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  • Nursing is the key area of workforce shortages in the NHS. In 2019, the Health Foundation’s REAL Centre commissioned Decision Analysis Services Ltd (DAS), to develop a nurse supply model.
  • This project took a whole system approach, accounting for both the evidence base on the factors that drive nurses' decisions and stakeholder input.
  • The model enables the REAL Centre to publish evidence-based estimates of the future supply of nurses over a 5 to 20 year time frame. This will help in assessing where the shortages in nursing workforce supply are likely to be most pressing and exploring the implications of different policies to fill those gaps.
  • This project ran from October 2019 to September 2021. The REAL Centre is responsible for further development of the model.

Even before the COVID-19 pandemic, workforce issues were identified as the single biggest challenge for health and social care in England. Registered nurses are the largest single NHS staff group, accounting for around a quarter of all staff and half of clinical staff in the NHS. Nursing has long been the key NHS shortage area and accounted for 42% of full-time equivalent vacancies in the NHS in England in June 2021.

One of the main reasons for the shortages in nursing, and in the NHS as a whole, has been a lack of long-term planning around staffing levels and a ‘boom-and-bust’ approach linked to funding. Most existing models take a simple and relatively crude ‘stock-and-flow’ approach to workforce modelling by simply applying joiner and leaver rate data to current staff numbers and extrapolating into the future. The lack of high quality, robust, and transparent projections of workforce supply and demand is a major factor underlying the lack of a coordinated workforce strategy. This is partly due to a lack of capacity and capability at both national and local levels, exacerbated by reorganisations of the system architecture.

In 2019, the REAL Centre commissioned Decision Analysis Services Ltd (DAS to develop a comprehensive new nurse supply model rooted in system dynamics. DAS is an independent management consultancy with expertise in simulation, systems thinking, programme management, investment modelling and data analytics. The model, which DAS transferred to the REAL Centre in September 2021, can be used to provide better informed projections of nurse numbers under alternative policy scenarios over a 5 to 20 year timeframe. It considers nurses working across multiple regions and sectors.

The model yields projections of nurse supply that promote longer-term thinking and support better decision-making around the nursing workforce. It provides a set of tools that support the appraisal of alternative policies from a long-term workforce planning perspective. It is a vital contribution to the evidence base and the wider debate on this key workforce issue.

As the ultimate model owner, the REAL Centre and the Health Foundation will be responsible for any further updates to the model. We are keen to work with stakeholders in policy and academic institutions who want to use the model as part of their own work. To find out more about the model, read our series of working papers and supporting material referenced below. If you would like to discuss how the model might be useful to support your research or policy initiatives, please get in touch.

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Working papers

Further reading

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