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Key points

  • 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.
  • However, disparities between service areas continue to widen. 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.
  • Across all staff groups, the NHS had 83,591 FTE vacancies in June 2020. 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.
  • 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.
  • Further, about 15% of registered nurses in the UK are trained outside the UK – more than double the OECD average.
  • The 50,000 target will be insufficient to meet increased demand. We argue there needs to be a shift in focus, away from a single top-down target to a more sustainable, long-term approach.

The current shortfall of nurses represents a major long-term and growing problem for the NHS. And the impact of COVID-19 has brought the urgent need to deal with the identified critical nursing workforce shortages into sharp focus.

The central aim of this report is to examine the supply of nurses to the NHS in England. It covers:

  • the scale and nature of the shortfall in nurses
  • the sources of nurse supply
  • recent trends and how these compare with the government's pledge for 50,000 extra nurses by the end of the parliament.

The analysis shows that achieving the government’s target 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.

It concludes that the 50,000 target will be insufficient to meet increased demand. There needs to be a shift in focus, away from a single top-down target to a more sustainable, long-term approach.

A long-term approach should start with robust, independent projections of the future demand for and potential supply of nurses – something the REAL Centre is developing as part of its Nurse supply model project. The recently published working paper Nurse supply model: progress so far sets out how the model is being developed and how it will be used increasingly to inform and assess nurse workforce policy.

About the authors

James Buchan is a Visiting Fellow in the REAL Centre team at the Health Foundation.

Nihar Shembavnekar is an Economist in the REAL Centre team at the Health Foundation.

Jane Ball is Professor of Nursing Workforce Policy, University of Southampton.

Anita Charlesworth is Director of Research and the REAL Centre at the Health Foundation.

Cite this publication

Buchan J, Ball J, Shembavnekar N, Charlesworth A. Building the NHS nursing workforce in England: workforce pressure points. The Health Foundation; 2020 (https://doi.org/10.37829/HF-2020-RC14).

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