Workforce problems are the most significant threat to delivering high quality care in the health service, NHS chief executives have warned, as they called for immediate action to tackle international recruitment concerns, including language testing for European nurses.
Two thirds of chairs and chief executives of NHS trusts said workforce concerns were the most pressing challenge for them, according to a survey by the NHS Providers organisation.
“[There has been a] fundamental failure at national level on workforce strategy”
The survey, which included half of all NHS mental health, community, ambulance and hospital trusts, also revealed 85% said it would be important to recruit from outside the UK in the next three years to deal with staffing shortages.
However, 38% said Brexit was expected to be a barrier to recruitment from the European Union over that period, and a third said regulatory requirements – including language testing for EU nurses – were also causing problems.
The NHS has one of the highest levels of reliance on overseas staff compared with countries with similar economies – 13% of nurses in the UK are from abroad, while the average is 6% among countries in the Organisation for Economic Co-operation and Development.
But the number of EU nurses coming to work in the UK has plummeted since 2016 – falling from 1,304 joining the register in July 2016, to 46 in April 2017.
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NHS Providers said that, while the media had linked this to the Brexit vote, trusts had said the introduction of language testing for EU nurses – brought in at the start of 2016 by the Nursing and Midwifery Council and fully taking effect by the summer – was “by far the largest contributing factor”.
As previously reported by Nursing Times, chief nurses have warned the International English Language Testing System (IELTS) exam was currently set at too high a level, meaning staff were taking months to pass or choosing to work elsewhere.
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Meanwhile, demand for NHS services was growing, said NHS Providers in its new report – titled There for us: a better future for the NHS workforce. Since 2013 emergency admissions had risen by 10% and diagnostic tests were up 19% – but the NHS workforce had only risen by 6%.
“The experience of 2017 has shown we cannot just assume an announced expansion of students will actually happen”
NHS Providers chief executive Chris Hopson accused the government of a “fundamental failure at national level on workforce strategy”. He also said the health service was “asking far too much of existing staff”.
Health service bosses had warned there were “no quick fixes” to improve the supply of UK-trained clinicians and, therefore, measures to ensure international recruitment could continue were needed in the short term, said Mr Hopson.
NHS Providers welcomed recent changes to language testing, which mean nurses from abroad can now be tested through an alternative English exam, but urged the NMC to continue its full review of testing “at pace”.
Meanwhile, the government must confirm the 60,000 EU staff working in the NHS have the right to remain in the country following Brexit, said NHS Providers, which is part of the NHS Confederation.
It must also devise a future immigration policy that allows to recruit staff from around the world, said the body, suggesting a collective international recruitment campaign should be set up instead of individual NHS trusts working on their own.
In addition, the organisation warned that the government must monitor and address any reduction in application rates to nursing courses or number of training places following the removal of bursaries.
The Department of Health and the NHS national bodies must work with trusts, universities and unions to ensure the announced 25% increase in student nurses in 2018 was delivered, it added.
“The experience of 2017 has shown we cannot just assume an announced expansion of students will actually happen,” said NHS Providers, referring to the late announcement of additional placement funding this year.
The “concerning” cuts to ongoing training budgets for nurses and other non-medical staff must also be reversed, following a 60% reduction by Health Education England in two years, it said.
“We recently announced the biggest ever expansion of training places for nurses”
Department of Health
The government’s plan to end its policy of pay restraint for NHS staff should also be delivered, with clear details about how it will be funded with extra money, rather than being paid for by existing NHS budgets, it added.
A Department of Health spokeswoman said the NHS had more nurses and doctors on wards now than in 2010, but acknowledged more staff were needed.
”That’s why we recently announced the biggest ever expansion of training places for doctors and nurses, as well as being clear that the future of EU nationals is a top priority in the Brexit negotiations and we want their valued contribution to the NHS to continue – to ensure the NHS has the staff it needs both now and in the future,” she said.