The dizzying scale of the nurse workforce crisis facing England has been laid bare by independent experts, who called on leaders to urgently boost the number of nurses in training through incentives to encourage students to enter the profession and support employers to take on apprentices.
In a hard-hitting report released today, the King’s Fund, Health Foundation and Nuffield Trust warned that NHS trusts in England could be short of up to 350,000 staff by 2030 if current trends around patient demand, training, recruitment and retention continued.
“In key areas such as nursing and general practice, we are potentially reaching a tipping point”
Ambitions set out in the new NHS 10-year plan, due in December, would be a mere “wish list” without a decent workforce strategy to support them, according to the three leading health think-tanks.
The document – called The health care workforce in England: Make or break? – noted that problems around workforce now posed a greater threat to the NHS than those around funding and cautioned that “one of the greatest challenges” sat with nursing.
It highlighted a series of well documented but startling figures that demonstrated the true scale of the problem:
- One in nursing eight posts in the NHS are now empty with 36,000 vacancies
- In 2016-17, 5,000 more nurses left the NHS than in 2011-12. Had the rate remained at 2012 levels through to 2017, there would have been 16,000 more nurses working in the NHS
- This includes a “worrying increase” in younger nurses quitting their jobs
- One in three nurses, midwives and health visitors are expected to retire in the next 10 years
- The removal of bursaries for nursing students in England contributed to an 18% drop in applicants between 2016 and 2017, which the report said was the biggest fall on record
- Between July 2017 and July 2018, 1,584 more EU nurses and health visitors left their roles in the NHS than joined it following Brexit
“The government cannot ignore this warning from leading independent experts”
The report highlighted the strain that staff shortages were piling on current nurses in the workforce. It said: “In key areas such as nursing and general practice, we are potentially reaching a tipping point whereby shortages make the working life of staff so difficult that this risks undermining efforts to remedy the crisis.”
Among factors listed in the document as contributing to the staff woes were the fragmentation of responsibility for staffing issues at a national level, poor workforce planning, cuts in funding for training places, and restrictive immigration policies exacerbated by Brexit.
The think-tanks warned that there was “no credible overarching strategy” currently in place to address these problems. They noted that central investment in education and training dropped from 5% of health spending in 2006-07 to 3% in 2018-19.
Prime minister Theresa May has promised an annual funding increase for the NHS of 3.4% over the next five years, resulting in an additional £20.5bn by 2023-24.
However, the authors of the new report said there was a “real risk” that this extra cash would go unspent, because there would not be enough staff to deliver the services.
“The warnings in this report are clear – there will be an impact on care if the number of vacancies continues to rise”
The report said the NHS 10-year plan needed to address the workforce issues both short-term through urgent measures such as boosting international recruitment and improving retention, and also long-term. It stressed the importance of increasing the number of people in training to become a nurse.
“The priority… should be to expand the number of student nurses and look beyond traditional routes to maximise the opportunities offered through alternative routes, such as apprenticeships, and under-represented groups,” the document said.
“Achieving the necessary level of expansion will require the government to review and improve the targeted incentives on offer, financial and otherwise, to students entering the profession, and to employers looking to become more directly involved in supporting education opportunities,” it added.
The health experts also echoed calls made this week in a report for the World Innovation Summit for Health to harness the full potential of nurses by enabling them to expand their skills.
The think-tank document said: “Rapidly changing patient needs, alongside medical and technological advances, will require all frontline staff to acquire new skills and adopt new ways of working over the next 10 years. But at present the NHS has struggled to make full use of the capabilities of its staff and new technologies, and progress is far, far too slow.
“For example, access to and effectiveness of primary and secondary care could be significantly improved through enhanced contributions from nurses and allied health professionals working in advanced roles as part of multidisciplinary teams alongside doctors and other staff,” it said. “This would also help to achieve better workload balance, with staff contributing at the optimum level of their skill set.”
An adequate workforce strategy would also need to include measures to fix inequalities in recruitment, pay and career progression in relation to gender and race, the document said. It noted that white nurses earnt 8.5% more than their Asian colleagues.
The NHS workforce issues could not be viewed in isolation from those facing social care as the two were “critically interdependent”, the report said.
Given the global shortages of health professionals, leaders should go so far as to plan for an “oversupply” of staff across health and social care to provide a future safety net, it added.
Leading nurse becomes patient safety charity patron
Source: Kate Stanworth
Commenting on the findings, Dame Donna Kinnair, acting chief executive and general secretary of the Royal College of Nursing, said: “The government cannot ignore this warning from leading independent experts.
“Long before we get to 2030, patient care is already being affected by the shortage of nurses – people waiting ever-longer for life-changing surgery or for a bed to become free,” she said.
“If next month’s NHS 10-year plan is to be genuinely forward-looking and more than a wish list, the nursing shortage must be addressed,” she added.
Dame Donna said funding for nurse higher education was “key” to tackling the crisis.
Sara Gorton, head of health at Unison, said: “This briefing reminds us all of the damage inflicted on the NHS by the repeated failure to plan, fund and support the health and care workforce.
sara gorton for index
“Instead of investing in staffing, ministers introduced restrictive immigration policies and cut training budgets, all of which end up costing the NHS more than necessary in the long term,” she said.
“Even potential solutions such as using apprenticeship routes to boost future nurse numbers are made unmanageable due to cumbersome government regulations and processes,” said Ms Gorton.
She added: “Despite the truly alarming turnover due to poor working conditions in the social care sector, workers continue to be ignored and exploited.
“If ministers are serious about securing the future of the NHS, they should invest in apprenticeships, identify the skills and training needed in social care and make professional development an option for all across health and social care,” she said.
Emma Broadbent, director of revalidation and registration at the Nursing and Midwifery Council, said: “The number of nursing and midwifery vacancies across the health service has been well documented and critically the demand for health and social care is rapidly increasing.
“The warnings in this report are clear – there will be an impact on care if the number of vacancies continues to rise,” she stated.
- One in 10 registered nurse posts vacant in NHS in England
- Number of nurses working in English NHS continues to fall
- Warning of possible 51,000 nurse shortfall in England after Brexit
“It’s encouraging to see that the number of nurses and midwives on our register from the UK and countries outside of the EU is increasing, and we look forward to welcoming the first qualified nursing associates in January,” she said.
“However, more needs to be done to retain the highly skilled workforce we have,” said Ms Broadbent. ”That means better investment in career development and training.
“It’s also critical that nurses and midwives are well prepared to care for people with increasingly complex health and care needs,” she said. “Our new standards of education will ensure nurses and midwives have the right skills and knowledge to provide better and safer care for their patients both now and in the future.”
She added: “We look forward to seeing the government’s ten year plan soon and we will continue to work with our partners across the health and care sector to support and develop the workforce.”
“This briefing clearly highlights the pressing challenges facing the NHS in relation to its workforce”
Danny Mortimer, chief executive of NHS Employers, said: “This briefing clearly highlights the pressing challenges facing the NHS in relation to its workforce.
“Employers are clear that there is much they need to do in their organisations to improve the experience of their people,” he said. “National action is also required: we must secure more flexibility with the use of the apprenticeship levy as well as re-instating funds to support CPD and workforce development.”
He added: “We will also continue to campaign, alongside our colleagues in the Cavendish Coalition, for a post-Brexit migration system that supports the recruitment of both highly trained health professionals and much needed and valued, lower wage roles in social care.”