Nurses (Photo by Morsa Images/Getty Images)

Can a workforce strategy solve the NHS’ staffing crisis?

17 Feb 2017, by Amina Khatun in Public services

Staff shortages in the NHS are nothing new. It has been a chronic issue affecting the NHS since cuts made to training budgets in 2010 and 2011; heightened by existing pay restraint, staff morale and workload issues. But recent events and detrimental government policy are only exacerbating the situation. The TUC is calling for a workforce strategy that responds to those challenges.

The ONS shows that between 2013 and 2015 there was a 50% increase in nursing vacancies from 12,513 to 18,714. That number currently stands at 24,000. It’s no surprise, then, that every single UK hospital now has a shortage of nurses.

The NHS Support Federation and TUC report is illustrative:

75% of A&E nurses said their shift did not meet the NICE recommended ratio of at least two registered nurses to one trauma patient.

The Royal College of Midwives (RCM) found midwives were driven away from the NHS by excessive workloads and poor staffing levels, many citing safety as an issue. 80% of heads of midwifery reported vacancies in their unit.

The Royal College of GPs (RCGP) warned that by 2020 the UK will face a shortfall of nearly 10,000 GPs, with one in 15 practices closing. At the same time, it’s been discovered that 15% of all A&Es are now facing closure.

There’s also increased pressures on the NHS, presented by a growing population and a higher proportion of over-65’s, often with long term conditions. With workforce shortages – staff have consistently complained of deteriorating patient care. Patients have been left unwashed, unmonitored and without crucial medications. It sets alarm bells ringing and reminds us of the Mid-Staffordshire scandal.

The government should be learning from its history. But is it? The worry is that numbers in staffing will only dwindle further by recent regressive issues.

End to student bursaries

The government’s abolition of NHS bursaries led to a 23% fall in applications to nursing and midwifery courses in the first year. All non-repayable NHS bursaries have been replaced with income-contingent loans. Students enrolling from 2017 are required to pay the full tuition fee of £9,000 – an estimated increase of 71% total costs incurred by a single student.

As well as overall reduction in applications due to the cost, many students either suffer from in-course attrition and drop-out or don’t pursue the profession upon completion.

The benefit to Higher Education Institutions (HEI) is also uncertain. That’s because any income generated from tuition fees will be used to fund bursaries. The Exchequer will also only be better off by £534m per cohort, and that’s only if students in nursing, midwifery and in Allied Health Professions achieve comparable post-graduate earnings as other graduates. Furthermore, the desired cost savings could all be wiped out altogether with the medium-term dependency on Agency staff. And that’s been the story for some time!

Decline in EU applicants

And then there came Brexit…

There’s been a decline in both domestic (5%) and EU applicants (7%) for nursing vacancies. The EU numbers are particularly worrying – coming after four years of 5-7% growth in applications. Could EU nurses be turning their backs on Britain?

Figures show that since the Brexit referendum there’s been a decline of nurses registering to work in the UK by 90%. By 2020, moreover nearly half of the workforce will be eligible for retirement – only intensifying the NHS’s staffing crisis. The NHS simply could not cope without the contributions of EU nurses, and without comparable growth in domestic applicants which are also tailing off. Doubts surrounding EU workers’ status are also affecting morale of the entire workplace. Patient care and safety will suffer until the government takes heed to recruitment and retention issues.

Time for a workforce strategy?

The solution might seem obvious, but we need a comprehensive workforce strategy. That addresses:

The impact of wage stagnation on recruitment and retention, morale and motivation

Future recruitment, including student commissions

Pay and reward of staff delivering NHS services across the UK

Positive approaches to improve productivity: including better rates for bank and overtime work; implementing the recommendations of the Boorman Review; and investment in staff

In the coming two years we will continue to press the case for an optimal workforce that serves patients well. This can’t be achieved without promoting the NHS as an attractive employer, with better terms and conditions that support recruitment and retention of staff, and many more initiatives that can be found here.

These ideas might just save the NHS from the staffing crisis it finds itself in! Because where would the NHS be without its workforce?