Restrictions on nurses’ pay and lack of progress on safe staffing policy both pose a serious risk to the quality of care in the NHS in England, suggests a new report.
The analysis of nursing workforce trends published by the Health Foundation paints a bleak picture of nurse staffing issues now and into the future, including the fact England could face a worst case scenario shortfall of 42,000 nurses by 2020, according to official data.
“Poor workforce planning is one of the key risks facing the NHS”
Last month, a House of Lords committee concluded a lack of workforce planning was one of the biggest threats to the future of the NHS.
The foundation’s In Short Supply report maintains that nurse numbers and staffing standards, together with pay policy, are “two of the most important issues” in the workforce policy debate.
“These pose both immediate and long-term risks to the ability of the NHS to sustain high quality care,” it stated.
The report, which pulls together existing information and research, raises concerns about safe staffing levels and warns that ongoing restrictions on nursing pay, and the impact of Brexit on recruitment, could make shortages even worse.
It also highlights “limited progress” made in England on national policy and guidance when it comes to safe staffing.
“Given the pressure on numbers, ensuring that nurses are deployed well to support safe and efficient delivery of care is vital,” said the report.
“There has not been a sustained direction for national policy on safe staffing and there has been limited progress in England on any national advice or guidance on how to determine safe staffing,” it added.
“Ensuring that nurses are deployed well to support safe and efficient delivery of care is vital”
Health Foundation report
It highlighted an apparent conflict between the need for local flexibility on staffing and “very specific ‘top-down’ requirements on agency use”.
Meanwhile, draft staffing guidance for England is less specific and standardised than approaches being put in place in other parts of the UK, like Scotland, and may look “weak” in comparison, said the report.
If England wants an approach that gives organisations flexibility in making nurse staffing decisions then it must be backed with the right support to avoid another “major quality failure linked to inadequate staffing”, it said.
The NHS will need to ensure nursing managers have the skills and resources to be able to analyse, implement and monitor “what is safe”.
The report also highlighted a need for “much more rapid progress” on identifying what works when it comes to safe staffing tools and use of data.
On the topic of pay, the report said “the time is right” to look again at nurses’ wages, flagging up NHS Pay Review Body calculations that suggest pay for nurses at band 5 and above will have been cut by 12% in real terms over the decade from 2010-11 to 2020-21. Pay restraint is set to continue until at least 2020.
“However, the time is right to assess the options on how best to determine the total reward package for NHS staff and decide if the current system continues to be fit for purpose, if it requires some alteration or if it is time for substantial change,” said the report.
“The NHS needs a pay policy that will enable it to recruit, retain and engage the workforce it needs to succeed,” it noted.
The 2016 NHS staff survey showed almost half of nurses were worried there are not enough staff at their organisation to allow them to do their job properly.
Failure to address issues like pay risk making existing staffing shortages worse, said the report, which quotes Health Education England data that suggests that, under the most pessimistic scenario, the shortfall of adult nurses could reach 38,000 by 2020.
For all types of nurses that figure could be 42,000 by 2020, the HEE data suggests.
These figures echo a Department of Health modelling exercises that came to light in leaked documents forecasting a worst case scenario shortage of nurses in health care of between 26,000 and 42,000 by 2025-26 if the flow of nurses from European Union and non-EU countries stops.
Overall, the Health Foundation report calls for a more co-ordinated approach to workforce planning, including pay, and argues that the lack of a coherent workforce strategy is “one of the Achilles heels of the NHS”.
Anita Charlesworth, director of research and economics at the foundation, said: “Poor workforce planning is one of the key risks facing the NHS. We are still not training enough nurses, doing too little to stop nurses leaving, and there seems to be no plan for pay policy following almost a decade of pay restraint.
“On top of this, the impact of Brexit means that international recruitment – the health service’s usual get out of jail free card for staff shortages – is at risk,” she said.
“Half of nurses don’t feel staffing levels are safe,” she said. “The stress this places on nurses is causing many to leave the health service, making it even harder to provide safe staffing levels and driving a vicious cycle which can’t be escaped with more quick fixes or short-term solutions.
“Whatever the outcome of the election, the new government will have to finally get a grip of workforce planning in the health service,” she added.
The report stated that current “piecemeal policymaking” – however well-intentioned – “is not serving the NHS well”.
“The NHS will not be able to move forward to deliver sustained efficiency improvements and transform services without a serious examination of its approach to pay and the way it plans and uses its nursing workforce across the system,” it added.
It stressed that “proper workforce planning” meant looking across different staff groups and “not focusing purely on the numbers of consultants or nurses separately”.
NHS England recently set out its plans for boosting and securing numbers of registered nurses including a new fast-track Nurse First training scheme, contracts to enable more flexible working, and a nurse retention collaborative to support 30 trusts with the highest nursing staff turnover.