Expert advice

James Buchan: Nursing workforce crisis is self-inflicted

The nursing shortage is about more than Brexit. UK governments, regulators and educators have all helped create the conditions for a crisis.
nursing shortage buchan

The nursing shortage is about more than Brexit. UK governments, regulators and educators have all helped create the conditions for a crisis

For years this country has been sleepwalking towards a major nursing shortage that is self-inflicted. The Brexit vote was a wake-up call, but it has merely quickened the pace towards a staffing crisis that was already coming.

Successive UK governments - with the exception of the early years of the Blair Labour government - have been serial under-investors in training sufficient new nurses to meet demand. The next government needs to do better. Across the decades, governments have relied on the quick and relatively cheap fix of international recruitment to close staffing gaps.

This did not matter so much while the inflow of nurses from other countries

...

The nursing shortage is about more than Brexit. UK governments, regulators and educators have all helped create the conditions for a crisis

 nurse shortage buchan
Barriers other than Brexit have helped create a shortage of nurses.
Picture: Getty Images

For years this country has been sleepwalking towards a major nursing shortage that is self-inflicted. The Brexit vote was a wake-up call, but it has merely quickened the pace towards a staffing crisis that was already coming.

Successive UK governments - with the exception of the early years of the Blair Labour government - have been serial under-investors in training sufficient new nurses to meet demand. The next government needs to do better. Across the decades, governments have relied on the quick and relatively cheap fix of international recruitment to close staffing gaps.

This did not matter so much while the inflow of nurses from other countries was high and easily tapped. But the likely impact of Brexit on nurse supply is exposing the fractured process of planning, educating and employing NHS nurses.

Damaging policies

Data presented by the Commons health committee in its report on Brexit highlighted just how reliant the NHS has become on EU nurses. At the end of last year, 7% of nurses working in the NHS in England were from other EU countries. In London it was twice that level.

The uncertainties of Brexit mean that these EU nurses may be unwilling to stay in the UK. The health committee reported that the monthly average number of nurses from other EU member countries joining the NHS between June and September 2016 was 820. A year after the Brexit vote it is less than a quarter of that, at only 204.

Brexit has not yet fully impacted, but four other policy changes are already damaging nurse supply.

Aiming too low

First, there is the ‘aim low’ approach of UK governments on nurse education funding. OECD data shows that the level of new nurse graduates in the UK is much lower than in many other OECD countries. In 2014 there were only 29 new nurse graduates per 1,000 of population in the UK, compared with 54 in Germany, 63 in the US and 76 in Australia.

This does not reflect a lack of interest in nursing as a career but a lack of funding and training capacity. In recent years there have been twice as many applicants for pre-registration nurse education in England as there have been funded places.

But England is now shifting from nursing student bursaries to a loan-based model. Applications for pre-registration nurse education this year have crashed. The end of the bursary model was lobbied for by the Council of Deans of Health. Now universities need to deliver on an increase in places.

Second is the continued inability of the NHS to sustain improvements in the retention of nurses. This is not helped by the public sector pay freeze, or by the announced reduction in funding for continuing professional development for nurses.

Costs and challenges

Third is the changes imposed by the Nursing and Midwifery Council to increase language testing and other aspects of the application process for international nurses, which has made it more difficult and more expensive for them to obtain UK registration. The decline in EU applicants is not only about fear of Brexit, it is also due to the registration process becoming more costly and challenging.

Fourth is that the immigration process for non-EU workers, including nurses, has become much more difficult in recent years. At its peak at the beginning of last decade, the UK was recruiting thousands of nurses every year from the Philippines, India and other non-EU countries.

A return to those recruitment levels will be virtually impossible unless there are changes in general immigration policy or preferential treatment for nurse applicants.

Blame Brexit if you will, but UK governments, regulators and educators were already making choices that constrain UK nurse supply. We have no one to blame but ourselves.


james buchan

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

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