News analysis: Will short-term workforce thinking derail NHS plans?

According to the report – produced after a December meeting between the WRT, the Department of Health, strategic health authorities and trade unions – the cuts may threaten government plans to move large portions of healthcare out of the acute sector and into the community.
‘Nurse training and employment have been reduced too sharply in the light of uncertain skill-mix development and productivity gain,’ the review team concluded.

It was even more damning about the state of the midwifery workforce, saying there was ‘insufficient capacity to meet demand’ and calling for immediate improvement in both recruitment and retention.

These concerns will come as no surprise to nurses and midwives and their representative organisations, who have been warning the government of such concerns since training and job cuts started to take effect in 2006.

In its report, the WRT suggests that numbers of whole-time equivalent (WTE) nurses will plateau and then decrease slightly over the next four years.

Unions are worried this will mean there will not be enough nurses to meet demand.

Unison’s head of nursing Gail Adams said: 'I don’t think that will be enough, especially if you look at the age profile of the workforce and take into account the fact that we’re competing with an international shortfall in nursing, which means the nurses we do train are going to be like gold dust and other countries will be seeking to employ them.'

The predicted plateau in nurse numbers results from a range of factors – reduced commissions in pre-registration training, lack of employment for newly qualified nurses, a sharp reduction in international recruitment and an increase in numbers retiring.

It is evident that the decrease in pre-registration commissions has been significant. In 2006–2007 the number of nursing and midwifery commissions fell by 10.4%, from 23,650 to 21,200. In 2007–2008 they rose just 0.7% to 21,350, according to further information from the WRT.

As has been well documented, this was largely a knee-jerk response to financial pressures on the NHS. But it will almost certainly have a long-term effect on the profession.

‘If you reduce the number of commissions for a couple of years, then you lose the infrastructure and you lose the nurse educators and mentors so we don’t have the infrastructure there to train people,’ Ms Adams warned.

Another knee-jerk reaction was the decision to take band 5 and 6 nurses and midwives off the shortage occupation list, which fast-tracks visas for those being recruited from non-European countries.

Unions have always been against this move and have said that it is a cause of serious concern to trusts.

‘We campaigned against this at the time, and the evidence that is coming back to us now is that it is causing trusts real problems,’ said Nicola Power, RCN research and information officer.

Ms Adams agreed: ‘We’ve always argued that there was no evidence to support this and that, in fact, what we were looking at was an unstable period because of the financial pressure on trusts.’

The figures on nurse retirement should also be a wake-up call. According to DH data, the number of nurses who retired in 2004 was 3,814. The WRT predicts that by 2012 that figure will have more than doubled to 7,905. By 2016 it will have almost tripled to 9,560.

In the lead-up to the December summit, the WRT commissioned research from the University of Warwick on the quality of workforce planning. ‘In the main, the modelling and related forecasting of the demand for skills in the UK health sector is not very sophisticated,’ the research concluded, finding no examples of fully integrated models.

One of the challenges has been obtaining, accurate data about the workforce, for example on student attrition rates. ‘We’re never going to be able to have effective workforce planning if we’re haemorrhaging students through attrition,’ said Ms Adams.

‘You need stability in terms of the number you train in order to effectively workforce plan,’ she added.

The WRT report estimates the current nursing attrition rate at around 16% and midwifery attrition at around 18%. However, Martyn Dell, WRT workforce development manager, admitted that the data is patchy and that there are sometimes discrepancies in the way in which different universities collect and record the information.

Indeed Ms Adams believes the rate is higher than that outlined in the WRT document. Other concerns raised in the Warwick report are that the NHS is failing to plan for all staff groups simultaneously. ‘One area where planners have a big blind spot is the requirement of the independent sector,’ said Ms Power.

Nurse unions argue that it is crucial for the DH and SHA workforce planners, who all attended the meeting in December, to heed the advice of the WRT.

Barrie Brown, Unite lead officer for nursing, says that urgent action is needed.

‘The government and SHAs must respond to this,’ he said.

‘These are very big and vital issues in terms of the modernisation and development of the health service – including those specialist areas which will be needed to deliver what has been actually promised by the government.’

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