Poor working conditions, including inadequate staffing levels affecting the quality of care, are motivating more nurses and midwives to leave the register than join it for the first time in recent history, according to figures released by the Nursing and Midwifery Council today.
Although recent media coverage has focused on the impact of Brexit and the falling numbers of European Union nurses joining the register, the regulator has today published figures that show it is mainly UK nurses and midwives leaving the register.
“We hope our data will provide evidence to support government and employers to look in detail at how they can reverse this trend”
Between 2016 and 2017, 20% more people left the register than joined it. This is the first time this has happened in recent history and has caused the register to shrink.
Since 2013, the size of the NMC’s register has been growing steadily every year. But as of March 2017 there were 690,773 nurses and midwives on the register – a drop from the 692,556 in March 2016.
In a survey conducted by the NMC last month about the reasons for leaving, which had over 4,500 responses from nurses and midwives who had left the register during the previous 12 months, 44% said it was due to working conditions (including issues such as staffing levels).
Meanwhile, 28% said it was down to a change in personal circumstances (such as ill health or caring responsibilities), and 27% said they had left due to disillusionment with the quality of care provided to patients.
Other reasons given included poor pay – 16% of respondents stated this was in their top three reasons – and 26% said it was due to difficulty in meeting the revalidation requirements, often because they were not able to practise for the required number of hours.
The difference between joiners and leavers is most pronounced for UK nurses and midwives. This group makes up around 85% of the NMC’s register. Between 2016 and 2017, 45% more UK registrants left the register than joined it.
“These figures are the starkest warning yet that nurses have put up with too much for too long”
Jackie Smith, NMC chief executive and registrar, said: “At a time of increased pressure on the healthcare workforce to deliver quality patient care, we hope our data will provide evidence to support government and employers to look in detail at how they can reverse this trend.”
The data also shows that the numbers of nurses and midwives leaving the register before retirement age is increasing. Excluding those who retire, the average age of the rest of those leaving the register has reduced steadily over time from an average of 55 years old in 2013 to 51 years old in 2017.
The data shows that rates of leaving are increasing across all age groups below 60 years of age. This is particularly noticeable for those aged under 40.
One reason for those leaving the UK register could be to practise overseas because the regulator says it has seen an increase in the number of verification requests – by licensing authorities, which are often the equivalent of the NMC in different countries – made about UK registrants.
Verification requests are an important indicator of the numbers of nurses and midwives who have left or may intend to leave the UK to work in a different country.
“The government need a sustainable, long term approach to NHS staffing, starting with the long overdue pay rise for NHS workers”
Responding to the latest NMC figures, Janet Davies, chief executive and general secretary of the Royal College of Nursing, said: “These figures are the starkest warning yet that nurses have put up with too much for too long. Our members have had enough, and as a result the profession is shrinking.
“Patients are paying the price for the government’s failure to plan for the future and it looks set to get worse. With more people leaving than joining, the NHS will be further than ever from filling the 40,000 vacant nurse jobs in England alone.”
“The average nurse is £3,000 worse off in real-terms compared to 2010. The 1% cap means nursing staff can no longer afford to stay in the profession and scrapping student funding means people can no longer afford to join it,” she said.
“Just as worrying is the fact that these latest figures show more British nurses are moving to work abroad,” she added.
Figures released by the NMC earlier this year showed a small but significant increase in the numbers of EU nurses opting to leave the register.
A survey of 247 EU nurses who left the register over the past 12 months shows that 58% said they were leaving or had already left the UK, 32% said Brexit had encouraged them to consider working outside the UK, while a further 32% said unhappiness with working conditions had encouraged them to depart.
The overall reduction in nursing numbers is most noticeable in England as most registrants are based there but there is some evidence that the other UK countries are showing similar patterns.
The overall number of initial joiners – which includes UK, overseas and EU registrants – increased from 25,208 in the year 2012/13 to 30,638 in 2015/16. This then dropped to 29,025 in the year 2016/17.
The numbers of UK registrants leaving has increased from 19,819 in 2012-13 to 29,434 in 2016-17.
The data released today covers the period between April 2012 and March 2017. Data for the first quarter of 2017 (April to June) will be released next month, although the regulator says it expects this to show a continued decline in overall numbers on the register.
“The Conservative government’s approach to workforce management in the NHS has been catastrophic”
Labour’s shadow health secretary, Jonathan Ashworth, said the reduction in the number of nurses on the NMC’s register should be a “badge of shame” for the government.
”The Conservative government’s approach to workforce management in the NHS has been catastrophic,” he said. “Their neglect of the NHS workforce, combined with the endless pay restraint, is driving people out of health professions.
“The government need a sustainable, long term approach to NHS staffing, starting with the long overdue pay rise for NHS workers which Labour argued for at the election,” he added.
A spokeswoman for the Department of Health said: “We are making sure we have the nurses we need to continue delivering world-class patient care – that’s why there are almost 13,100 more on our wards since May 2010 and 52,000 in training.
“We also know we need to retain our excellent nurses and last week we launched a national programme to ensure nurses have the support they need to continue their vital work,” she added.