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.”