Workforce pressure points: Building the NHS nursing workforce in England (REAL Centre, December 2020)

Summary

This report by The Health Foundation’s REAL Centre (research and economic analysis for the long term) looks at pressure points in the nursing workforce. It aims to examine the supply of nurses to the NHS in England in light of the ongoing shortfall of registered nurses, which represents a major long-term and growing problem for the NHS.

Content

Key findings

• From 2010/11 to 2017/18, the number of full-time equivalent (FTE) nurses in the NHS barely changed, even as NHS hospital and community sector activity levels increased by 26%. Since 2017/18, nurse numbers have increased, with the number of FTE nurses and health visitors in the NHS rising by 4.8% in the year to June 2020.
• Disparities between service areas continue to widen. The number of FTE nurses working in adult hospital nursing grew by 5.5% in the year to June 2020, while the number working in community nursing grew only by 1.6%, and by 3.8% in mental health. Over the past 10 years, only adult nursing and children’s nursing have seen increases in FTE nurse numbers, while the numbers in community nursing, mental health nursing and learning disability nursing are all lower than they were in June 2010.
• Vacancy rates are one measure of staff shortages as they highlight posts that the NHS is funding but cannot fill. Across all staff groups, the NHS had 83,591 FTE vacancies in June 2020. Registered nurse FTE vacancies accounted for close to 38,000 (45%) of these. A quarter of all nursing vacancies are in mental health. This is particularly concerning as Covid-19 is likely to lead to further demand for mental health services.
• The overall skill mix of the NHS nursing workforce continues to become more diluted. The number of FTE nursing support staff increased at over twice the rate of growth in registered nurse numbers in the year to June 2020.
• The main ‘supply’ of new nurses to the NHS comes from undergraduate university degree courses. In 2020 there was a 23% increase in the number of students accepted onto nursing degree courses in England (relative to 2019) – the highest annual number of acceptances since 2011.
• The UK ranks below the average of high-income OECD countries in terms of the number of practising nurses and the annual number of new nurse graduates relative to its population. On both counts, the UK reports lower ratios than comparable countries such as Germany, the USA and Australia.
• To achieve the required increase in the number of new graduate nurses from domestic education, the UK needs to find solutions to the long-term bottleneck that makes expanding the numbers in training challenging. These solutions could include increasing the use of simulation-based clinical experience, or reducing the total clinical hours required to be on a par with undergraduate nursing courses in the USA and Australia.
• The UK has been highly reliant on recruiting nurses trained outside the UK. About 15% of registered nurses in the UK are trained outside the UK – more than double the OECD average.
• Our analysis shows that achieving the government’s target of employing 50,000 NHS nurses by the end of the parliament will only be possible with sustained investment and policy action on domestic supply, including a marked improvement in retention of the current nurse workforce. Coordinated, ethical and effective international recruitment will also be required. To meet the 50,000 target the government will need an average of 5,000 international recruits a year up to 2024/25.
• But the 50,000 target will be insufficient to meet increased demand. As such it represents a political attempt to galvanise a system drifting from one reactive measure to the next. We argue there needs to be a shift in focus, away from a sigle top-down target to a more sustainable, long-term approach. This should start with robust, independent projections of the future demand for and potential supply of nurses.