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Draft workforce strategy for NHS in England reveals increase in nurse turnover rates

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Almost 9% of the nurse workforce left the NHS in England in the past year following years of rising turnover rates, official analysis has revealed in a draft workforce strategy for the health service.

Today’s new plan, drawn up in draft form by Health Education England alongside other national bodies, shows that 8.7% of NHS nurses left the health service in 2016-17 for reasons other than retirement. The number has been rising steadily since 2012-13, when 7.3% of nurses left the NHS, according to the 10-year strategy proposals.

“We need to look at ways to tackle the number of vacancies and staff leaving the profession”

Ian Cumming

If the number leaving had remained at the same level as in 2012, there would be 16,000 more nurses in the NHS, indicated the draft strategy document – called Facing the Facts, Shaping the Future, A health and care workforce strategy for England to 2027.

Meanwhile, the turnover rate of nurses leaving NHS trusts to move to other parts of the health service, has increased from 12.3% in 2012-13 to 15% in 2016-17.

“This suggests that insufficient growth in supply, more retirements, and increased demand for staff are leading to greater competition between trusts for nurses,” said the draft strategy report.

The document said that, despite the fact there had been an overall increase in the number of nurses and midwives working in the NHS – of around 15,000 – between 2012 and 2017, the health service was still falling short of how many it needed.

In addition, the HEE analysis reiterated that the number of learning disability nurses decreased by 1,061 in the past five years, and the number of mental health nurses fell by 2,824 during the period.

The report also highlighted new analysis by regulator NHS Improvement which found that, as of September this year, there were 36,000 vacancies for nurses in England – of which 92% were covered by bank and agency staff.

The document does not include specific figures about the number of nurses required in the next 10 years, but it does estimate overall that the NHS will require 190,000 extra clinical posts by 2027 - if nothing is done to reduce demand through service changes or improved productivity.

The strategy outlined the steps being taken by HEE and other bodies, such as Public Health England, to tackle the problems among the nursing workforce, and for other professions too.

These include increased numbers of funded nurse training places in previous years and the government’s commitment to fund more clinical placements following the removal of student bursaries.

In addition, a new national recruitment campaign to attract more people into nurse training is underway, said the report.

HEE’s ongoing return to practice initiative, which provides former nurses with refresher training to go back to work, will also expand so that 1,000 people take part every year. Since it launched in 2014, 2,461 nurses have completed the programme.

Meanwhile, HEE will lead a new return to practice campaign specifically aimed at the 34,000 mental health clinicians that are not currently employed by the NHS.

Many nursing associates are also expected to go on to complete additional training to become registered nurses in the future, said the report.

It is estimated that 45,000 nursing associates will have qualified by 2027, with around 17,000 having completed the extra training to become a nurse, said the report.

The strategy is a draft document with a number of areas that will now be ”consulted upon widely” over the coming months and a final report will be produced next July to coincide with the NHS 70th anniversary.

The overall plan, the development of which was announced last month by health secretary Jeremy Hunt, will be the first comprehensive health and care workforce strategy in over 25 years.

The consultation on the draft strategy, which started today, finishes at 5pm on 23 March 2018. Specifically, it asks respondents to answer six questions on workforce issues and the proposals (see below).

NHS national director for quality Ian Cumming

Ian Cumming

Ian Cumming

Commenting on the new document, HEE chief executive Professor Ian Cumming said: “Continuing with a business as usual approach to workforce planning is no longer sustainable. There needs to be a major shift in the ways we plan in order to make sure we can meet the health needs of the country’s diverse and growing population in the future.

“The report tells us there are some areas of strength, 6,000 more staff working in primary care, the highest-ever number of people entering GP training in the history of the NHS.”

“However, increasing the workforce alone is not the only answer, we need to look at ways to tackle the number of vacancies and staff leaving the profession,” he added.

Responding to the draft strategy, Danny Mortimer, chief executive of NHS Employers, said: “Employers particularly welcome the commitment to a full and extensive consultation of this NHS workforce strategy.

“It is an important step to set out a clear national narrative which describes the impact of the plans to date regarding our workforce whilst recognising the vital work which is still to be done,” he said.

Janet Davies, chief executive and general secretary of the Royal College of Nursing, said: “The government has acknowledged that the workforce crisis is the single most important issue facing health and social care today, and we look forward to working with ministers to find properly funded solutions.

“Recruiting more nurses is paramount, and we are concerned about the higher cost of apprenticeships – a nursing degree is still the fastest and safest route into nursing,” said Ms Davies.

“Yet student numbers are not increasing – the government must invest in student funding and take responsibility for building a sustainable domestic supply of nurses,” she said. “The future NHS workforce should not be secured through personal debt.

Highlighting recent falls in central funding for trusts to spend on post-registration training, she added that patients deserved a “well-trained and innovative workforce”.

”The government must reverse cuts to vital continuing professional development funding to safeguard the future of health services through strong and effective nurse leadership,” she said.

Sara Gorton, chair of the NHS unions and Unison head of health, said: “Although the strategy is welcome, it needs more work to become the solid, comprehensive plan that unions have been pursuing for years.

“NHS strategy is currently shared between nine organisations,” she said. “All these bodies now need to work together with the unions to ensure the final document has a focused, realistic approach to staffing.

“The plans must have a stronger emphasis on work-life balance and making working conditions better for the million plus people who care for patients,” she added.

“We welcome the fact that workforce problems are at last being grasped”

Alex Bayliss

Alex Baylis, assistant director of policy at the King’s Fund think-tank, said: “The difficulty in recruiting and retaining staff is a huge challenge across the NHS, currently epitomised by a growing shortage of nurses and declining numbers of GPs.

“This is the result of a history of poor workforce planning and policies. To avoid history repeating itself, a complete overhaul of the system for planning future workforce needs is required,” he said. “This makes the new workforce strategy a crucial document that is long overdue.”

Mr Bayliss noted that the think-tank welcomed the fact that workforce problems were “at last being grasped” and also that they were to be “addressed jointly” by all the NHS national bodies, rather than just Health Education England.

He added: ”The draft strategy identifies many of the key issues, but it will require significant further thought and development, so we look forward to this happening over the consultation process. With this in mind, it is also good that this marks the start of a discussion.”

Consultation questions:

  • Do you support the six principles proposed to support better workforce planning; and in particular, aligning financial, policy, best practice and service planning in the future?
  • Do you feel measures to secure the staff the system needs for the future can be added to, extended or improved, if so how?
  • Do you have comments on how we ensure the system is effectively training, educating and investing in the new and current workforce?
  • What more can be done to ensure all staff, starting from the lowest paid, see a valid and attractive career in the NHS, with identifiable paths and multiple points of entry and choice?
  • Do you have any comments on how to better ensure opportunities to; and meets the needs and aspirations of; all communities in England?
  • What does being a modern, model employer mean to you and how can we ensure the NHS meets those ambitions?
  • Do you have any comments on how we can ensure that our NHS staff make the greatest possible difference to delivering excellent care for people in England?
  • What policy options could most effectively address the current and future challenges for the adult social care workforce?
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