Latest workforce figures seen by Nursing Times reveal a plunge in nurse numbers while doctors continue to increase, sparking claims that the NHS is becoming “over doctored” at the expense of nursing.
The figures have fuelled concerns about a serious nursing workforce shortage at a time when posts are also being cut, and renewed calls for the government to clarify its education and training plans.
The most recent internal NHS workforce analysis, distributed to a Department of Health advisory group and seen by Nursing Times, shows a net fall of 3,647 nurses between May 2010 and July this year. In the same period the number of doctors increased by 2,303.
The document is called the Core Brief and was prepared for the DH by the NHS Information Centre. It states that the increase in the medical workforce is “mainly due to doctors starting to take up foundation level 1 posts after coming out of medical school”.
The report suggests a growing trend developing since separate figures, published by the Information Centre in March, showed that last year nursing numbers fell for the first time in more than a decade. This initial decrease was small – a drop of just 650 compared to 2009.
However, the chief executive of one hospital trust told Nursing Times the decline was the beginning of a “serious workforce shortage”, which would lead to “problems ranging from moderate to severe” for the NHS.
Royal College of Nursing policy director Howard Catton told Nursing Times the difference was in part due to reductions in the number of nurse training posts, which began several years ago. However, he said trusts could also be spending less money on nurses because they were under pressure to employ too many trainee doctors.
He said: “Shouldn’t the increase be in nursing, given what we know about the aging population and increasing numbers of patients with long term conditions?
“Are we over-training doctors and now having to make cutbacks elsewhere? The question is whether we are over-doctoring the system,” he said.
Southampton University chair of health services research Peter Griffiths said decisions to commission fewer nurse trainees in recent years were likely to be proved wrong. He said they were based on “untested assumptions” about replacing nurses with healthcare assistants and demand for hospitals dropping.
He said the trends could reflect doctors’ stronger voice in workforce planning. “There is a sense there is a stronger power base arguing the case for protecting medical numbers and defining the need for doctors,” he said.
Professor Griffiths said there was also less pressure on trusts to employ all newly qualified nurses than doctors. He said: “There is an assumption nurses will flex to accommodate. With the medical workforce there is not quite the same view.”
Mr Catton added that the figures demonstrated why the government needed to quickly clarify its plans for changes to education and training planning and funding.
Under the plans, a new body Health Education England will be created to oversee a system of provider-led networks. Mr Catton said the organisation had the “chance to get to grips” with workforce numbers because it would bring together national planning for all professions.
But he said it was unclear whether it would have sufficient representation from non-medical professions. For example, he noted that the current doctors’ training body, Medical Education England, would form the basis for Health Education England.
Council of Deans of Health policy director Matthew Hamilton also said the contrasting trends in the nursing and medical workforce demonstrated the need to plan for all professions together, and for Health Education England to be strong.
He said for nursing there was currently “little of the national oversight that you get in relation to medical education and training and figures”. Currently Medical Education England works at a national level while nurse planning is done regionally.
Mr Hamilton said: “HEE will be effective if it has this oversight. It will be important for it to have some teeth otherwise who will be thinking about why, for example, the number of doctors are going up and nurses are going down?”