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NHS facing potential nurse workforce crisis, study warns

A government-commissioned report has revealed the NHS could be crippled by a shortage of nearly 200,000 nurses in just three years’ time, Nursing Times has learnt.

The major study makes predictions on changes in healthcare demand and the supply of registered nursing staff in the NHS in England between 2011 and 2016.

The report, compiled by the Centre for Workforce Intelligence, is not yet in the public domain but has been submitted to the Department of Health and is understood to have been read by ministers.

In the worst case scenario, the gap between supply and demand will grow year-on-year, leading to an overall shortage of around 190,000 registered nurses by 2016, the report predicts.

Under this scenario, demand for registered nurses will rise from 600,000 staff in 2011 to 700,000 in 2016, but the supply of nurses will fall from around 570,000 to around 510,000 over the same period.

Nursing Times revealed last year that the number of nurse training places at universities had been slashed by 2,500 places – a drop of 12.7%.

Meanwhile, 57% of respondents to a Nursing Times survey earlier this month described their ward or unit as already sometimes or always “dangerously understaffed”.

The new report is aimed at informing workforce planning in the NHS to help meet future needs. It is also understood to project nursing workforce demand and supply beyond 2016 as far forward as 2030.

In the best case scenario, the report will suggest there could be enough nurses in 2016, but only if demand remains at 2011 levels – unlikely given current trends in patient acuity driven by the country’s ageing population.

Peter Sharp, chief executive of the Centre for Workforce Intelligence, told Nursing Times the worst case scenario figures did not necessarily mean there would be an actual staff “shortage”.

“It’s only a shortage if someone is willing to employ someone and can’t,” he said. “We can see there will be greater demand – how that demand is met is another question.”

He said the NHS needed to find new ways of re-engaging and motivating existing staff, pointing out 65% of the staff likely to be working in 2030 would already be working now.

In particular he highlighted how healthcare assistants were used (see opposite). “In the past the use of HCAs has frankly been poor; poor in training with little or no regulation, but just because that’s been the case it doesn’t mean it should always be that way.

“We have to find ways of improving the existing workforce with new and different ways of working to help meet the rising demand,” he said.

If there is a shortage, the NHS may need to recruit nurses from overseas, as it has done in the past.

But this will be more difficulty in the future given new, tougher immigration rules and the fact the UK has signed up to a World Health Organization commitment to be self-sufficient in securing its own healthcare workforce.

Howard Catton, director of policy at the Royal College of Nursing, said it was good to highlight the potential shortage of staff, noting also the Mid Staffordshire Foundation Trust public inquiry report published this month by Robert Francis QC.

“The Francis report has shone a spotlight on having the right numbers of nurses and the link between that and high quality care,” he said.

“There is absolutely a numbers issue and we need to see the supply line stabilised. We can’t afford to keep cutting the number of pre-registration training places. We also need to work much harder to keep people in the profession.”

Health Education England, along with Local Education and Training Boards (LETBs), will take on responsibility for the training and education of all healthcare professions from April.

A spokeswoman from HEE said there were limits to the predictions in the centre’s report, but it was a “contribution” to the debate on future staffing needs.

She added: “We will work with LETBs to produce robust workforce plans based upon the information they will have from local providers – as well as different forecasts of the future that various commentators have made – to ensure the NHS has staff in the right numbers, with the right skills and the right values and behaviours to meet the needs of patients.”

A Department of Health spokesperson said: “It is important that the NHS has the right staffing in to deliver high quality care to patients.

“The role of the Centre for Workforce Intelligence is to consider and  report on a wide range of scenarios based on a number of factors; including whether the education and training of health care professionals planned will meet future demand.”   

Readers' comments (75)

  • Chickens coming home to roost maybe?

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  • this is just what the tories want, they can then move more private companies in

    more profit for thier rich friends at the expense of the ill..well done cameron..

    we will cut the nhs not the deficit

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  • Anonymous | 19-Feb-2013 10:13 am

    Ok we all understand where you stand politacally

    Any thoughts about where the Tories rich friends are going to recruite nurses ?

    The point of the article is to highlight the potential lack of nurses ! If such a shortage occures it will affect all sectors of the health care economy !

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  • No s--t sherlock; we've known for a long time that the registered nurse population was going to decrease dramatically, partly due to a lot of middle aged nurses retiring, but those nurses are leaving earlier than planned because of what is happening to the pensions. Also nurses are really fed up and leaving to do something else. This country prefers to deal with crisis management rather than careful planning and looking after the staff they have. Its so crap!!

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  • Well said Jenny.

    Is there really any surprise in this? The working conditions, rubbish pay, decimated terms and conditions, constant attacks, criticism and blame,etc etc etc, has had a devastating effect on moral.

    So many current nurses are leaving the profession now or at the very least wish they could, fed up with the way they are treated and the conditions they have to put up with.

    The majority of nurses I personally speak to all say that if they had their time again they would never have entered in the first place.

    And how are they going to attract new recruits to the profession when they see all this? Low pay for a degree and a lot of sacrifice, awful working conditions, no real prospects (that is if they are lucky to actually find a job!)constant attacks, criticism and so on in the media, who would willingly choose that?

    And they wonder why there will be a staff shortage?

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  • wouldn't a little common sense and foresight have helped to predict this as well as the lack of provision of community services, care of the elderly and other vital public services? it seems all of these demographic problems have been known for a very long time by everybody else except the government who ignore the problems which affect the daily lives of British citizens and keep themselves far too occupied with more trivial priorities of their own.

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  • The debate is philosophical and political so the twain can not be separated. The response to the crisis is to cut nurse training places by 12%. The solution is to go for the cheap option usually sourcing of nurses from third world. This is now not guaranteed due to a racist immigration policy. Nurses can now go to other countries that guarantee them security and a friendly environment.

    Its important to reinforce that for those with money these things do not matter much as their wealth can cushion the rich. They may not all be Tories. Those who will suffer are the poor and marginalised groups.

    Training HCA is a must' For the task we need good education services. A happy workforce will deliver better care . The narratives about staff leaving show all is not well at the workfloor.

    To play games with people's health would be a major mistake. Clearly these issues need open and democratic debate which would try and generate some consensus.

    There is a democratic deficit in how things are now done in the UK and we should all be politial.

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  • Nursing is struggling now. The profession is failing to attract academically able young people

    The recruiting ground is now amongst people in their late twenties /thirties and in some cases even older.

    Many of these recruites enter uni via some kind of access scheme. Something like 20%+ fail to complete.

    Some site family pressures others cannot cope with the academic demands of the course. Many find themselves in financial difficulty or have problems with child care.

    Many problems have to be addressed before we can be assured of the professions future.

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  • Jenny, I agree but that is only the start of the problems.

    I think the start of the solutions is to offer nurses a starting pay that a) isn't an insult, b) recognises the degree plus level quals, skills, and training nurses have, (as well as the work we do), and c) is stable and not constantly under attack.

    That is how to begin, and I stress that word, to attract decent people.

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  • No surprise the shortage will get worse.
    More nurses retiring, some especially before pension changes take effect. It is a physically + mentally exhausting job. How many people in Parliament have fallen asleep during sessions, and that's nowhere near as physically exhausting (mentally, I'll fall asleep listening to all that babble) and that does not involve dealing with concerned patient's + relatives a lot of the time. If they fall asleep in the middle of the day, chances of they people 'look after' dying are also unlikely.
    Lower number of places to train nurses at universities. If in-house only training is great, then why is it hard for a lot of nurses to secure funding, training + development for courses, time off the ward for the programmes, protected time with their mentors to properly assess, develop and supervise training needs, and to meet concerns and areas for development.
    Also to meet the requirements and demands of enabling future nurses to have both excellent knowledge and practical skills, courses have both high theoretical and practical elements, incorporating university and hospital/community and other placements on degree-level programmes are now necessary; cannot just use workbooks or only focus on one or other side (ie no good if its purely hospital training). Why should students go through this very difficult nursing training, when they can find easily other degree programmes, probably similar effort and stress, can offer better rewards and working conditions when they qualify and take a lot less flak in their jobs.
    Less people would want to become nurses, due to all the negative publicity in the press, media and from existing nurses who find their working conditions extremely difficult and demoralising. Odd bits of good news is not enough to change this culture of attacking nurses.
    Caring and compassionate nurses will leave, due to the constant feelings of being battered and not listened to at work. More importantly, its people who create these policies for changes in the first place, are not listening and only promoting their own agendas, which is having this domino effect of poor care right through from strategic management to frontline delivery and allied support services.
    Cuts will affect public, private and voluntary sectors; private companies will also find it more difficult to poach nurses from public sector when the shortages gets worse.
    Much easier for skilled and experienced nurses to leave their jobs/roles to use their skills elsewhere locally or abroad, wherever their skills and attributes are valued and respected. Yes, its an employers market picking up which excellent nurse they want to hire and/or which poor nurse they want to fire. It doesn't help recruitment of excellent staff if there's less to choose from and doesn't help retention if staff want to leave to find better prospects elsewhere.
    Anyone given a choice of jobs, would take the one offering better remuneration packages, overall working conditions and environment where they are not subjected to any abuse from anyone.
    People will only realise what they've lost, when its too late and find that they need more good nurses. When people are ill, it doesn't matter if you're very rich or poor, you'll need help and staff to deliver it. But do people think about how we let the care services get into such a state when their fit and well, or only bring it up when it directly affects them and by then its late for changes to really help them.

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  • Susan Markham

    Anonymous | 19-Feb-2013 8:57 am

    "Chickens coming home to roost maybe?"

    Yes they are... and these chickens started as eggs in the mid 1980's.

    Nearly 30 years later we are reaping the product of what they sowed...

    Don't get me wrong... I don't believe that "Too Posh to Wash" crap or the idea that RNs don't need a degree.... These days they do....

    First off I have worked with a lot of UK degree nurses who do wash – and they are damn good nurses. I also have worked with a lot of HCAs who are also damn good nurses – And I am proud to say that I bullied five of them (who I managed) into eventually becoming bloody good compassionate RNs!

    Secondly.... I think that the education standards have dramatically dropped over the last four decades. When I started back in the 70's you had to have a minimum of four 0-levels to be considered to enter Registered Nurse training... alas that's the equivalent of a degree in today's employment market.

    It is not the fault of the youngsters coming up and thinking they want to be nurses... it is the fault of successive governments for dumbing down the levels of education.

    When Leon Brittain was the Minister for Education in the 1980's he did a press conference and one of the journalists asked him whether he saw the future of students as “low-tech” or “high-tech?” He replied “No-Tech!”.... His prophecy has come true!

    I look at the tests/modules/whatever the teenagers today have to complete to get GCSEs and I think.... “My Lord – this is what we had to do to complete the 11 Plus in the 1960's!”

    So.... Maybe... (and I am not saying I am correct) perhaps it might be right that only people who can currently pass a diploma or a degree should be considered for a Registered Nurse training course.

    AND.... here's where I am going to diverse from the apparent, current, logic.... I think that after the Newbies have done their degree (or diploma) they should be vetted (like we were in the old days) by a panel of learned people... in my day it was the Senior Tutor Of Nursing, The Director Of Nurse Education, The Area Nursing Officer, a Sister and a Charge Nurse... (in no particular order!)

    Seriously... in these days when 20-year olds cannot write English – let alone text it properly... when nurses are FaceBooking pictures of patients and then getting reported in the media...?

    We have a situation where the new 30 is actually the old 15....

    Just to elaborate on that – we have 30 year old nurses doing stuff that we would have thought as funny (40 years ago – and if we'd had the technology) at the age of 15 years old.

    I am hurtling towards 60 years old and I cannot understand this nonsense – either you want to be a Nurse or NOT? It is not a case of “I want to be an nursing administrator”....

    In 1974 I left school with eight O-levels and 3 A-levels (in Physics, Zoology and Botany.) I went to work at Preston Hall Hospital, Maidstone as a Health Care Aid/Nursing Assistant. In 1977 I started my RMN training at Oakwood Hospital, Maidstone. I then did my SRN training in 1980... I spent five years training in total. Eventually I went to work in France, Spain, Germany, Bermuda and then Canada.

    In each country I had to “re-certify” (apart from Germany and Bermuda) and it was an absolute joy to personally establish that the UK training was the best in the world.

    Yes – it sounds like a marvellous testimonial doesn't it.... Yeah it would have done if I hadn't have to leave so many relationships behind... My zest for new experiences and new horizons meant that I was rather reckless on the relationship front.

    It was my fault and I don't apologise for it. If you have a dream you have to follow it.

    To begin with where this message started....

    "Chickens coming home to roost maybe?"

    Ah well, not in my case I fear... I gave my soul to Nursing and shanked everything else... there's no little chickens coming home to my home – not even an elderly rooster.

    As I said before... I am glad that I won't be alive long enough to see the destruction of the NHS.

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  • in a nutshell, the impression I get from all of what is going on in health care in the UK at the moment is that nobody understands or appreciates (or even wishes or tries to familiarise themselves with) the job nurses do or the qualities, skills and qualifications required to meet the complex needs and ever increasing demands of patient care. The general perception, especially from government and the authorities, seems to be that there are huge numbers in employment which is very costly and they can be easily replaced by far less qualified labour, which is much cheaper, with possibly fewer qualified nurses just to supervise them, carry out some of the more specialised tasks and run the wards. They may possibly have woken up to the fact that unless they recruit people with the right qualities, train them to meet current health and labour market needs and employ more qualified nurses there will be a serious shortage which will be totally detrimental to patient care. If they do not retain those with more experience and specialist training then standards will drop, or is this not a matter of concern to them?

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  • I have recently had a career break due to my husband being very unwell, and i have been trying in the last 12 months to get a job back nursing, I still have my registration and having to pay the fee's whilst not earning. But my main concern is that eventually my registration will run out nad i will be unable to work. So i approached my local nhs hospital, the hospital i had worked at before my career break, the one i trained at, and unable to get a job through the normal channels i even offered to work for nothing just to get my foot back in the door. But nobody could and would help me get back to the career i love and am good at. What a waste of my talents and resources. Too much resources are put into recouting nurses from abroad and not enough effort is put into maintaining the work force we already have.

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  • What nurses and all health care personnel need is more open dialogue with everybody involved to discuss exactly what direction it is planned that nursing should take so that it is clear and transparent to all what is expected of them. Any change is better accepted, or decisions on what measures need to be taken to support or reject it, if people have a good understanding of their role and exactly where they stand so they can work effectively and plan their personal and professional futures. This is about particular groups of people and these people must be consulted and involved in every level of the decision making which concerns them. Without this it just results in a situation of preoccupation with the difficulties, uncertainty, doubt, frustration and even loss of self-esteem and despair impacting on people's health and their ability to focus on the care they deliver to their patients. It seems that the spirit of many caring and high calibre professionals, students and prospective nursing staff is unnecessarily, (and maybe even intentionally as an unethical and failed means of control), being totally broken and destroyed.

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  • Anonymous | 19-Feb-2013 5:07 pm

    my experiences have been somewhat similar and I do not think these are isolated cases.

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  • who, in their right mind, would want to be a nurse? all we get is criticism, we work our socks off for what - slagging off in the tabloids, whatever we do it is never enough. the money is rubbish, the hours are rubbish, the quality of care you can provide is rubbish because there are not enough staff and at the end of a 30 year career you get a thank you of 10 pounds per years service.

    the occasional thank you might be appreciated.

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  • tinkerbell

    despite all its problems OUR NHS was still a beautiful idea. It defined us as one of the most civilised societies on planet earth regardless of race, creed, colour or status and treated everyone the same without discrimination.

    So many governments have come and gone and interfered and destroyed what was OURS.

    It's almost over now and all the kings horses and all the kings men couldn't put humpty together again.

    We will miss it when it's gone as probably only the wealthy will be able to afford to be healthy.

    Perhaps one day the 'little people' will fight back and reclaim it.

    Nursing is being put on track on a road to nowhere. NHS nurses will probably be transferred to the private sector.

    The railways were privatised, gas and electricity were privatised and look what's happened there. No success story except for the profits to be made for the fat cats whilst fleecing the average working person.

    In the meantime would the last one to leave please turn out the lights?

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  • Really??
    The Centre for Workforce Intelligance....where have you been??
    This is old hat for world nursing stats as a whole.
    Look up on You Tube World Without Nurses.
    Nursing does not bring money in...It just costs government big time. And we all know unless we are money makers Goverments dont like us! And so untill nurses worldwide get it known that it is an ESSENTIAL PROFESSION AND WARRENTS RESPECT ....reports like this will keep going. Though sheesh...this ones a bit slow.

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  • Yvonne Bates | 19-Feb-2013 6:46 pm

    Hi Yvonne. Good to see a post from you. Hope things are going well in Oz. If you're still dipping in and out of NT online, you'll see how things are here!

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  • Susan Markham

    tinkerbell | 19-Feb-2013 6:32 pm

    Jeez... I am going out into the backyard now and slit my throat... NOT!

    If Britain now needs to see an example of what the NHS was set up for in 1948.... then it should look across the Pond to our cousins in Canada where health care/service is FREE at the point of use.

    For an example go to...

    and see where the Canadians have got it RIGHT and we have messed up

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