NHS England’s December 2025 figures put the vacancy rate at 6.7% — down from highs that felt unmanageable a couple of years ago. 100,165 open roles. 22,559 in registered nursing specifically, sitting at a 5.2% nursing vacancy rate. There has definitely been an improvement.

But as many workforce managers will know, if you dig into where those vacancies sit, the picture isn’t quite that straightforward. The roles that remain hardest to fill — theatres, ICU, mental health, diagnostics, allied health — haven’t shifted proportionally. The headline number has improved partly because easier-to-fill roles have filled. The complex end of the market is still complex.

There’s a reasonable argument that what we’re seeing is a concentrating problem rather than a shrinking one. Overall vacancy volume is down, but the remaining gap is weighted towards specialties where candidate supply is genuinely constrained and where the cost of a vacancy — in service impact, agency cover, staff pressure — is highest.

At the same time, the wider UK labour market has softened. ONS data shows health and social work vacancies fell from 154,000 to 131,000 between 2024 and 2025. But lower vacancy numbers do not necessarily mean lower workforce need. In many cases, they may reflect tighter budgets, slower hiring activity, improved fill rates in less competitive roles, or organisations adapting services around persistent staffing shortages.

What it probably doesn’t reflect is a materially easier market for the specialties where hiring pressure has always been most acute.

The real challenge for NHS employers in 2026 may not be vacancy volume alone, but vacancy concentration. The market is no longer uniformly difficult — but the pressure has become more focused around the roles that are operationally hardest to replace and most critical to service delivery.

 

That matters because headline improvement can create the impression that workforce pressures are easing evenly across the system when, operationally, many organisations are still carrying significant risk in specialist services.

 

The workforce conversation is therefore shifting from “How many vacancies do we have?” to “Which vacancies matter most?” — and that is a much more complex problem to solve.