The NHS nursing workforce could crash by up to 100,000 over the next decade due to a combination of spiralling cuts to posts, falling student places and a retirement bubble, academics have warned.
Research commissioned by the Royal College of Nursing reveals that even if current trends remain steady, the NHS nursing workforce in England stands to shrink by nearly 43,000 over the next 10 years.
The research forecasts what will happen to the current NHS workforce of 352,000 qualified nurses, midwives and health visitors based on a number of different scenarios.
In the worst case scenario, a quarter of the nursing workforce is lost, leaving just 253,000 staff in post by 2021-22.
For this scenario to occur, inflow of newly-qualified nurses would need to fall by 31% – as occurred in the last major downturn in training commissioning between 1991-92 and 1994-95 - all nurses over the age of 50 would retire over the next 10 years, and the number of nurses leaving the service for other reasons would rise by just 0.5% a year.
Under a different scenario, the NHS stands to lose 56,000 registered nurses if the number of newly qualifieds remains at current levels but there is an increase in nurses leaving for reasons other than retirement – for example through a rise in redundancies or post cutting.
In a further scenario, the workforce falls by 61,000 even if cuts to posts and training places are halted. The scenario envisages a significant rise in nurses retiring, potentially in order to beat the introduction of the unpopular pension reforms.
The researchers warn that their projections “highlight the vulnerability” of the NHS nursing workforce to policy changes.
“For example, if reforms to NHS pensions lead to more nurses remaining in employment for longer, the nursing workforce could, despite a lower intake from education, shrink comparatively little (2.6% over 10 years).
“Conversely, if these reforms result in a short-term rise in the numbers taking retirement then the NHS could face a rapidly diminishing nursing workforce and staffing shortages.”
Lead author James Buchan, professor of health sciences at Edinburgh’s Queen Margaret University, said: “The scenarios we have set out are all possible futures – where we are in 10 years will depend on decisions made now by policy makers about numbers of new nurses to train and retention policies.”
He suggested the sectors likely to see greater demand in coming years could also be worst affected by workforce shrinkage, due to retirement patterns.
“The sections of the workforce with the highest proportions of nurses reaching retirement age are in the community nursing area and in nursing homes,” he told Nursing Times.
Professor Buchan warned that the service might attempt to remedy any significant drop in registered nurse numbers by employing more lower band staff or looking overseas.
He said: “We have over-relied on massive scale international recruitment in the past as a quick fix, and this could very well happen again – but there will also be cost containment pressure to shift skills mix by making more use of assistant practitioners and healthcare assistants.”
RCN general secretary and chief executive Peter Carter said “urgent and immediate action” was needed. He said: “One clear first step must be to stabilise the numbers of registered nurses and reverse decisions to cut student nursing places by 10% by 2012.”
The bleak forecast follows warnings from the Department of Health about “worrying signs” in the way some trusts were planning to make savings through its quality, innovation, productivity and prevention (QIPP) programme.
Speaking to Nursing Times’ sister title Health Service Journal last week, DH national director for improvement and efficiency Jim Easton said some were making financial efficiencies through improving quality and productivity, but warned others were just making staffing cuts instead.
He said: “There are two ways of achieving changes in staffing. One is that you do something like productive ward work and you redesign the way nurses and support staff on a ward work in a way that delivers quality, and gains productivity.
“The other is that you just take your off-duty rosters and take 3% off them. The first is delivering QIPP, the second of those is not.”
The research forms part of the forthcoming RCN Labour Market Review 2011, which will be published later this year.
The most recent previous forecast of the future nursing workforce – carried out in June 2009 by the NHS Workforce Review Team – projected a decline in headcount from 382,496 in September 2008 to 340,116 in September 2020.