‘No coherent workforce plan’ as NHS faces worsening nurse shortage

The nursing shortage is worsening, with NHS workforce planning in England unfit for purpose and no coherent strategy to tackle it, says a report that demands action led by the government.

The nursing shortage is worsening, with NHS workforce planning in England unfit for purpose and no coherent strategy to tackle it, says a report that demands action led by the government

  • NHS workforce planning in England is not fit for purpose, says a Health Foundation report.
  • The charity says falls in the number of nurses and nursing students risk overstretching the profession and undermining progress made on nurse numbers since the Francis report.
  • ‘Collective action led by the government’ is needed to combat the worsening situation, it says.

NHS workforce planning in England is ‘not fit for purpose’, warns a new report, criticising the lack of a coherent strategy to tackle nursing shortages.

The report by the Health Foundation charity argues that the situation is worsening, with fewer nurses coming into the NHS and fewer remaining in it. It calls for urgent collective action, led by the government, to remedy the issues.

Picture: iStock

New figures from the Nursing and Midwifery Council show that between October 2016 and September 2017 35,363 nurses and midwives left the register – up from 31,178 during the same period the previous year.

The Health Foundation report identifies nurse retention as a ‘pressure point’ for the NHS, given that annual turnover rates are as high as one in three nurses at some trusts.

Applications down

Health Education England, which is responsible for delivering a workforce with adequate numbers and skills, estimates that 87,000 nurses will leave the NHS for reasons other than retirement by 2021.

Further pressure has been created by the removal of the nursing student bursary on 1 August, in favour of loans and tuition fees – a move intended to release funding to increase the number of student places.

Figures from the Universities and Colleges Admissions Service (UCAS) show there has been a drop of 1,200 (23%) in the number of people applying for undergraduate nursing courses starting this year in England.

Workforce expert James Buchan of Queen Margaret University in Edinburgh, who co-authored the Health Foundation report, says reversing these negative trends requires a national, sustained and shared long-term vision.


nurses and midwives left the register between October 2016 and September 2017

Source: NMC

Professor Buchan says: ‘We need better integration, regulation and funding for the NHS, as well as better recruitment, retention and planning in the workforce.

‘Sometimes the first we hear of a decision on an initiative for the NHS workforce is from a government press release – it leads to a sense of a disjointed approach.’

An announcement this year about funding extra nursing student placements, which came ‘in the last gasp of the cycle of UCAS applications’, is one example, he says.

In August, just weeks before undergraduate courses started, the government announced it would fund an extra 10,000 clinical training placements for nurses, midwives and allied health professionals, meaning universities could increase their places.

Monitoring student attrition

The Health Foundation report highlights ‘complex and poorly understood’ reasons for falling nursing student numbers, especially mature students.

It calls for systematic monitoring of attrition data, citing an investigation by Nursing Standard that revealed one in four UK nursing students drop out before completing their studies.

Professor Buchan adds that pay rates for UK nurses are below those in Australia and the United States, countries that have been successful in increasing their nursing student intakes.

Anita Charlesworth
Anita Charlesworth

Health Foundation director of research and economics Anita Charlesworth says: ‘This year has been characterised by a series of one-off announcements and initiatives, beset by unrealistic timescales and the lack of an overall strategy.

‘The challenges must be met by collective action, led by the government, to put in place a coherent strategy to provide a sustainable workforce for the NHS.’


community nurses left the workforce in the year to April 2017 – creating challenges for government plans to shift the focus from hospitals to the community

Source: NHS Digital

In response, a Department of Health spokesperson says there are 10,600 more nurses on wards since 2010 and says the number of nurse training places has increased.

‘We have a clear plan to ensure the NHS remains a rewarding and attractive place to work, including more flexible working for nurses,’ she says.

But Professor Buchan says comparing whether there are more or fewer nurses than there were at a specific date in the past misses the point.

‘The real question is: are there sufficient nurses now?’ he says.

‘There is an imperative locally to focus on what can be done to improve retention levels for nurses and other staff.’

Focus on retention

There is huge variation in non-medical turnover rates between NHS trusts, ranging from less than 10% a year to more than 30%, according to data from NHS Digital for 2016-17.

RCN chief executive Janet Davies says it is ‘shocking’ that some parts of the NHS lose almost a third of their entire staff every year.

‘We know that low levels of pay and inadequate staffing are exacerbating already poor morale among nurses – the huge sums being spent on perpetual recruitment at these trusts is money that should be being spent on patient care.’


nurses are expected to leave the NHS between 2016 and 2021 for reasons other than retirement

Source: Health Education England

In September, after a year-long drive targeting retention in 92 trusts, NHS Employers released guidance on staff retention for employers, including solutions such as:

  • Better support for new starters.
  • Offering flexible working and retirement options.
  • Building line manager capability.

Professor Buchan suggests organisations might look to the characteristics of hospitals accredited in the Magnet programme, which have been successful in retaining nurses and attaining adequate staffing levels.

Better outcomes

Originating in the US, the Magnet Recognition Program is an evidence-based approach to achieving better outcomes for patients and staff.

Professor Buchan says the characteristics include investment in ongoing professional training, nursing input in the highest levels of the organisation, and nurse involvement in determining staffing patterns.

‘You can have a good hospital in challenging labour market situations – it is not the case that all hospitals in one area are good or bad.’

How one trust stemmed losses

In 2016, Buckinghamshire Healthcare NHS Trust had a nurse vacancy rate of almost 17%.

Focus groups conducted by the trust found nurses were leaving for reasons including poor line management, poor work-life balance, lack of professional development and a perceived lack of appreciation.

The trust created a nurse retention action plan offering:

  • More support for nurses aged over 50 (a third of the nursing workforce) through flexible retirement options and equipping managers to support an older workforce.
  • Second-year preceptorship support to continue support for newly qualified nurses.
  • An ‘itchy feet’ programme – making it easier and simpler for staff to move around internally, before advertising a role externally.
  • Recognising length of service at five, ten, 15 and 20 years.

The trust improved nurse retention by 2% in 2016, and saw a significant reduction in recruiting and funding temporary and agency staff, according to NHS Employers' retention guidance.


This article is for subscribers only