The NHS does not have the number of nurses it needs

A new report from the National Audit Office has argued that the NHS does not have the number of nurses it needs, with over 43,000 vacancies in July to September last year.

The NHS Long Term Plan of last year acknowledged the need to increase staff numbers, noting that the biggest shortfalls were in nursing. The NHS set up the People Plan programme to plan how it would secure the workforce it needed to meet its future service commitments. Two years previously, Health Education England noted pressures on the nursing workforce. In that two year period, indicators such as the nursing vacancy rate had worsened.

However, the NHS People Plan has, for a variety of reasons, been delayed. The NAO has released its report to set out the facts on: the current scale of NHS nursing shortages; challenges to the main entry routes for nurses joining the NHS and other workforce-related issues that future plans will need to address; and progress made on the People Plan so far.

Data shows that there has been a five per cent increase in overall nurse numbers in hospital and community services between September 2010 and September 2019. There has also been a five per cent increase in students starting undergraduate nursing degrees, between 2017–2019, compared with target of 25 per cent. However, NHS trusts report nursing vacancies of 43,590.

The NAO says that, despite overall increases in the number of nurses, the NHS does not have the nurses it needs. As at September 2019, the NHS had a nursing vacancy rate of 12 per cent, a rise of one per cent from September 2017. The Long Term Plan sets a target of reducing nursing vacancy rates to five per cent by 2028. NHS England and NHS Improvement has estimated that around 80 per cent of vacancies are filled by temporary staff.

Nursing vacancy rates are particularly high for mental health trusts (16 per cent) and in London (15 per cent). The proportion of overseas nurses varies from 30 per cent to 36 per cent in London regions to five per cent to eight per cent in the north‑east, north-west, and Yorkshire and Humber regions. Some sectors, such as primary care and community providers, also have a higher proportion of older nurses, who are closer to retirement.

Regarding entry routes into nursing, from 2017, the government changed the funding arrangements for nursing degree students, a major source of new NHS nurses. The number of applications for nursing degrees dropped significantly following the funding changes and subsequent numbers of new students have been below the Department’s targets.

The NHS Long Term Plan signals the need for a step change in the recruitment of overseas nurses, but the NAO says that recent national initiatives to increase numbers have not met their targets. Overseas recruits already make up between 20 per cent to 25 per cent of nurses joining the NHS. The number of overseas nurses working for the NHS is recorded as having risen by 28 per cent between September 2014 and March 2019.

However, against a target of 2,500, the Health Education England-led global learner programme only attracted around 1,600 nurses in the two years 2018 and 2019. It now has an increased target of 15,000 nurses between 2020 and 2024.