Analysis published today by the Health Foundation’s REAL Centre shows that the NHS in England could face a shortfall of around 38,000 full time equivalent (FTE) registered nurses by 2023/24 relative to the numbers needed to deliver pre-pandemic levels of care. This is despite the expectation that the government could meet its own target of recruiting an additional 50,000 FTE registered NHS nurses by the end of the parliament.
The findings, which call into question the ability of an incoming government to rebuild the NHS and improve standards of care following the pandemic, are part of a wider research report on the future of the NHS workforce in England.
It argues that the government, in setting the target of an extra 50,000 nurses, fails to grasp the growing demand for care driven by an ageing population and an increased number of people with complex health conditions. The UK has fewer nurses per head of population than the OECD average. While NHS nurse numbers in England have increased over the past 3 years, they have not kept pace with demand. NHS nursing shortages vary by geography and service area. The current government target of 50,000 extra NHS nurses does not focus on targeting nursing recruitment where it is most needed, such as in primary, social and community care, and learning disability and mental health services.
Longer term challenges
The analysis also explores potential gaps in the nursing workforce over a longer time period beyond the next election by looking at three different scenarios. Under the ‘current policy scenario’ where current trends continue and nurse workforce policies are unchanged, the nurse shortfall in NHS trusts in England is projected to be 30,300 FTE by 2030/31. This nursing shortfall over the next decade would pose a serious threat to the level of care the NHS was able to provide for patients.
In a ‘pessimistic scenario’ where more nurses leave the profession early and the number of newly registered internationally recruited nurses declines after 2023, NHS trusts could face an even greater shortfall of around 140,600 FTE nurses by 2030/31.
The analysts warn that some areas of nursing face bigger shortfalls than others, with general practice and adult social care in England facing persistent shortages to the end of the decade.
Policies to help improve the longer-term picture
However, the report authors highlight that the situation can be turned around with better long-term planning. Specifically, policymakers need to fund and deliver sustained increases in students starting nursing degrees; reduce student nurses leaving before qualifying; reduce the proportion of nurses leaving the NHS before retirement age whilst also continuing to recruit international nurses. In this ‘optimistic scenario’, the analytical projections suggest it would be possible for the number of nurses in NHS trusts – although not in general practice and social care – to match projected demand by the end of the decade.
In this webinar, we explored the REAL Centre’s upcoming report on updated NHS workforce supply...
Anita Charlesworth, Director of Research and REAL Centre at the Health Foundation, said:
‘Nurses are indispensable to the delivery of NHS care but due to a lack of long-term planning, persistent high vacancy rates mean the NHS cannot deliver the level and quality of care people rightly deserve.
‘The NHS in England appears to be on track to recruit the additional 50,000 nurses promised by the government by 2023/24, but this relies heavily on sustaining historically high levels of international recruitment, very much a ‘quick fix’ and does not replace the need to train and retain more nurses in the UK. The 50,000 target is arbitrary and not based on the number of nurses the NHS needs; nor does it ensure that nurses are recruited to the areas and types of care where the need is greatest. 50,000 extra nurses will still leave the NHS almost 40,000 short of what is needed.
‘If the new prime minister wants to rebuild the NHS and return it to pre-pandemic levels of care, they need to make nursing a more attractive career choice and put in place a robust, costed long-term plan to address workforce shortages, backed up by independent projections of how many staff will be needed.’
As well as specific projections on the nursing workforce, the REAL Centre’s report also assesses future supply and demand trends for the wider NHS workforce. It says that, if current trends continue, the NHS could face a shortfall of around 160,000 FTE staff across all staff groups by 2030/31. This is around 55% higher than an estimated NHS workforce shortfall of around 103,000 FTE staff in 2021/22.
Notes to editors
- The REAL Centre’s NHS Workforce projections 2022 will be available at this link when the embargo lifts. www.health.org.uk/publications/nhs-workforce-projections-2022
- The government appears to be on track to meet its own target to recruit an additional 50,000 FTE registered nurses by 2023/24 across NHS trusts and general practice in England as compared to 2018/19. While meeting the target would mean the number of FTE nurses working across the NHS HCHS and general practice increases from around 301,000 FTE to 351,000 FTE between September 2019 and March 2024, the number needed in 2023/24 to meet pre-pandemic levels of care using existing care models is estimated to be around 389,000 FTE, which would leave a shortfall of around 38,000 FTE nurses in 2023/24.
- At the beginning of 2020/21, the NHS Hospital and Community Health Service (HCHS) in England employed a little over 300,000 FTE registered nurses and health visitors. The REAL centre’s projections suggest that in the ‘current policy’ scenario, this number will increase to around 318,400 FTE by 2023/24, leaving a shortfall of around 50,600 FTE nurses in 2023/24 (relative to projected demand of around 369,000 FTE nurses in the NHS HCHS in 2023/24). In the optimistic scenario, the number of FTE registered nurses is projected to increase to around 322,800 by 2023/24, leaving a shortfall of around 46,200 FTE relative to projected demand. In the pessimistic scenario, the number of FTE registered nurses is projected to increase to around 305,100 by 2023/24, leaving a shortfall of around 63,900 FTE nurses relative to projected demand.
- Further, the REAL centre’s projections suggest that in the ‘current policy’ scenario, the number of FTE registered nurses in the NHS HCHS will increase to around 382,600 by 2030/31, leaving a shortfall of around 30,300 FTE nurses in 2030/31 (relative to projected demand of around 412,900 FTE nurses in the NHS HCHS in 2030/31). In the optimistic scenario, the number of FTE registered nurses is projected to increase to around 457,300 by 2030/31, implying a ‘surplus’ of around 44,400 nurses relative to projected demand in 2030/31. In the pessimistic scenario, the number of FTE registered nurses is projected to decline to around 272,300 by 2023/24, leaving a shortfall of around 140,600 FTE nurses relative to projected demand.
- In the ‘current policy’ scenario, the number of FTE nurses in general practice is projected to decline by around 0.6% a year (from 16,600 in 2021/22) over the 9 years to 2030/31. Even in the optimistic scenario, we project only a slow increase in nurse supply in general practice from around 16,600 in 2021/22 to just over 17,000 by 2030/31. In the pessimistic scenario, our model projects that nurse supply in general practice will decline by just over a quarter (28%) to around 12,000 by 2030/31. This is driven primarily by current trends and our assumptions regarding increases in nurse leaver rates in this scenario.
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