Analysis

Number crunching: are there enough nurses?

Using freedom of information requests, the RCN has found that despite the Conservative party's statements of increased nursing numbers, all is not as it seems for the nursing profession

Using freedom of information requests, the RCN has found that, despite the Conservative party's statements of increased nursing numbers, all is not as it seems for the nursing profession

How much is enough? Throughout the election campaign, the Conservatives have been keen to point out how it has increased the number of nurses in hospitals.

A common figure quoted is more than 12,000 on wards since 2010. This is right; the numbers working in hospitals have risen following the drive to improve safety in the wake of the Stafford Hospital scandal.

11.1%

The nurse vacancy rate in England, equivalent to 40,000 nurse vacancies

The statistic tells only part of the story, however. An in-depth analysis by the RCN, released at its annual congress,

...

Using freedom of information requests, the RCN has found that, despite the Conservative party's statements of increased nursing numbers, all is not as it seems for the nursing profession


An analysis by the RCN has revealed there is a shortage of full-time nurses. Picture: Alamy

How much is enough? Throughout the election campaign, the Conservatives have been keen to point out how it has increased the number of nurses in hospitals.

A common figure quoted is ‘more than 12,000 on wards since 2010’. This is right; the numbers working in hospitals have risen following the drive to improve safety in the wake of the Stafford Hospital scandal.

11.1%

The nurse vacancy rate in England, equivalent to 40,000 nurse vacancies

The statistic tells only part of the story, however. An in-depth analysis by the RCN, released at its annual congress, in Liverpool in May, has laid bare the full picture.

Using freedom of information responses, the RCN found there is actually a shortage of about 40,000 full-time nurses in England, double the number from 2013, when the union last carried out similar research.

This figure has been calculated after the RCN asked about unfilled posts. It found that across hospitals, the community and mental health more than 11% of posts are vacant. Responses were received from three quarters of trusts.

6%

The vacancy rate in 2013 (20,000)

The vacancy rate was highest in mental health (14%) and lowest in specialist hospital trusts (8%). But even in hospital trusts, where the greatest investment has been, more than 12% of posts are unfilled.

The figures compare unfavourably to other parts of the UK, where official vacancy rate data show that around 4% of posts are vacant in Scotland and 5% in Northern Ireland. Figures were not available for Wales.

‘The report paints a picture of the NHS struggling without the nursing staff it knows it needs,’ says RCN general secretary Janet Davies.

'There’s no certainty about the next generation. Some are being deterred by low pay, some by the considerable pressure and others by the new costs of training to be a nurse'

‘Nurses are being asked to work longer and harder, staying on beyond their shifts, even when they’ve already worked 12 hours flat out to give patients the care they deserve, before going home exhausted and sometimes in tears.

‘For some, it is just too much. But when a nurse leaves, who replaces them? There’s no certainty about the next generation. Some are being deterred by low pay, some by the considerable pressures and others by the new costs of training to be a nurse. We desperately need to retain the experienced nurses we have currently got.’

The scale of the problem was echoed by a survey of directors and deputy directors of nursing from across the UK. Some 82% of those polled by ComRes said they thought services are kept running only through the ‘goodwill’ of staff.

Nearly half are worried about skill mix, with many trusts employing more healthcare support workers or starting to reduce the number of registered nurses. The problem, it seems, is that too many staff are leaving and replacing them is proving too difficult.

In terms of recruitment, 90% of the nurse leaders said they are concerned, while 84% identified retention as a problem.

37%

The highest vacancy rate

The impact of Brexit is clearly a factor, the RCN report states. It quotes a recently leaked Department of Health workforce modelling paper which warns that the nursing supply could fall by 42,000 by 2020.

Bottom line

But the problems go far deeper than that. The bottom line, according to the RCN, is that there is too little funding in the health service. This has manifested in several policies that have all contributed to the shortfall.

Top of the list is undoubtedly pay. Ms Davies says the curb on pay since 2010 effectively means that salaries have been cut by 14% once you take into account the rising cost of living.

Unsurprisingly, the RCN has called for the 1% limit on annual pay rises, in place until 2019, to be lifted. In fact, the college is warning it will carry out a formal strike ballot if the cap remains once the election is over.

7 of the 10 trusts

with the highest vacancy rates are mental health trusts 

Other policies are also highlighted by the report, including cuts to nurse training places between 2010 and 2013, historically poor workforce planning and the scrapping of bursaries, which comes into force in England this year.

They have led the RCN to call once again for ‘enforceable and effective’ safe staffing rules to be introduced in England and Northern Ireland; Wales has already started to do this, while Scotland has promised to do so.

Inconsistencies

But, tellingly, it is not just the nurses’ union that has been raising the alarm. NHS Providers, which represents trusts themselves, has spoken out strongly about the workforce problems.

Chief executive Chris Hopson says: ‘Years of pay restraint and stressful working conditions are taking their toll. Pay is becoming uncompetitive.

‘Significant numbers of trusts say lower paid staff are leaving to stack shelves in supermarkets rather than carry on working in the NHS.

‘And we are getting consistent reports of retention problems because of working pressures in the health service causing stress and burnout.’

Government review

Mr Hopson wants the new government to review the pay cap immediately on taking office.

And, if the government fails to act, there are signs that different regions could go their own way. Talk of regional pay and workforce agreements could once again arise with new mayors in place. Greater Manchester mayor and former health secretary Andy Burnham has already promised to explore a new funding scheme so nurses who train in the area and agree to work locally for a set period receive help towards their university fees.

He says: ‘These are tough times for nursing and new thinking is required if we are to break out of this downward spiral. In Greater Manchester we want to do things differently.’

It is an issue, it seems, that is simply not going to go away no matter what stance the new government takes.

So how do the RCN figures square with the 12,000 figure quoted by the Conservatives?

The 12,000 represents a rise of more than 7% in six years.

But, when you look at the figures for the entire workforce, the increase has been much less. The officially published data on nurses in post show that total employed has risen by 2% between 2010 and 2016 to just more than 300,000.

This is because the rise in hospital-based nurses has been offset by big falls elsewhere: 13% in mental health, 14% in community services and 36% in learning disabilities.

But the RCN is not so much concerned with whether the size of the workforce has gone up or down; instead it focuses on how far short of the staff needed the health service is.

 

Further information

Safe and Effective Staffing: The Real Picture


Nick Evans is a freelance health writer

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