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'Desire to save money' caused NHS nurse shortage, says damning report

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Government advisors have recommended that ministers keep nursing on the immigration shortage occupation list, in a move likely to help trusts recruit overseas nurses from outside of Europe.

The Migration Advisory Committee warned that the UK was in the grip of a national shortage of nurses and it recommended “reluctantly” that the profession be retained on the list, while delivering a scathing attack on NHS workforce planning.

“We have reluctantly made this recommendation”

David Metcalf

In a report published today, it said adding nursing to the shortage list would meet an expected demand by NHS trusts for non-EU nurse immigration of 11,000 by 2020.

The independent committee suggested the annual number be capped at 3,000 to 5,000 a year, with the limit reducing gradually over the next three years.

Nurses were placed on the shortage occupation list on a temporary basis by home secretary Theresa May in October, pending the outcome of today’s review of the evidence and subsequent advice.

It followed increasing concerns raised by nursing directors and unions about the health service’s ability to recruit staff from outside of the European Economic Area – comprising the EU and much of Scandinavia.

In its report, the committee said it was “sensible” to allow health sector employers continued access to the shortage occupation list due to “the lack of another short term solution”.

Department of Health evidence to the committee suggested it will be another three years before there are enough UK-born nurses to meet demand, it noted.

Committee chair Professor Sir David Metcalf said: We have reluctantly made this recommendation.”

There was presumption by the NHS and government that non-EU nurses provided the NHS with a “get out of jail free card”, he said.

But he added: “There is no good reason why the supply of nurses cannot be sourced domestically. The long-term solution to addressing this shortage is recruiting and retaining staff by providing sufficient incentive and opportunity.”

The committee went on to strongly criticise workforce planning, claiming the nationwide shortage of nurses had been driven by a desire to save money.

“The Department of Health needs to get its act together”

David Metcalf

It blamed the Department of Health, Health Education England and NHS trusts for not recognising obvious warning signs over a number of years and highlighted that similar financially driven decisions were being made again.

It said HEE would have commissioned 3,000 extra nurse training places for 2016-17, but financial cuts following November’s spending review meant it commissioned only 331 extra places – a tenth of what was needed.

“The Department of Health needs to get its act together. Almost all of the reasons why there is a shortage should have been anticipated by the DH and other related health bodies,” Sir David told Nursing Times’ sister title Health Service Journal.

In its conclusion, the report said: “It is clear to us that the current shortage of nurses is largely of the health, care and independent sectors’ own making.

sir david metcalf

sir david metcalf

David Metcalf

“The sectors failed to train enough nurses or failed to make provision to train their own nurses should the supply of publicly funded nurses fail. They have taken either no or insufficient account of the needs of other sectors when making their planning assumptions,” it said.

“They restricted pay growth. They have complex institutional structures, which blur the decision making process and lead, amongst other things, to poor information and data making it difficult for them (and us) to understand and respond meaningfully to labour shortages,” said the report.

It added: “They did not learn the lessons from the late 1990s-early 2000s when a similar shortage (and reliance on foreign nurses) occurred.

“Almost all of these issues relate to, and are caused by, a desire to save money. But this is a choice, not a fixed fact,” it said. “The government could invest more resource if it wanted to.”

The committee said it was “self-evident” that a cut of 4,800 in nurse training places between 2009-10 and 2012-13 was a “significant contributing factor” in the current shortage, with no corresponding fall in demand.

Gail Adams

Gail Adams

Gail Adams

Unison head of nursing Gail Adams said: “The NHS is still desperately short of nurses, so hospital trusts across the country will have breathed a collective sigh of relief at the news that they are to be allowed to continue recruiting staff from overseas.”

Professor Dame Donna Kinnair, director of nursing, policy and practice at the Royal College of Nursing, said: “This is a positive and forward-thinking recommendation that will benefit patients, staff and the health service. It also lays bare the short term decisions and failure to plan for the long term which have led to this position.”

Danny Mortimer, chief executive of the NHS Employers organisation, said: “We are delighted with the recommendation to retain nurses on the shortage occupation list.

Donna Kinnair

Dame Donna Kinnair

Donna Kinnair

“Demand for skilled overseas staff will continue whilst domestic supply increases and this decision will be welcomed by all providers of health and care,” he said. “We await with interest the full response from the Home Office.”

However, Mr Mortimer added that suggesting the NHS was underpaying international recruits relative to their domestic counterparts, as a matter of policy, “misunderstands the way in which previous service in the NHS is recognised by employers”.

Professor Martin Green, chief executive of Care England, said: “We… strongly agree with their recommendation to keep nurses on the shortage occupation list.”

He added: “The Migration Advisory Committee acknowledge that the Department of Health and Health Education England have not effectively undertaken workforce planning across the independent care sector resulting in a shortage of nurses in care homes and most recently highlighted for adults with learning disabilities.”

More findings from the MAC report

  • Non-EU nurses were found to be paid £6,000 less than equivalent UK workers. After unsocial hours pay was included the difference remained £3,000-4,000
  • The overall vacancy rate for nurses in England is 9.4% – almost double the NICE recommended level. In London some trust vacancy rates were 17%
  • Median pay for nurses is £31,500, which is £7,500 below the median pay in other graduate occupations
  • Nurse turnover has increased from 7.8% in 2008-09 to 9.3% in 2014-15
  • Current predictions by HEE that supply will meet demand by 2019 do not factor in the needs of the care sector
  • NHS trusts are failing to use existing flexibility in Agenda for Change to increase pay to attract and retain nurses
  • To maintain real terms pay value, the median wage for nurses needed to increase by 16% between 2010 and 2015
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