Poor workforce planning has long been the Achilles heel of the NHS in England. The UK spends close to the European average on health, at almost 10 per cent of GDP, but we have fewer doctors and nurses per head of population than comparable countries.
Over recent years the number of doctors working in the NHS has increased rapidly. There were 20 per cent more full time equivalent consultants in the NHS in 2016 than in 2010. But the number of nurses has not kept pace—increasing by just 1 per cent over the same six years. When you factor in population growth, this does not bode well for the future of the health service. When you factor in Brexit, the picture looks even more grave.
While money worries have dogged the NHS in recent years, staff shortages are fast overtaking money as the main concern of NHS leaders (though of course the two are linked). Last week saw the publication of data suggesting a significant increase in the number of vacancies across the NHS. The vital signs for the NHS workforce are not good and nurse staffing in particular looks to be flashing for urgent and significant attention.
The NHS is short of around 30,000 nurses, and 49 per cent of NHS nurses say they don’t think there are enough staff for them to do their job properly. This matters for individual patient care but also the overall efficiency of the NHS. The Health Foundation’s research found a clear association between consultant productivity and nurse numbers. It’s an obvious point but health care is delivered by a team. Rapidly increasing doctor numbers without ensuring that there is a full complement of the whole patient care team is a classic, if depressing, example of defeat snatched from the jaws of victory.
Around one in 10 nursing posts was vacant in 2016—double the number in 2012. Based on current training plans and trends in staff leaving the service, the NHS will still be short of 16,000 nurses in 2021.
In the past, England has relied on international recruitment as a “get out of jail free card” to avoid the consequences of these workforce policy failures. But the outlook for international recruitment means that the government may have run out of cards. Nurse workforce shortages are not a uniquely British phenomenon—the global demand for nurses is rising but the supply of trained nurses is struggling to keep up. Still, our problems look particularly acute.
"The NHS will still be short of 16,000 nurses in 2021"In England alone, 22,000 NHS nurses come from the EU—that’s around 7 per cent of the workforce. Since the EU referendum many are leaving and the number arriving has plummeted. Brexit didn’t create the NHS staffing crisis but it risks making a difficult situation much worse. Figures from the Nursing and Midwifery Council (NMC) show that just 46 EU nurses registered to be eligible to work in the UK this April, compared with an average of almost one thousand per month in the first half of 2016. This is not a gradual decline but rather a striking post-referendum drop.
One option to remedy this would be to continue international recruitment, but aim beyond the EU. Over recent months recruitment from non-EU countries has gone up but not nearly enough to compensate for the decline in EU staff.
Nursing in the UK has become relatively less attractive financially for overseas staff. Pay for a typical ward nurse has risen by less than inflation for seven years. The cost of living is increasing as inflation re-emerges in the UK and the sharp fall in the pound since the referendum means that the value of earning in the UK when sent abroad has fallen. For the same reasons, working abroad is increasingly more attractive for UK nurses.
The fundamental problem the government needs to address is that the UK trains far fewer nurses per head of population than comparable OECD countries. That will have to change. The system of funding nurse training has changed this year from training bursaries to the standard student loan scheme for university degrees. The aim of this policy is to expand nurse training places which have been capped, meaning that large numbers of applicants were turned away each year. The number of applicants has dropped by over a fifth but that still leaves more applicants than places. But whether it will lead to an expansion of places is uncertain, because the issue of how additional clinical placements—a core part of nurse training—are to be funded has yet to be resolved.
It is clear that to secure the NHS the government needs to make nursing workforce issues a priority. To do that it needs a proper workforce strategy that addresses training, pay, career structures, recruitment and retention together. And importantly, this strategy needs to be supported by specific funding.
