Statistics are charting a dangerous shortfall in nurse numbers, and the problem won’t go away until we face up to the need to foster more home grown talent, writes Jan Quallington
In the run-up to the general election, there was constant talk of what could be done to rescue the NHS from crisis.
‘We are surrounded by statistical evidence highlighting the scale of the problem’
But for all the political rhetoric, few commentators seem to be aware that we are already teetering on the brink of disaster on an unprecedented scale, unless something is done now about training more nurses.
The ongoing failure to act means many health services will grind to a halt unless the incoming government takes immediate action.
The new administration, whatever its composition, will have to move within its first weeks in office to avert this impending disaster, by expanding the number of student nurses.
- Staff shortage fuels recruitment of nearly 6,000 overseas nurses
- Four out of five hospitals miss own nurse staffing targets
We have known this time bomb is ticking. Health Education England was created in 2012 to provide “national leadership” for nurse workforce planning, but it has simply presided over a worsening disaster.
We are surrounded by statistical evidence highlighting the scale of the problem. The Centre for Workforce Intelligence has predicted the shortage of nurses could be as high as 190,000 by 2016; meanwhile, the number of nurse training places has fallen by 2,500 since 2011, a drop of almost 13 per cent.
A National Institute for Health and Care Excellence report last year said an extra £414m was needed immediately to produce safe staffing levels.
‘The majority of nurses say their wards are sometimes, or always, “dangerously understaffed”’
We also know from repeated surveys among nurses that the majority say their wards or units are sometimes, or always, “dangerously understaffed”.
This is happening at a time when it is universally recognised that demand for NHS services is rising at a steady rate of 4 per cent a year.
We know there is a predicted NHS budget shortfall of £30bn by 2020, and we will not get any closer to reducing the deficit by spending extra millions plundering the world’s supply of temporary agency nurses.
The problem was painfully laid bare in the appalling revelations of the Francis report two years ago, which looked at 1,200 apparently avoidable deaths and thousands of examples of cruel or substandard care at Mid Staffordshire Foundation Trust.
‘One-third of the workforce is already nearing retirement age’
A shortage of properly trained staff was identified as a major factor, but despite the continuing litany of reports on care of elderly and frail people lacking compassion, alongside news of regular crises in overstretched accident and emergency departments, little is being done.
It is hard to understand how much more evidence is needed before proper action is taken.
The Francis report led to a decision to fund an extra 500 nurse training places in 2015-16, but this is only a start, as one-third of the workforce is already nearing retirement age.
Nationally, the Royal College of Nursing said 50,000 people applied for 21,000 nurse training places last year, indicating plenty of people have an interest in the career.
‘We are ready, willing and able to increase our numbers’
It is impossible to understand why more use is not made of the excellent facilities available. My institution is allocated 167 training places, but we can only accommodate an additional 50. Every year we turn away five perfectly qualified and enthusiastic candidates for each place we offer.
We are ready, willing and able to increase our numbers and design courses to enable more people with foundation level qualifications to undertake further training in a very cost effective way. The same must apply to many other universities in England.
We have to ask ourselves why this is being held back by a highly questionable quota system of training places.
According to the RCN, it costs the NHS about £70,000 in total to train a nurse for three years, who at entry level will then earn around £21,478 a year. Even with employers’ national insurance contributions and pension added, a newly qualified nurse will not cost more than £24,000 a year.
This is somehow considered too expensive, and so short term, costlier measures to plug the gaps are adopted instead.
It is beyond absurd to read of hospitals paying £2,200 for an agency nurse to cover a 12 hour shift, as reportedly happened recently at Shrewsbury and Telford Hospital Trust.
‘The solution of producing more committed, trained nurses, continues to stare us in the face’
It is equally ridiculous for other hospitals to regularly pay upwards of £1,000 per shift to bring in overseas nurses. They may be well qualified but have no investment in their workplace and no intention to stay, despite the generous and costly support packages offered to them.
This issue is in addition to the questionable morality of the aggressive recruitment of nurses from parts of the world that can ill afford to lose their expensively trained and vitally needed workforce.
It is immensely frustrating that the obvious solution of producing more committed, domestically trained nurses, continues to stare us in the face.
We can only hope that the next government sees the light more clearly than the present administration.
Jan Quallington is head of the Institute of Health and Society at Worcester University
“We note the unwarranted criticism of Health Education England in your comment piece from Jan Quallington. To set the record straight, HEE increased adult nurse commissions significantly in its first year and increased them again the following year. Since our establishment, we have grown adult nurse training places by 13.6 per cent. In addition, although our remit is primarily for the future workforce, we have taken decisive short term action to help the service and our ongoing return to practice campaign has already secured a further 1,300 nurses. Planning the future workforce is, of course, more than just a numbers game. We need to ensure that future patient needs are met and that we have enough people with the right skills, values and behaviours available to work in the most appropriate settings. It would be wrong to train excess numbers of any healthcare professionals, that is not good value for money for the taxpayer and risks unemployment for the individuals concerned.”