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Nurse shortages put future plans for primary, community and mental health care at risk

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Concerns have been raised over the ambitions of the new NHS Long Term Plan, with analysts highlighting an “ongoing deterioration” in workforce numbers in critical areas such as primary and community care, nursing and mental health.

Their research, published today, also highlighted that applications and acceptances onto nursing degrees in England have fallen in recent years, and the number of students starting nursing degree courses in the country in 2018 had also dropped to its lowest level since 2013.

“Providing more care outside of hospitals is central to the NHS Long Term Plan but the health service faces an uphill struggle”

Anita Charlesworth

Moving care out of hospitals and closer to people’s homes has been promised as a continued priority in the long-term plan, but new analysis by the Health Foundation think-tank reveals that there are “worrying trends” in the workforce needed to support this.

The report highlighted that NHS staff numbers are failing to keep pace with demand. It noted that the number of nurses and health visitors working in community health services has continued to decline, falling by 540 whole-time equivalent (WTE) staff in July 2018, compared to a year before.

The long-term plan also sets out ambitions to improve mental health care, yet the report shows that numbers in mental health nursing have increased by less than half a percent (170 WTE), while psychiatrists have seen the smallest percentage increase at 0.6% amongst doctors.

For learning disabilities, another priority area earmarked in the long-term plan, there was a fall in nurses of 3.7% (120 WTE) over the same period, according to the report – titled A Critical Moment: NHS Staffing, Trends, Retention and Attrition.

Overall, the report noted that the number of overall NHS staff saw a “modest” increase of 1.8% (18,570 WTE) against a backdrop of more than 100,000 vacancies reported by trusts in England.

According to the research, nursing numbers grew by 0.5% (1,300 WTE) and there are now over 41,000 vacancies- more than one in 10 nursing posts.

The report echo similar warnings made recently in a report from the National Audit Office and in evidence given by health policy experts to a high profile committee of MPs. 

As revealed last week, applications to study nursing in England have increased slightly from last year but are still down 30% since student bursaries were scrapped, latest figures reveal.

But the report noted that 2018 was the second year in a row that applications and acceptances onto nursing degrees in England had fallen. The foundation claimed that this was “almost certainly” impacted by the changes to the nursing bursary, though combined with a dip in the population of 18-year old as well.

The number of students from England starting nursing degree courses in 2018 also dropped to its lowest level (20,250) since 2013, a fall of 8.1% since 2016- the last year when new nursing students were eligible for NHS bursary funding.

“We urgently need a coherent strategy that involves government health departments, the Home Office, regulators and employers”

Anita Charlesworth

Though this contrasted with the increases last year in new nursing students in Wales (5.5%) and Scotland (4.4%), which both reached all-time highs, the report added.

The report also noted that staff retention has worsened since 2011-12, with work life balance increasingly reported as a factor for people leaving the NHS. It was found that the issue of retention was most stark in community trusts where on average, one in five staff left their role over the course of 2017/18.

Recruitment from within the EU has also fallen significantly, the report noted. The Health Foundation have warned that there remains no ‘joined-up’ policy approach to international recruitment and added that the government’s approach to immigration risks further undermining the efforts to fill the gaps by exacerbating shortages of certain key health professionals.

For doctors, while the number of those who are hospital-based continued to grow, the number of GPs has fallen by 1.6% (450 FTE) over the year in September 2018, which the Health Foundation noted was moving further away from the government’s pledge to find 5,000 extra GPs by 2020.

Anita Charlesworth

Anita Charlesworth

Anita Charlesworth

Anita Charlesworth, director of research and economics at the Health Foundation, said: “Providing more care outside of hospitals is central to the NHS Long Term Plan but the health service faces an uphill struggle.

“If it can’t recruit and retain more health care professionals in primary, mental health and community care, this will continue to be an unrealised aspiration,” she said.

Ms Charlesworth added: “There is unfortunately no sign that the long-term downward trend for key staff groups, most notably GPs, will be reversed.”

She highlighted that much “hinges” on the separate workforce implementation plan, which is due to be published later this year with details on how staffing ambitions in the long-term plan will be realised.

“But to bring an end to chronic workforce shortages for good, action must go beyond specific policy measures and address the underlying major fault lines in the current approach, particularly the lack of alignment between staffing and funding, and the damaging impact of wider government policy,” she noted.

In terms of international recruitment, Ms Charlesworth said that, despite it remaining “vital”, it was being “constrained by migration policies and the uncertainties of Brexit”.

“We urgently need a coherent strategy that involves government health departments, the Home Office, regulators and employers, and which is embedded in overall national health workforce planning,” she warned.

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