Comment

Candace Imison: Nursing shortages are putting the future of the NHS at risk

The evidence is clear: serious gaps in the nursing workforce are growing. A national strategy to ensure the health service has the staff it needs is essential, says the Nuffield Trust's director of policy.
Nurse shortages

The evidence is clear: serious gaps in the nursing workforce are growing. A national strategy to ensure the health service has the staff it needs is essential, says the Nuffield Trust's director of policy

When it comes to the future of the health service, pressure on the workforce is as great a threat, if not greater, than pressure on finances.

This was my argument in evidence to the House of Lords' recent inquiry into the long-term sustainability of the NHS. It was therefore good to see these risks recognised in the committee's final report , which stated that the absence of a national, comprehensive and long-term strategy to secure the right workforce

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The evidence is clear: serious gaps in the nursing workforce are growing. A national strategy to ensure the health service has the staff it needs is essential, says the Nuffield Trust's director of policy


The NHS is struggling to cope with multiple workforce pressures. Picture: Alamy 

When it comes to the future of the health service, pressure on the workforce is as great a threat, if not greater, than pressure on finances. 

This was my argument in evidence to the House of Lords' recent inquiry into the long-term sustainability of the NHS. It was therefore good to see these risks recognised in the committee's final report, which stated that the absence of a national, comprehensive and long-term strategy to secure the right workforce needed over the next 10-15 years 'represents the biggest internal threat to the sustainability of the NHS'.

But whereas the health service's financial difficulty can be resolved by increased funding, the loss of experienced, highly-trained staff who are leaving the NHS cannot be so easily reversed.

The gaps in the nursing workforce are serious and growing. In London around one in five nursing posts is unfilled, and this rises to one in three for some mental health providers. Across the country, one in five district nursing posts is vacant, and nearly one in two children's nursing posts, according to the RCN's Labour Market Review 2016 and evidence to the NHS Pay Review Body 2017-18

To put these numbers in context, National Institute for Health and Care Excellence guidance recommends a maximum vacancy rate of 5%, or one in 20. The total current shortfall in the NHS is at least 24,000 nurses, according to figures obtained by the BBC using a freedom of information request.

The cumulative cost to patients, staff and organisations is considerable. The RCN's evidence to the pay review body states that a tenth of trusts' nurse pay bill is currently spent on agency staff. This is a huge waste of time and money as well as a threat to the quality of care.

Top of the agenda

But while the current position is bad, it could get much worse. We have become reliant on the EU for nursing staff to fill the gaps in the nursing workforce. Brexit not only cuts off this supply but is already driving NHS staff from the EU to leave the UK.

In addition, one in three nurses are due to retire in the next ten years, creating a huge hole in the workforce. And far from the move away from bursaries enabling a significant expansion of nursing places, the early evidence from higher education is that it looks as if we will be lucky to maintain current numbers. The prospect of earning £8,000 less than the average graduate, and pay rises that fail to keep pace with inflation, will not help attract people into the profession.

Last but not least, there are rising numbers of nurses leaving the NHS before retirement. Overall, the number of staff leaving the NHS because of poor work/life balance has grown by 10,000 in the past five years, from more than 6,500 a year to around 16,500, NHS Workforce statistics reveal.

Despite all these pressures, NHS chief executive Simon Stevens' Delivery Plan for the Five Year Forward View, published last month, optimistically sets out how forecast growth of 6,000 nurses could be considerably higher. It does not recognise that it could be considerably lower. Recent leaked forecasts from the Department of Health suggest possible shortages of between 26,000 and 42,000 nurses. 

The lack of urgency about prospective gaps in the nursing workforce is also reflected in the Sustainability and Transformation Plans produced by local areas, many of which have no strategy in place to address this problem.

The NHS cannot put its head in the sand any longer. Addressing workforce pressure needs to be at the top of everyone's strategic agenda.


About the author

 

 

 

Candace Imison is director of policy at the Nuffield Trust, a health think tank 

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