The growth rate in NHS nurse numbers in England has halved this year compared to the last, with experts claiming the slowdown could mark a return to trusts prioritising budgets over safe staffing.
There were more than 3,300 additional whole-time equivalent registrants working at NHS trusts across the country in May, compared to the same point in 2014, according to analysis of latest workforce data by Nursing Times.
“[Agency use is] in some cases a deliberate decision by trusts to maintain a higher level of longer term vacancies to try and exert more financial control”
During the same period in 2013-14 the pace of growth was double that, with the nursing, midwifery and health visitor workforce growing by around 6,500 WTE posts.
The slowing trend is even more marked for increases in the numbers of acute, elderly and general nurses.
There were an additional 1,800 WTE staff in the 12 months to May, our analysis of the latest data from the Health and Social Care Information Centre shows. However, almost 5,500 extra WTE workers were employed in the NHS during 2013-14.
The tailing off of the surge in nurse recruitment following the 2013 Francis report into care failings at Mid Staffordshire Foundation Trust has led experts to warn that trust decision-making has reverted to focussing on cost-cutting rather than safe staffing.
One academic claimed it could lead to another “Mid Staffs-type” situation, in which patient safety was compromised due to an overreliance on temporary workers.
Professor James Buchan, nursing workforce expert at Edinburgh’s Queen Margaret University, said some trusts were deliberately keeping vacancies open with the intention of using agency staff to plug gaps at the last minute.
“You can manage with fewer whole-time equivalents with 12-hour shifts… in a large hospital that makes a considerable [financial] difference”
Professor Buchan said it helped trusts control their finances on a day-to-day basis, rather than making long term investments in permanent nurses.
“Agency use in some cases does reflect difficulty in recruitment, but in others it is also a deliberate decision by trusts to maintain a higher level of longer term vacancies to try and exert more financial control when times are difficult,” he said.
“Financially that might make more sense. It doesn’t make any sense at all in terms of continuity of care or building up a sustainable workforce.
“I don’t think the slowdown in growth reflects overall a supply problem. Trusts can, if they wish, still recruit from abroad,” he said. “It’s more likely a sign of NHS finances beginning to bite again.”
Professor Buchan also noted that, while there were more WTE nurses in the NHS than when the Stafford Hospital scandal occurred, it was only a marginal increase when broken down among trusts. As of May, there were 317,400 NHS nurses, midwives and health visitors, compared to around 310,800 in 2010.
“There is a risk of reversing into a Mid Staffs-type situation again – given the compounding factors of financial constraint and supply difficulties around recruiting and retaining experienced, permanent nurses,” he said.
Jennifer Hunt, visiting professor in nursing at Anglia Ruskin University and a former chief nurse, echoed his concerns, saying trusts were “horrendously overspent”. She said the tailing off of growth in the permanent workforce was worrying because she expected future modelling around safe staffing to expose the need for even more nurses due to increased complexity of care.
Professor Hunt said trusts’ interest in recruiting more nurses may now be waning due to enough time having passed since the initial wave of publicity and pressure from campaigning groups immediately after the Francis report.
She also suggested the slowdown in growth may be due to the increased use of 12-hour shifts.
She highlighted a study by King’s College London and Southampton University – commissioned by the chief nursing officer for England – which found the proportion of staff nurses on wards working these shifts has almost doubled to more than 50% in recent years.
“You can manage with fewer whole-time equivalents with 12-hour shifts,” said Professor Hunt. “You don’t need as many on your establishment because you haven’t got that overlap period [of staff between two shorter shifts]. Overall in a large hospital that makes a considerable [financial] difference.”
Professor Hunt also noted there was a lack of student nurses qualifying to help fill vacancies and also that the pool of registrants who were willing to be employed as permanent nurses was dwindling.
Health Education England has committed to increase nurse training places to ensure there are 23,000 additional WTE nurses by 2019, compared to 2014 levels. Around 13,000 of those are expected to be adult nurses, 6,000 will be children’s nurses, 2,600 mental health nurses and 1,500 additional learning disability nurses.