NHS could cut 6,500 nurse jobs as recession bites

1 September 2009 | By Dave West

The number of nurses in England will be cut by more than 6,500 in the next three years, according to one of the first estimates of how the recession will affect jobs in the NHS.

Nursing Times calculated the figure based on foundation trust hospitals’ plans. But experts say expected cuts in investment mean the actual reduction is likely to be much larger.

The Royal College of Nurses said the figure was “deeply worrying” because of the potential impact on quality of care.

Foundation trusts, which account for about half of hospital trusts, are planning on average a 2.17 per cent cut in nurses between 2009-10 and 2011-12. The figures were in plans submitted to their regulator and sent to all FTs last month.

If similar cuts were applied to the 303,315 nurses employed by all acute and mental health NHS trusts in 2008 it would mean 6,590 fewer nurses overall.

The total number of NHS nurses has increased every year in the past decade except in 2006, when the NHS faced huge financial problems and there was a drop of about 6,700.

The estimate for non-clinical staff is a 3 per cent reduction in the next three years – which equates to about 12,800 posts.

RCN head of policy development Howard Catton, responding to the estimate for nursing numbers, said: “What we are looking at is deeply worrying because we know of the direct relationship between nurse staffing levels and the quality of care.

“We know that taking out nurse numbers just to achieve savings or balance the books is highly likely to have an immediate and detrimental impact on patient care.”

Reductions of the size estimated would not mean widespread redundancies because of numbers leaving the profession each year. But they will lead to more recruitment freezes and the bigger funding cuts predicted by finance experts for the following years could mean more redundancies.

As well as considering overall cuts in nurses, trusts may replace specialist nurses with general.

There will be pressure on trusts reducing numbers to be sure the cuts will not affect patient safety and care, particularly in light of the scandal at Mid Staffordshire foundation trust, where nurses were cut to save money.

Mr Catton said: “If these sorts of calculations are being made it is absolutely critical there needs to be, alongside the robust economic plans, a robust and detailed impact assessment about what it will do to patient care.”

Some of the expected reduction may be due to plans to reduce numbers of patients in hospitals in favour of services in the community. More nurses may be needed in the community and fewer in hospitals.

However, unions say this should be achieved through retraining rather than cuts in hospital nurses. There is concern hospital staff will be cut with no new capacity elsewhere.

Professor James Buchan, a health workforce expert at Queen Margaret University College, said: “We will need to be assured there is some sort of overarching plan so if FTs are assuming that [new community services] is happening, the other stakeholders are making sure it is.”

Recruitment freezes will make it difficult for newly trained nurses to get the jobs they want.

Professor Buchan said more may change careers, fail to progress through nursing or move to other countries. This is a problem because more nurses will be needed in the future.

He said: “Job cutting may balance the books but is building up quality and workforce problems for the long term.”

Predictions of large staff cuts will increase pressure on unions in negotiations on pay from April 2011.

One acute foundation chief executive said: “We will be saying we think some element of a pay freeze will help mitigate the worst effects in reductions of employment.”

York University professor of health economics Alan Maynard said staff reductions of the size estimated would achieve nowhere near the cost cuts needed in coming years and pay cuts would be likely too.

He said: “I can see little alternative to pay cuts of 5-10 per cent with careful protection of the low paid.”

UNISON head of nursing Gail Adams said in a statement: “The NHS has an ageing workforce. This leads to significant losses of staff each year. But if we are to keep quality patient care, it is vital that these staff are replaced.

“The next few years will be challenging for the NHS. Although it is protected under this year’s spending plans, with budget cuts looming across the public sector, this protection could come to an end.

“My fear is that staff losses highlighted by Monitor could be an underestimation, and patient care will suffer.”

In response to Nursing Times’ calculations, a Department of Health spokeswoman said: “The NHS is in a very healthy position regarding recruitment and retention, with supply broadly matching demand in most areas.

“Local NHS organisations are best placed to plan and develop the workforce to deliver the right staff with the right skills. Providers and commissioners will need to develop their workforce plans as part of their finance and service planning to ensure that the workforce best meet the needs of their local populations and takes account of future demand.

“Benchmarking is all about driving up productivity. The NHS has undergone rapid expansion in the last 10 years, and has now moved into a more stable period. It is therefore important that we utilise our existing staff more effectively, using innovation to drive up quality of care and productivity.”

Readers' comments (16)

Anonymous | 2-Sep-2009 8:18 am
in the trust i work for, from October on we are not allowed to use agency staff any more it is putting pressure already on the team i work with as we are trying to comply with this aready, but in some cases it would mean in emergency situation, i.e some one goes of sick last minute or no one can be found to replace that the staff, manily qualified, as in most cases has to stay on, which wooould mean workin like it nearly happend to me the other night 24 hour shift, after having done a long day but luckily an agency, which was agreed by management came in. wiht job cuts this could happen more ofter and sickness rate increased due to this.
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Paul Ayrton | 2-Sep-2009 8:27 am
This news flies directly in the face of the previous edition's "compassion in nursing" article. When I did my training and for a good many of my years as a staff nurse, this was all just part of the job, and it was soul-destroying to watch values shift due to the consumer-driven implementation of "targets". I'm ashamed of my nursing background, and now advise anyone thinking of joining the profession to think twice. Then reconsider. Then think even longer. Then forget it, because there won't be a job for them after qualification.
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Anonymous | 2-Sep-2009 1:41 pm
From a health & safety point of view, by working 24 hours you are contravening health and safety rules and should anything happen (as is very likely due to tiredness) the trust woiuld be liable for this, therefore it would ultimately cost much more money in real terms by paying out compensation. Working these length of times usually results in mis administration of medication and you should refuse to work ( for the sakes of the patients) ass the consequences of working could be much worse!
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Anonymous | 2-Sep-2009 3:51 pm
Why, oh why is it always nursing numbers that are scrutinized when cuts are having to be made? Why not take a really good look at the staggeringly, top heavy management tiers within the NHS? Cutting some of these inane, totally worthless administration posts would financially make more sense; managers earn far more than nurses! And what about the duplication of all management posts within Primary Care -by getting rid of a whole layer of managers in every PCT it would save the NHS a fortune! These administrators only make a mockery of 'patient-focused' care or 'death with dignity' or 'compassion in nursing' by their inept, money wasting decisions that only ever impact negatively on both patients and staff. Cut their jobs and it's a win/win situation - save money and lose pointless people whose only function is to attend meetings! Genius!!!!!!

However, if the NHS is looking to cut clinical nursing jobs, after nearly 35 years in nursing I could be persuaded to go for a very favourable redundancy package....

.....and then return working for more money back-filling the post left vacant by my redundancy!!!! Don't laugh, it will happen that way - my experience tells me so!!!
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SANDRA KENNY | 2-Sep-2009 4:01 pm
The following statement is an extract from the above article made by a Department of Health spokeswoman:
“The NHS is in a very healthy position regarding recruitment and retention, with supply broadly matching demand in most areas. Local NHS organisations are best placed to plan and develop the workforce to deliver the right staff with the right skills. Providers and commissioners will need to develop their workforce plans as part of their finance and service planning to ensure that the workforce best meet the needs of their local populations and takes account of future demand."
“Benchmarking is all about driving up productivity. The NHS has undergone rapid expansion in the last 10 years, and has now moved into a more stable period. It is therefore important that we utilise our existing staff more effectively, using innovation to drive up quality of care and productivity.”

Could someone please translate this statement into English for me please?
I've tried to understand what it actually means - but it seems to go all around the houses and eventually doesn't say anything at all really! This individual is clearly from another planet and knows nothing about the NHS at all!!!
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Anonymous | 2-Sep-2009 7:54 pm
Most of my team have stated to me in the last few months, if this goes on I will be off work with stress, the 'this' being a shortage of staff to carry out the role of care co-ordination for clients with a serious mental illness. The Government and senior staff keep telling us we need to do more, now it seems as if there will be even fewer nursing staff to carry out this role. When will staff stand up and say a enough is enough, we need to start flagging up the risk to clients and the others of the current staffing levels. I, like others would not encourage anyone to start a career as in the NHS, we are no longer valued, we are constantly told to increase our work load, we are given the blame for any problem that arises, the situation which led to the problem never being addressed.
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Pat Huxtable | 3-Sep-2009 8:23 am
I've recently had to retire from nursing, qualified back in '74. I just wonder when oh when is anything within the NHS ever going to stand still so people can breathe and take note of what's happening to what used to be the wonderful profession of nursing. When I read through comments above, I note the number who are anonymous, that tells a story. Whilst I was in the NHS, there were so many colleagues who felt so much frustration around their work, were continually tired out and that much used word stressed! but most were frightened to say anything because they felt that they'd be told, You don't want your job, there are plenty more waiting for one! As one anon writer commented upon the ridiculous levels of management, yes and what the whatsit do they all do all day? Sit far away from where the action is! God forbid that they should see any of that! They do paperwork exercises and stare at computer screens to find ways of coming up with meeting Government targets, (the main things that have completely eroded the good will of many many employees). How on earth people in management and I used that word advisably cannot see that what they're doing escapes me! Management are a breed a part they're so far up their own importances that they forget that there are human beings somewhere far away from them who are sick to death of being managed by people with very little care or understanding of the frustrations in today's nursing world. How about a Lemming drive for them, Beachy Head is high enough and broad enough!
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Anonymous | 3-Sep-2009 9:29 am
here we go again! it's like a merry go round of farce the NHS....get rid of thousands and a few years later a recruitment drive to set thousands on.

When will govts learn that all the NHS requires is stability not re-engineering on a constant basis. As an organisation it is appallingly dictated from whitehall. Once one govt dictates new policy it is replaced by another with it's new 'vision' of the NHS!
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Lenny Allen | 3-Sep-2009 9:50 am
Listening to the radio this morning the health secretary stated that there is a further 11% budget being issued to the NHS and it is up to local trusts to decide where they are putting this money; he denied any cuts are to be made!!!

I understand the anger and frustration of everyone who is forced into working short handed or have a team which is obviously too small to fullfil the role required, but I think that the auther of "Anonymous 2-Sep-2009 - 3.51pm" is wrong in his/her attack of other workers within NHS hospitals. I would be safe to say this person is most likely to be a trade union member, it is not right to recommend other people lose their jobs to save another group. We should be sticking together to ensure everyone's jobs are safe and secure.
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kathleen white | 4-Sep-2009 0:18 am
Lenny Allen appears to misunderstand what "anonymous 2-Sept-09, 3.51" is saying. The author is not attacking other "workers". The incompetent, corrupt,so called managers that s/he is referring to, are not workers. They are box-ticking experts,fixated on designing policies that even they themselves do not adhere to. A drain on the healthcare services that they know very little about. It is difficult for them to understand healthcare, particularly when not understanding is more beneficial to their promotion and pension. I know that there are some good managers out there, but sadly they are in the minority. Anonymous is making the point because the article being commented on is "cuts to nurse jobs". I have yet to see a headline recommending the same ratio of cuts to managers posts.
The real concern is that shortage of experienced nurses results in poor patient care. Nurses who are couragous enough to report such concerns, are routinely subjected to bullying & harassment by so called managers who don't like having their mismanagement/incompetence questioned. A nurse who raises valid concerns about NHS healthcare can wave goodbye to career prospects,unless they want to move to the private sector or go abroad.
We should be sticking together to provide good healthcare, and not "to make sure everyone's jobs are safe and secure". We need the correct quality & quantity of staff.
A word of advice Lenny- Don't believe everything you hear on the radio,don't believe what the health secretary says and above all don't believe that local trust managers will put the extra 11% where it is needed, unless of course you think that new office furniture,an army of secretaries,and more documents with boxes for ticking are needed.
Kathleen White
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Anonymous | 5-Sep-2009 6:06 pm
''Some of the expected reduction may be due to plans to reduce numbers of patients in hospitals in favour of services in the community. More nurses may be needed in the community and fewer in hospitals.''

What a load of rubbish. Where I work, the patients will never go back into the community. It's just too dangerous. Are they saying this will work for the likes of Broodmoor and Ashworth as well?!
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Anonymous | 8-Sep-2009 8:37 am
The trust I work for is now trying to introduce a compressed working week to save money and staff, the proposal is that we work 291/2 hours one week and 511/2 hrs second week .What ever happened to flexible working hours and what impact will this have on the worklife/balance ,are nurses not allowed a social life as this is not going to be put into practice for the rest of the so called trust.Also what about the detrimental effect on patient care when staff go off sick because of stress and exhaustion, of having to deal with trying to find cover?
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Anonymous | 8-Sep-2009 7:52 pm
After the Baby P debacle you would have thought trusts would be trying to employ more health visitors and social workers but no our pct has got a job freeze on!! I forsee a large number of people being off with stress very soon and also some health professionals will decide they have a better quality of life on the dole. We need more nurses etc. not less especially as it has recently been reported that the population as a whole is the highest ever.
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Anonymous | 9-Sep-2009 9:36 am
This is such an emotive area! But I would challenge the statment 'we need more nurses'. Sadly the governement initiative for more nurses resulted in 'bums on seats' in education facilities and the quality of many nurses was and is suspect. Recent experience as a carer of an elderly person horrified me. The attitude of the ward staff, their lack of respect and the total disregard of basic care and dignity (deliberately mixing sexes to clear a bay and make it easire for the night) was an insult to me as a human being and a nurse.

What we need is for nurses to take responsibility for their profession, to stop tolerating bad practice and to monitor and weed out the bad apples. More is not always best. I would prefer to be cared for by fewer, caring, well-motivated, well educated/trained nurses than by lots who are standing around doing nothing.

This is relevant for all NHS staff; clinical, clerical and managerial. It is time to get rid of the coasters, poor performers and dangerous at all levels to give us the lean, mean caring machine that every single one of us expects and deserves. At the same time we need to look at how we do things - this is how we always do it won't wash anymore. We have to be prepared to change but change for a reason not a target or new government dictat. We need to change for our sakes and the sake of our patients. Cahnge to make the patient experience a better, easier, slicker one.

Lets demand qaulity and not quantity as far as staffing is concerned.
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kathleen white | 11-Sep-2009 9:23 pm
"Anonymous 9-Sept-2009 9:36 am" clarifies the situation in 3 paragraphs. I, like many others have witnessed similar poor practice. The problem however is even more complex. Many so called managers support sub-standard nurses,probably because these nurses tick the boxes that keep incompetent managers happy.
Many nurses with high integrity who act as advocates for patients do not receive adequate support or recognition. In fact they are frequently subjected to bullying and harassment in an effort to drive them out of the profession where they are desperately needed.
I know this from experience. I raised valid concerns about breaches in child protection policy,dishonesty,dirty workplaces and worse. A heavy boot style response kicked in fast. I sat through meetings where senior managers (mainly nurses), HR advisors and union reps blatently lied in an effort to cover up their incompetence and corruption.Too many union reps are cosy in bed with management,instead of representing the members who pay their wages.
Not surprising therefore that the "coasters, poor performers and dangerous at all levels" described in the previous comment are thriving and multiplying. The current workplace culture allows this. It is being replicated UK wide,as described in CAUSE website.
www.suspension-nhs.org
Kathleen White
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Anonymous | 11-Mar-2010 10:21 am
Lenny Allen | 3-Sep-2009 9:50 am, I agree with "Anonymous 2-Sep-2009 - 3.51pm" . And what if she/he is a union rep. thankgod they exist.
I can't say I'd trust a governement head not to revise any plan he/she felt necessary, people can be placated very easily, stops a lot of fuss so they can carry on and plan their cuts where needed. The bottom line, the frontline staff you can't do without and these are the people delivering hands on care. There was uproar when HCSW took on more of the trained nurses role and we had to accept that. Similiary, a review of others role within NHS Trust may be required. Whilst it is not right to recommend other people lose their jobs to save another group.....when it comes down to the people in this country lying in hospital beds, they I'm sure you'd agree you don't want people to continue to suffer because of poor quality of frontline staff and because managment voiced their needs over people too ill to do so.
ThankGod for people like Julie Bailey.
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