Last week’s research by the Institute for Employment Studies revealed the scale of challenges facing the NHS nursing workforce, with one in three nurses due to retire in the next 10 years. In line with much of the broader evidence, we found that demand continues to outstrip supply and that the reported overall vacancy rate across healthcare providers was approximately ten per cent.[1]
The report identifies three key causes of the current nursing shortage:
1.The Government have not funded enough student nursing places (despite demand for these places far outstripping supply).
2.The nursing workforce is ageing. The research reveals that there are not enough nurses entering the system to fill the gap or offset the loss of skills and experience that will take place when one third of nurses reach retirement age in the next ten years.
3.Since the Francis Report, safe staffing levels and increasing healthcare demands on NHS services have pushed up the demand for nurses, while at the same time Trusts have faced greater financial difficulties that have made the recruitment of nurses more challenging.
This poses an urgent question for Government, healthcare providers and workforce planners around who will fill this gap in the workforce. There are three realistic possibilities for filling this gap.
First, Government and healthcare providers could recruit more nurses from outside the European Economic Area (EEA).[2] International nurses, from countries like India and the Philippines have always played an important role in the NHS, and continue to do so, making up 8 per cent of the total nursing workforce in England. In March 2016, the MAC recommended that the Government grant up to 15,000 visas over the next three years to non-EEA nurses in order to ease the current nursing shortage. This will ease the immediate to short-term pressures on the NHS but it is questionable whether this will be enough to make up for the loss of a third of the nursing workforce over the next ten years.
Second, it is possible to recruit more nurses from the EEA. EEA nurses constitute 4.5 per cent of the total nursing workforce in England (up from just over one per cent in 2009), mostly from countries such as Spain, Portugal and Ireland. However, with the uncertainty around the status of EEA workers in the UK, post Brexit, the recruitment pipeline from Europe is likely to be hit hard.
Lastly, the Government could act now to ensure that we have a ‘homegrown’ domestic supply of nurses. This will require adequate and sustained investment in workforce planning, but this is likely to be the most sensible way of addressing a potentially gaping hole in our future nursing workforce. For too long now, there has been a lack of long-term, strategic workforce planning that offers oversight, coordination and alignment of the different dimensions of the nursing workforce (financial, education, employment and international recruitment). For example, workforce planners have known for several years now that the ageing nursing workforce is a problem, and yet very little, if anything, has been done about it; and in recent years there has been a lack of student nursing training places despite demand for nursing courses outstripping supply. It is time that workforce planners in the Government stop using international recruitment as a ‘quick fix’ to nursing shortages in the UK, while ignoring more systemic workforce issues. For example, having recently scrapped the student nurse bursary, the government will now need to monitor the impacts of this decision closely in case it puts people off training to be a nurse, thus reducing the potential pool of new recruits.
One last sobering thought: this issue is not just about numbers. Workforce planners need to consider the years of experience, skills and expertise that this ageing workforce will take with them when they retire. Replacing that will be an altogether more challenging task
[1] For example, see NHS Employers (2015), NHS Registered Nurse Supply and Demand Survey Findings. Leeds: NHS Employers.
[2] The EEA includes all European Union (EU countries) and also Iceland, Norway and Liechtenstein.