Nursing shortage: the nettle politicians struggle to grasp

The NHS workforce crisis needs joined-up government action, not empty election promises

The NHS workforce crisis needs joined-up government action, not empty pre-election promises

Decisions in government departments that aren't 'joined-up' can have unintended
consequences for healthcare staff Picture: Alamy

When Her Majesty’s Revenue and Customs (HMRC) implemented a new pension pot ‘cap’ for UK taxpayers, it had unintended consequences for the NHS.

The change means some senior medical staff will be hit with a larger tax bill than anticipated, so they are reducing their hours or retiring early. 

Waiting lists for operations, already long, are getting longer because surgeons are cutting their hours to avoid tax penalties.

Department of Health and Social Care gives to the NHS and the tax authorities take away

One part of the government in England – the Department of Health and Social Care – has invested heavily to achieve a 25% increase in the supply of medical students.

But this is being undermined by another government department, in the short-term at least, with HMRC’s changes in pension rules leading to a reduced supply of doctors’ hours.

‘What we need is a responsive and joined-up government. What we have is a general election, a time of quick fixes and empty promises’

Similarly, no one set out to cause nursing shortages, but the unintended result of both government action and inaction is more than 43,000 nursing vacancies in the NHS in England.

It was claimed that the shift to a student loan system would be a way of achieving big increases in nursing student numbers. But the unintended (though not unforeseen) consequence has been the opposite, with applicants to nurse education drastically reduced.

Nursing shortages are made worse by Brexit – however unintentionally

An unintended consequence of the Brexit vote is that it has exacerbated nursing shortages.

The vote was not about international nurses – there is even some evidence that Brexit voters are supporters of international nurses working in the NHS – but the outcome has created uncertainties about the status of European Union nurses.

Since the Brexit vote in 2016, many EU nurses have left the UK, while few have arrived. 

To deal with these consequences, what we need is a responsive and joined-up government, using targeted funding in a systematic way. What we have is a general election, a time of quick fixes and empty promises.

Don’t be surprised if the doctors’ pension problem is sorted soon. The more complex and costly nursing shortages, however, will demand more effort on the part of the incoming government.

James Buchan is professor in the faculty of health and social sciences at Queen Margaret University, Edinburgh



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