A “worrying” picture of nurse staffing levels has emerged, experts have warned, as the latest workforce figures for England reveal a sustained decline in the number of nurses in the NHS compared with the year before.
In April 2017, for the first time since 2013, there was a drop in in the number of nurses and heath visitors when looking at the same point 12 months earlier, according to new analysis of official NHS statistics.
“It is worrying that the number of nurses is going down at a time when services are already overstretched”
The analysis, published today by the King’s Fund think-tank, also highlighted that this trend continued in May and June 2017 – the most recent point for which data is available from NHS Digital.
While the number of nurses in the NHS normally fluctuates from month to month within a year – usually reaching a high point in the autumn when newly qualified staff begin employment and declining by the summer – this represents the first time since 2013 that there has been a year-on-year reduction.
As of June this year, there were 316,725 nurses and health visitors, which was 703 fewer than in June 2016, when there were 317,428.
Taking into account different hours worked by NHS nurses, this is equivalent to a drop in the number of full-time equivalent nurses, from 283,674 last June, to 282,603 this year.
There had previously been a growth in staffing following the 2013 report by Sir Robert Francis into care failings at the former Mid Staffordshire NHS Foundation Trust, which revealed a focus on financial savings over quality of care.
But in recent years this growth has slowed, with some predicting the end of the so-called “Francis effect”. Nursing Times also reported earlier this year on the first signs of the NHS health visitor workforce shrinking.
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Richard Murray, director of policy at the King’s Fund, who carried out the analysis, said the sustained decline occurring this year was partly due to the health service’s traditional “safety valve” of overseas recruitment becoming more difficult.
This was due to new language testing requirements for European Union nurses brought in last year, and also potentially the UK’s decision to leave the EU, he said in a blog post also published this morning.
“This analysis reinforces the need for mandated staffing levels and investment in nurse education”
This was also on top of a rise in the number of workers leaving the NHS due to burnout, he added. It was “no wonder nursing staff feel hard pressed”, he said, highlighting that the workforce was only 0.7% larger than it was in 2010, despite demand rising, including a 14% increase in emergency admissions.
He noted that, while the government’s decisions to remove bursaries this year was partly intended to increase the amount of trainees, in fact recent figures had shown fewer new student nurses had been placed at university so far.
The health secretary’s recent announcement of further clinical placement funding for next year “will hopefully turn this around but cannot do so quickly,” said Mr Murray, noting it took several years to train a nurse.
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“There is good evidence that having enough nurses is essential for delivering safe care, and so it is worrying that the number of nurses is going down at a time when services are already overstretched and the demand for care is rising,” said Mr Murray.
“This means the NHS is less equipped to cope with the demands of a winter that was already threatening to stretch the NHS to the limit,” he warned.
He claimed NHS workforce planning had been neglected “for too long” and that a strategy was “desperately needed.”
Royal College of Nursing chief executive and general secretary Janet Davies said the figures revealed a ”worrying decline”.
“When the NHS has never been busier, it is haemorrhaging experienced nurses at a faster rate than it can find new recruits,” said Ms Davies.
“A lethal cocktail of extreme pressure inside the NHS, a collapse in European nurses and falling pay levels left the profession demoralised and people heading for the door,” she said.
“Patient safety is always the first priority for trusts, but this becomes much more difficult when staff are placed under intolerable pressure”
“This analysis reinforces the need for mandated staffing levels and investment in nurse education. Health and care providers must give urgent assurances that services are safe for patients this winter,” she added.
Saffron Cordery, director of policy and strategy at NHS Providers, also said the reduction in nurses was “deeply worrying”.
“It comes as demand for care continues to grow. Staff are overstretched and performance is slipping, a point underlined by the Care Quality Commission in its State of Care report,” she said.
“Patient safety is always the first priority for trusts, but this becomes much more difficult when staff are placed under intolerable pressure,” she added, also noting that a workforce strategy was “long overdue”.
Labour health spokesman Jonathan Ashworth said: “This new analysis exposes the government’s hollow promises on nurse recruitment. Far from delivering the nurses needed to keep patients on wards safe, nurse numbers are now in fact falling in our NHS.”
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He blamed the 1% pay rise cap on public sector workers and the government’s “chaotic” approach to Brexit.
“As winter approaches, these workforce failures leave our NHS precariously exposed. We need a sustainable long term plan for the NHS which deals with the staffing crisis and gives the NHS the funding it needs,” he said.
A Department of Health spokeswoman highlighted that the analysis included not only nurses, but health visitors as well.
”Patients should be told that we actually have more nurses on our hospital wards since April 2016 not fewer, which alongside last week’s announcement of the biggest ever increase in nurse training places, underlines our commitment to ensuring the NHS has the nurses it needs to provide the best possible care for patients, both now and in the future,” she said.
“There are also 3,193 more EU nationals working in the NHS than at the time of the referendum – we have been absolutely clear that they play a vital role in the NHS and want to see their excellent work continue long after the UK leaves the EU,” she said.