Health Education England says service must recruit 190,000 more staff by 2027 but instead low pay and work pressure are driving skills drain

This article is more than 2 years old

This article is more than 2 years old

The NHS is beset by acute shortages of nurses and paramedics and is facing a skills drain, with staff quitting because of pressurised jobs and poor pay, health service chiefs have said.

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While the NHS in England has 40,000 more clinical staff than in 2012, it is short of 42,000 nurses, midwives and therapists, according to Health Education England, which has drafted the NHS’s first strategy in 25 years to tackle chronic understaffing.

HEE, the NHS’s staffing agency, also warns that the health service workforce, which already stands at 1.4 million, will need to increase by 190,000 by 2027 unless the rise in illness recedes.

HEE admits that the service’s workforce has developed huge gaps in recent years in which the ageing and growing population has created a greater need for care. It warns ministers that radical action is needed over the next decade to ensure the NHS has enough staff to cope with the growing burden of illness.

Bank and agency personnel cover most of the vacant shifts. But HEE warns that patients could receive poorer care because unavailability of staff is so common that 8% of vacant shifts go unfilled, thus “increasing pressure on existing staff and potentially impacting on quality”.

“Shortages of this magnitude mean care for patients is suffering and staff are being stretched far too thinly. Unless something major happens quickly, more and more employees will quit, making a bad situation much worse,” said Sara Gorton, head of health at the union Unison.

Shortages are now so acute that:

• The NHS is short of 42,000 nurses, midwives, physiotherapists and occupational therapists.

• A widespread lack of nurses is most severe in London, where 15% of posts are vacant, and lowest at 8% in the north-east.

• There are 1,674 (26%) fewer district nurses and 842 fewer learning disability nurses than in 2012.

• GP numbers have fallen by 1% over the last five years despite a key government pledge to increase the total by 5,000 between 2015 and 2020.

• Almost one in three paramedic jobs are vacant across England.

• The number of nurses leaving the profession rose from 7.1% in 2011-12 to 8.7% last year.

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NHS organisations welcomed the draft strategy as something trade association NHS Providers called “a sensible and constructive start” to tackling the workforce problems. Prof Ian Cumming, HEE’s chairman, urged the NHS to become more “family-friendly” by offering more flexible working.

The blueprint also argues that NHS staff will need to be trained differently to adjust to a new era in which less care is provided in hospitals and more in GP surgeries, clinics and patients’ own homes.

But some questioned HEE’s lack of detail on the future of recruitment from overseas – which the NHS has relied on to plug gaps since its creation in 1948 – and on who will foot the bill for enacting the measures recommended to improve both retention and recruitment.

The NHS does have more than 40,000 more clinical staff than in 2012, including more adult general nurses, A&E consultants, health visitors and community mental health nurses, HEE points out.

But it has identified four key factors that are prompting increasing numbers of staff to quit, which it says is a major problem. They are pressure of work, lack of flexible working, inadequate pay and lack of career development.

“Ministers have repeatedly promised to boost staff numbers but have repeatedly failed to deliver,” said Justin Madders, a Labour shadow health minister. “Under this government we have seen a series of failed policies driven through by ministers, with historic cuts to training places, the end of the nurse bursary and the self-defeating public sector pay cap which have all contributed to huge gaps in the NHS workforce.”

Meanwhile, 79% nurses feel their workplaces are too short-staffed to give patients proper care, according to new research by the Institute of Employment Studies.

Almost as many (77%) feel that patient care is compromised several times a month because of staff shortages.

The IES’s survery of 7,720 nurses, commissioned by the Royal College of Nursing, also found that the existing exodus of nurses could get even worse because 37% say that they are looking for a new job.