A new report published today by the Health Foundation’s REAL Centre finds that despite recent increases, there have been significant falls in key areas in the NHS nursing workforce in England over the last 10 years.
The report authors raise concerns that the nursing shortfalls, together with the backlog in routine care and growing need for health care, is likely to make recovering from the pandemic particularly challenging. They say the government will need to exceed its target of 50,000 new nurses in England by 2024/25 if it wants the NHS to fully recover from the pandemic.
The report, Building the NHS nursing workforce in England, provides an in-depth analysis of the last 10 years of trends in recruitment and retention in the nursing workforce. It says that increases in NHS nurse numbers in recent years are likely to be insufficient in the face of growing health care demand, made more pressing by the impact of the COVID-19 pandemic. The report concludes that while the government’s 50,000 nurses target is achievable, it may still leave key service areas well short of the numbers needed.
The report shows that although overall nursing numbers have gone up by 8% since 2010, the number of health visitors and nurses working in community nursing, mental health and learning disability services are all lower than they were in June 2010. The number of mental health nurses dropped by 8% in the 10 years to June 2020; health visitors dropped by 15%, there was a 12% drop in the number of community health nurses and a 39% fall in learning disability nurses.
However, in the last year there have been increases in nursing numbers across all areas but at varying rates. The number of nurses working in adult hospital nursing grew by 5.5% in the year to June 2020, while the number working in learning disability nursing grew only by 2%, and in mental health by 3.8%. The report adds that these modest increases in part reflect nurses signing up to the Nursing and Midwifery Council’s ‘temporary’ register, initiated as part of the COVID-19 response, and may not go far enough to address longer term nursing workforce shortages.
The authors say the long-term trends are particularly concerning as people with learning disabilities are more vulnerable to COVID-19 than the general public, and the pandemic is likely to lead to increased demand for mental health services. The charity’s analysis shows that the impact of the pandemic is likely to drive up demand for mental health services by at least 11% a year and lead to an additional 1.8 million referrals over the next 3 years.
Anita Charlesworth, Director of Research and REAL Centre, said:
‘Nine months into the pandemic, the nursing workforce is under incredible strain. One in 10 nursing posts are vacant, and absence rates remain high. Our analysis shows that although nursing numbers are going up overall, in some areas they are lower than they were 10 years ago. This is hugely concerning as we are now in a situation where the number of people waiting for routine elective care exceeds 4 million and there is growing demand for mental health services.
‘Fixing the nursing crisis is not just about getting more nurses into the system, it is also about ensuring the workforce is fully supported and we have nurses available where they are needed most, including in mental health services, learning disability services and in the community. This is absolutely critical to enabling the country to recover from the deep impact of the pandemic. Nurses can only care for the nation if we care for them, which means attractive pay and conditions, flexible approaches to training, development and working life.
‘To fully recover from the pandemic, the government will need to exceed its 50,000 new nurses target and put in place robust systems for recruiting and retaining a nursing workforce fit for the future.’
Further findings from the report include:
- Nursing continues to be the most significant workforce shortage area in the NHS. The vacancy rate for registered nurses exceeded 10% in June. Registered nurses accounted for 45% of all vacancies in NHS hospital and community health settings in England.
- Within the NHS nursing workforce, there are signs the ‘skill mix’ is becoming diluted. Numbers of nursing support staff increased at over twice the rate of growth in registered nurse numbers in the year to June 2020.
- The main source of new nurses to the NHS comes from domestic university degree courses. In 2020 there was a 23% increase in the number of students accepted to 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 both the number of practising nurses and the annual number of new nurse graduates relative to its population. The UK has just under 8 practising nurses per 1,000 population (7.8), while the OECD average is 9. Germany has over 13 practising nurses per 1,000 population, while Australia has 12 and Belgium and the Netherlands each have 11.
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