Nurses and midwives are continuing to leave the profession at a greater rate than they are joining, highlighting “major” staffing challenges facing the health and care sectors, the Nursing and Midwifery Council has warned as it released new figures today.
Over the summer the NMC published data from March showing its register had shrunk in size for the first time in recent history – from 692,556 in 2016 down to 690,773 in March 2017.
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Nurses told the regulator at the time they were giving up their PIN mainly due to poor working conditions, including staffing levels.
Today’s data shows that the trend has continued. The number of nurses and midwives on the register was 691,416 in September 2016, but the figure is now down to 689,738 this September. This represents a loss of 1,678 registrants in the space of a year.
It is being caused by an increase in both the number of UK and European Union nurses leaving the register, in combination with a sharp drop in the number of EU nurses coming to work in the UK.
The first indication that the rate at which nurses from the EU were coming to the UK to work had dropped significantly was revealed in January.
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The NMC’s latest data, published in a report today, reveals countries that accounted for almost all EU nurse recruitment between 2012 and 2016 – Spain, Portugal, Poland, Romania, Italy and Ireland – have seen up to a 95% decline in nurses coming to the UK in the past year, echoing the previous reports.
“It’s worrying that we are seeing a continuing rise in nurses and midwives leaving the register”
Between 2012 and 2016, recruitment from Spain – which was the most popular country for sourcing EU staff – resulted in an average of 1,966 nurses joining the register each year. But between 2016 and 2017 this dropped to 104.
Overall, the number joining the register from the EU has decreased by 89%, from 10,178 last year to 1,107 this year.
However, the regulator highlighted the decline in the total number of nurses and midwives able to work in the UK was also down to the increase in those leaving the register.
Over the past few years there has been a gradual rise in the number of UK registrants departing the register annually – from 20,878 in 2013, to 26,653 last year and then 29,019 in 2017.
There has been a similar trend among EU staff, but the relative increase was far more pronounced in the past 12 months – from 2,435 leaving in 2016 to 4,067 this year.
Number of nurses and midwives leaving the register by country of initial registration
|Country||October 2015 to September 2016||October 2016 to September 2017|
|Rest of the world||2,090||2,277|
NMC chief executive and registrar Jackie Smith said it was concerning that there was so far no sign of recovery since the summer.
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“It’s worrying that we are seeing a continuing rise in nurses and midwives leaving the register, and our data is clear that this is being driven by both UK and EU registrants,” she said.
“These figures continue to highlight the major challenges faced by the UK’s health and care sectors around the recruitment and retention of staff,” said Ms Smith.
“Nurses and midwives work incredibly hard in very difficult circumstances. Those responsible for workforce matters will no doubt respond to what these trends are showing,” she added.
Employers and unions have described the figures published by the regulator as “alarming”.
“These alarming new figures from the NMC represent a double whammy for the NHS and patients”
The Royal College of Nursing noted there were already an estimated 40,000 vacancies for nurses in the NHS and said the government had failed to reassure EU nurses they were wanted in the UK in the wake of Brexit.
“These alarming new figures from the NMC represent a double whammy for the NHS and patients,” said Janet Davies, chief executive and general secretary of the RCN.
“Theresa May has left it far too late to send out the message that professionals working here are desperately needed, and that she will give them priority in the Brexit negotiations. It is no surprise that, for as long as the prime minister fails to do this, many feel they have no choice but to leave,” she added.
Unison head of health Sara Gorton said: “The latest drop in the number of nurses and midwives is more than worrying. Although the reduction in the number of UK nurses may not be huge, the overall figures will have a major impact on the NHS and patients.
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“This is because EU nurses are leaving en masse, creating a huge gap in the workforce. Brexit has left many feeling uncertain about their future in the UK,” she said. ”It’s vital for the NHS that the government now secures the right to stay for European nationals.
“At a time when the NHS is struggling to cope with a rising number of patients, the last thing the service needs is a chronic fall in the number of nurses and midwives,” said Ms Gorton.
“Staff retention is a huge issue. If more nurses continue to leave than join, staff-patient ratios will become even more dangerous. Ministers must address the recruitment crisis in the NHS now,” she added.
Unite’s head of health, Sarah Carpenter, said the figures further underlined the need for an increase in pay for NHS staff. The government has already stated that the long-standing 1% cap on salary rises is now “scrapped” but more details on pay are expected in the autumn budget on 22 November.
“NHS organisations are working hard to find ways to address staff concerns and to retain vital nurse skills”
Ms Carpenter said: “The disturbing NMC findings are further evidence, if more were needed, that the NHS needs a massive cash injection, with a large tranche earmarked for a generous pay rise for staff.”
NHS Employers chief executive Danny Mortimer said: “These figures show an alarming increase in the number of nurses and midwives from Europe leaving the register, which is even more concerning alongside a pronounced decline in the number joining the register.”
“NHS organisations are working hard to find ways to address staff concerns and to retain vital nurse skills, but they also need national support,” said Mr Mortimer, who is also co-convenor of the Cavendish Coalition – a group of health and social care organisations that has come together to ensure that the health and social care system can continue to meet its staffing needs following the UK’s withdrawal from the EU.
“Expansion of nurse training, revisions to language testing and improving access to affordable housing are welcome interventions to support staff retention, but investment is also needed in pay and training budgets, known as continuing professional development,” he added.
The Royal College of Midwives described the NMC’s latest report as “concerning”. Jon Skewes, RCM director for policy, employment relations and communications, said: “What is worrying for the RCM is the slow pace at which midwives are in fact joining the NMC register.
“Given the fact we remain 3,500 midwives short in England alone, the concern for the RCM is how we will ever narrow the gap on the current shortage of midwives,” he said.
Mr Skewes said years of pay restraint and staffing shortages in the midwifery profession had affected recruitment and retention.
He added: “The impact of Brexit and the uncertainty for midwives from other European countries is also evident in this report with a significant reduction in EU midwives joining the register clearly highlighted.”
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Health secretary Jeremy Hunt, speaking yesterday to MPs, noted that a major dip in the recruitment of nurses from other European Union countries “was to be expected” in light of the UK’s decision to leave the EU.
He stressed the importance of EU health professionals to the NHS and said that “we want to do everything we can to get them to stay”, but also highlighted recent announcements designed to boost numbers of clinical placements for student nurses and alternative routes into the profession.
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In its official response to the NMC figures, Mr Hunt’s department stated that EU nationals made up only 5% of the NMC’s register and claimed that the government’s recent announcement on placements would lead to an additional 5,170 pre-registration nurse degree training places from 2018.
A Department of Health spokeswoman said: “These figures represent a mere 0.2% decrease and there are in fact more nurses on our wards since last year.
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“We are fully committed to supporting hardworking NHS staff through helping them to balance work-life commitments and we are also ensuring the NHS has the staff it needs for the future through our 25% increase in nurse training places – the biggest in the history of the NHS,” she said.
Jonathan Ashworth, Labour’s shadow health secretary, claimed the new figures exposed the government’s “hollow promises” on nurse recruitment. “It’s staggering that numbers are falling when all the evidence shows we need more nurses in the NHS, not less,” he said.
“The truth is that the government has totally failed in its planning of the NHS workforce,” he said. “The disastrous pay cap has pushed staff to the brink and the end of bursaries has led to a fall in places on nursing degrees. Now Theresa May’s chaotic approach to Brexit is directly impacting staffing levels in the NHS.”
“With winter coming it is essential the NHS can get enough staff in place to deliver safe services for patients,” he said. ”The government needs to get a grip and come up with a sustainable long term plan for the NHS which deals with the staffing crisis and gives the NHS the funding it needs.”
Liberal Democrat health spokeswoman Judith Jolly said: “This is yet more evidence of a deeply worrying ‘Brexodus’ of EU nurses from the NHS. Our health service is already overstretched and understaffed, it cannot afford to lose this many nurses.
“It is not good enough for the government to say it is confident NHS staff from the EU will be able to stay,” she said. “Ministers must give a cast-iron guarantee that the European nurses and doctors who keep our health service afloat can stay here no matter what.”
Siva Anandaciva, chief analyst at the King’s Fund think-tank, said a ”new workforce strategy is desperately needed” and highlighted that having enough nurses was “essential for delivering safe care”.
“It is therefore deeply worrying that nurses are leaving the profession when the NHS is already struggling to fill vacant positions and the demand for care is rising,” he said.
“Our own analysis suggests that the number of NHS nurses and health visitors has fallen for the first time in four years, which will make it even harder for the health service to cope with the coming winter pressures, particularly given how stretched the system is already,” he warned.
“While the government’s recent commitment to increase nursing training places is welcome, training nurses takes many years and will not meet the short term needs of the NHS or its patients,” he added.