Peter Carter, Interim Chair North Middlesex Hospitals, former general secretary & CEO Royal College of Nursing
The phenomena of a shortage of nurses in the National Health Service (NHS) of the UK are not new. In 1948 the year the NHS came into being there was funding for 85,000 nurses however there were 30,000 vacancies. Percentage wise this puts the current difficulties in the shade. It was this massive shortage in the post war era that started the trend to recruit overseas particularly from British Commonwealth countries and Ireland. The current management of NHS in England are not responsible for creating the current difficulties but they certainly have the responsibility to address the issues and it is quite apparent that the CEO Simon Stevens, Chief Nursing Officer Ruth May et al are doing that.
The current scenario is as follows. There are 44,000 nursing vacancies and this number is rising. On the Nursing and Midwifery Council (NMC) register in the UK there are 685,000 nurses and midwives. Of these 200,000 are over the age of fifty and will be retiring over the next ten years. We are currently training 20,000 nurses each year however there is an attrition rate at many Universities in double digits. This coupled with the growing trend of UK nurses to go overseas to countries such as Australia, Canada, New Zealand the USA further creates difficulties in the system and then very worryingly last year 17,000 nurses under the age of 40 took themselves off the NMC register. The “Brexit” factor has resulted in a 96% reduction in less than a year in nurses from overseas seeking to register in the UK. There is also emerging evidence that nurses from EU countries are leaving to return either to their home countries or to countries where they have security of tenure.
The challenge with recruiting from overseas is compounded by the fact there is a worldwide shortage of health worker’s and in particular nurses. In his seminal work Human-solving the global workforce crisis in healthcare, Mark Britnell the Global Chairman & Senior Partner for Healthcare Government & Infrastructure at KPMG International is the eminent global expert on healthcare systems, predicts there will be a demand by 2030 for 80million health workers worldwide and that there will be a shortage of 18 million.
Now before I am inundated over social media being accused of selling nursing down the river let me say up front that the evidence is clear that the higher ratio you have of registered nurses the better clinical outcomes. Distinguished luminaries such as Linda Aiken of the of Penn University, Jane Ball University of Southampton and Alison Leary London South Bank University to mention but a few have the evidence to support this.
The number of students in training has increased over the past few years but we are still not up to the number we were in 2004. There are copious examples of ill thought through cuts to training commissions. By way of example in 2012 the number of places in London was cut from 2000 to1580. The consequences of this in London have now come home to roost.
So what are the solutions? First of all do everything possible to increase the number of training places. Secondly have employment policies that retain staff and thirdly despite the ethical issues recruit from overseas. The bad news is that the mathmatics are such that these initiatives will not be enough. We therefore have to look for a different type of worker and this is where Nursing Associates come in. This month a milestone was passed in that 1,000 Nursing Associates have joined the Nursing and Midwifery register. This is welcome news but is only touching the tip of the iceberg. We need to train thousands of Nursing Associates. This is not in any was to diminish the role of nurses, quite the opposite but this is the only realistic way to address the here and now problem The hand grenade has gone off and the only way to deal with the collateral damage is to support the initiatives already being championed by Dido Harding Chair of NHS Improvement, Simon Stevens and Ruth May but also for all employers, professional organisations and Unions to get four square behind the recruitment of Nursing associates. Give me an army of Nursing Associates as opposed to wards and other clinical areas left with insufficient staff. A failure not to act now is not worth contemplating.