Experts have warned of a “growing gap” between government plans to increase the size of the NHS workforce in England and the reality of falling numbers of nurses and doctors, while criticising workforce planning for being “not fit for purpose”.
In a report by the Health Foundation think-tank published today, workforce experts noted that the number of nurses working in the NHS had fallen in the past year – mostly due to a decline in the number of community and mental health nursing staff employed by the health service.
This echoed similar findings from a recent report by fellow think-tank the King’s Fund that described a “worrying” trend since April of falling numbers of nurses in the NHS – a drop of around 700 in the space of a year.
Meanwhile, today’s Health Foundation report – titled Rising pressure: the NHS workforce challenge – highlighted that applications to nursing courses had also fallen following the removal of bursaries – by 23% in England this year.
It also noted that official clearing figures collected in September had shown around 1,200 fewer new student nurses were due to start at university this year compared with 2016, which meant the number of trainees had returned to levels last seen in 2015.
Nursing has traditionally attracted a large number of applicants from older students. This year there are around 10% fewer people aged 20 and over starting a nursing degree, added the report.
Meanwhile, new degree-level nurse apprenticeships, due to start this autumn, have been largely delayed, noted the think-tank.
The report authors blamed the drop in the number of trainee nurses this year on the government’s poor implementation of student funding reforms and “even poorer” communication by its departments.
“Most critically, the arrangements for funding clinical placements, so that higher education institutions could expand places, were finalised too late in the process,” they said.
“This year has been characterised by a series of one-off announcements and initiatives”
The Health Foundation also said that, despite recent plans by the NHS to reduce turnover of nurses, its analysis of the proportion of staff staying at their NHS trust in a year suggested a “worsening picture”. At some trusts the number of all NHS staff leaving in a year was around 30%, it warned.
In addition, it said that while the government had set ambitious targets to increase the mental health workforce – 19,000 additional members of staff by 2020 – there had been limited information about budgets or how roles would work alongside existing workers.
“Never has it been more important to manage training, recruitment and retention well,” stated the report.
But although it had been recognised at a national level that more nurse training places, fewer student drop-outs and reduced staff turnover were needed, the analysts said there was a “substantial disconnect between headline statements and actual policy implementation”.
They also pointed to a “lack of overall national policy coherence across the funding–staffing connection”, noting Health Education England’s annual workforce plan for 2017-18 has still not been published, despite being due in April.
The HEE plan should include the number of specialist nurse training places that have been funded this year – such as those for health visiting and district nursing.
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The think-tank called for an effective, co-ordinated workforce policy for the NHS, instead of the government’s recent “isolated and often reactive responses” to staffing concerns.
Anita Charlesworth, director of research and economics at the Health Foundation, said: “There is a growing gap between rhetoric about the government’s ambitions to grow the NHS workforce, and the reality of falling numbers of nurses and GPs.”
“This year has been characterised by a series of one-off announcements and initiatives, beset by unrealistic timescales and no overall strategy,” she said.
“The challenges and risks ahead for the NHS are well known, and must be met by collective action, led by the government to put in place a coherent strategy to provide a sustainable workforce for the NHS,” she added.
“Never has it been more important to manage training, recruitment and retention well”
Responding to today’s report, the Royal College of Nursing reiterated its previous concerns about the “deeply worrying” drop in the number of nurses this year.
“The reduction in students begs the question of how the promised expansion in nurse numbers in the future can be achieved,” said RCN chief executive and general secretary Janet Davies.
“It is shocking to learn that some parts of the NHS are losing almost a third of their entire staff every year,” she added, noting the extra money trusts were spending on recruitment could be used for patient care.
Jonathan Ashworth, Labour’s shadow health secretary, said: “This latest warning is the culmination of an incompetent strategy, which has left our health service with a shortage of 40,000 nurses, 3,500 midwives and 10,000 GPs.
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“For years the Tories have taken NHS staff for granted and asked them to do more for less, resulting in a recruitment and retention crisis which threatens patient care on a daily basis,” he said.
A spokeswoman for the Department of Health said: “Patients can be assured that the NHS has the staff it needs to provide the best possible care – over 12,700 more doctors, 10,600 more nurses on our wards and over 5,600 fewer managers and senior managers since May 2010.
“We have a clear plan to ensure the NHS remains a rewarding and attractive place to work, including more flexible working for nurses and greater safeguards for junior doctors, alongside an historic 25% increase in undergraduate medical school and nurse training places,” she said.
A Treasury spokesman added: “We have already confirmed that the across-the-board 1% public sector pay policy will no longer apply. The independent pay review process is now underway for NHS staff and will report in spring 2018.”
Rob Smith, director of workforce planning and intelligence at Health Education England, said he acknowledged the “important issues flagged” in the report.
However, he suggested HEE’s record was positive, citing that adult nurse commissions increased by 15% over the four years that it was responsible for those nurses, who will have only graduated this year.
He also highlighted that the body had secured 3,596 nurses on return to practice programmes and had created the new nursing associate role, which already had 2,000 people training and providing care to patients.
“Of course challenges remain and we are working with NHS partners to reduce turnover and improve retention in the existing workforce,” he said.