timely way.

Workforce planning has never been one of the strengths of the NHS, and the Interim People Plan, published earlier this month by NHS, is simply the latest attempt to focus on recruitment and retention. But there are a number of factors beyond the control of the health service which make this challenge so difficult to overcome at this point in the history of the NHS.

An ageing population: Britain is getting older. This is well-known, but the implications for the workforce are not so widely appreciated. Put simply, there aren’t enough younger people available to replace those about to retire. The current shortfall of 40,000 nurses owes much to high numbers who have retired or gone part-time ahead of retirement. A decision to end nursing bursaries for trainees has not helped. Similarly, more than 1,000 GPs retired last year, exacerbating shortages. A survey by the University of Warwick suggests that 40 per cent of GPs intend to quit within five years.

Brexit: There is no escaping the impact of the UK’s decision to leave the European Union. For many years, the NHS and social care have relied heavily on healthcare professionals from overseas, and from the EU in particular. Now, EU staff are leaving in their thousands and far fewer Europeans are willing to take their chances in Britain, at least until some of the uncertainty surrounding Brexit is lifted. In the meantime, NHS trusts and local authorities are struggling to fill vacancies. Shortages are particularly acute in areas where the cost of living is highest, such as London and the Home Counties.

Global competition: Even before Brexit, the UK was facing stiff competition for skilled staff in a global market. The landscape has changed since the days when the NHS could summon Commonwealth doctors and nurses. Rising living standards and increasingly sophisticated public health systems in the Middle East, Africa, Asia and the Americas have fuelled demand for healthcare professionals at every level. Young clinicians in developing countries are being offered opportunities to develop their careers at home instead of travelling halfway around the world for work. If they chose to move abroad, competition for their services is intense. The NHS is no longer in pole position.

Ethical international recruitment: The King’s Fund think tank says the NHS needs to ‘ethically recruit’ 5,000 nurses a year from overseas simply to meet demand. This means abiding by rules put in place by the World Health Organization, mainly to protect developing countries facing critical shortages of health workers.  Currently, more than 150 countries are the WHO list. Britain’s best hope for international recruitment is that this list will evolve over time to reflect changing circumstances. Already, both China and the Philippines have asked for their own local dynamics to be taken into account to allow the ethical recruitment of some staff.

The NHS skills shortage is here and now, and is having a significant impact on patient care. It cannot be solved through any single measure and will take many years to address, even if there was a consensus on the best approach. What is clear is that ambitious long-term plans and strategic reviews will flounder unless the NHS has the clinicians it needs to care for patients.

Martin Barrow is former health editor of The Times and a long-term senior Salix associate