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NHS relying on less skilled and foreign nurses

UK is struggling to train enough nurses and fewer EU trained nurses are now coming to the UK

Ingrid Torjesen

Thursday, 28 November 2019

The NHS is struggling to deal with the growing and widespread nursing shortages, and is having to rely on less skilled staff to fill the gaps, a report from the Health Foundation has found.

The UK does not train enough nurses domestically, and there has been a severe drop-off in supply of EU trained nurses since the Brexit vote in 2016. As a result, the UK has significantly ramped-up its recruitment of nurses from non-EU countries over the last year, the Health Foundation found.

The report, Falling short: the NHS workforce challenge, reveals that between March 2018 and March 2019, the NHS saw the biggest annual increase this decade in its overall workforce. But it warns that this growth masks an ongoing shift in the mix of clinical staff employed in the NHS – while numbers of doctors have increased, much-needed growth in the number of registered nurses has been outstripped by increases in clinical support staff, including health care assistants and nursing associates.

While there were 4,500 more full-time equivalent (FTE) nurses, an increase of just 1.5%, the NHS employed 6,500 more FTE support staff for doctors, nurses and midwives – a 2.6% increase.

The Health Foundation says there has been an effective “hollowing out” of the NHS workforce as increases in the numbers of doctors and clinical support staff are set against growing registered nurse vacancies, which rose to a record-high of almost 44,000 in the first quarter of 2019, and growth in the level of output the NHS is delivering (including numbers of operations, consultations, diagnostic procedures and A&E visits in a year), which grew by almost a quarter (23%) between 2010/11 and 2016/17.

The figures suggest that in some cases, clinical support staff are effectively filling the gaps left by the widespread shortages of nurses, raising questions of quality and safety, the Health Foundation says. It acknowledges that changes in the mix of staff within the NHS can be positive if they reflect changes in patient need, and are underpinned by evidence-based policy, but says these developments appear to be a largely unplanned response to the failure to train and recruit enough nurses in recent years. 

Nursing shortages have also contributed to a growing gap in the number of nurses working in hospitals compared to those working in the community. While the number of hospital nurses has grown by 2.2%, nurses working in the community, excluding health visitors, grew by just 0.7% over the last year. At the same time, mental health nurses grew by just 0.6%, leaving the number of nurses working in community and mental health services below levels in 2014. These changes cast doubt on the NHS’s ability to make planned improvements, including to mental health services, and deliver on a key ambition to move more NHS care out of hospitals and into the community.

The Health Foundation says that the NHS will need to recruit at least 5,000 more international nurses a year until 2023/24 to prevent nurse shortages from impacting on patient care and acting as a brake on ambitions to improve the NHS. However, in 2017/18 only around 1,600 joined the NHS and there is a global shortage of nurses.

There was a marked increase in numbers joining the nursing register from outside the EU in 2018/19 – including 1,791 from India and 3,118 from the Philippines. This follows an 85% fall in the number of nurses coming to the UK from countries within the EU, since the 2016 Brexit vote and changes to English language testing requirements – numbers have gone from 6,382 in 2016/17 to 968 in 2018/19.

The analysis also reveals a similar trend in general practice. Between March 2018 and March 2019, there were 453 fewer qualified, permanently employed GPs – a fall of 1.6%. The government’s original target of recruiting 5,000 additional GPs by 2020 now seems almost impossible, the Health Foundation says. As a result, temporary staff and GPs in training are making up a greater proportion of the GP workforce than ever before, and non-GP clinical staff are playing an increasing role in the delivery of care. For example, the number of pharmacists in primary care grew from 743 to 1,137 in the last year – an increase of almost 40%.

Anita Charlesworth, director of research and economics at the Health Foundation, said: “While it is encouraging that politicians have made pledges aimed at addressing the workforce challenge, we need to be realistic on bold promises to greatly increase numbers of nurses and GPs quickly.

“Two obvious solutions to the nurse staffing crisis would be to train more nurses in this country and retain more existing staff. But the UK is struggling to grow the numbers starting nursing degrees. and while there must also be action to address this – for example, by giving nurse students the cost-of-living support that they need – it will take time to have a significant impact on the numbers of nurses. Our projections show that, with concerted policy action, the NHS might be able to retain around 11,000 more nurses by 2023/24 than at current trends.”

She added: “Whatever happens with Brexit, we will need more nurses from abroad than we are currently attracting to keep the NHS running. The incoming government must therefore ensure that our migration policy does not put barriers in the way of recruiting them.”

Niall Dickson, chief executive at the NHS Confederation, which represents organisations across the healthcare sector, said: “This report makes for sobering reading and shows how precarious the NHS staffing situation is.”

He added: “All of the major political parties have identified the staffing challenge in their manifestos and this is welcome. What we need to see from an incoming government is urgent action to address what are now widespread shortages among doctors, nurses and other key staff.”

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