Decline and fall Despite recruitment drives, figures show the numbers of nurses, midwives and health visitors are still falling. And they're getting older, writes Barbara Millar

Want to work more hours for less money? Its hardly an attractive proposition. The public see nurses as over-stretched and underpaid, so its not surprising that getting people to join and then stay in the profession is difficult.

Now the number of nurses has fallen to a seven-year low. But the long-term trend is positive, according to the organisation responsible for registering them.

The annual statistics, just published by the UK Central Council for Nursing, Midwifery and Health Visiting, do contain a glimmer of hope.

UKCC spokesperson John Knape points out they show the first increase for seven years in the number of admissions.

The former may well reflect the governments success in persuading nurses and midwives who had left their respective profession to return to practice, he adds.

Overall, however, the picture is less rosy. The number of nurses, midwives and health visitors on the register fell by 3,220 to 634,229 last year.

The number of practitioners leaving the register shot up by nearly three times - from 7,173 in 1997-98 to 21,174. But the number of first-time registrations was up, from 16,382 to 17,954.

But John Stock, research officer with the Royal College of Nursing, points out that this rise is entirely due to an increase in the number of registrants from outside the UK.

The sheer volume of overseas registrants is a clear indication that the NHS is still looking abroad to fill the gaps in the workforce, he says. The data is simply not there to support the argument that the recruitment problem has gone away .

Long-term age and gender trends also continue. Only 13.3 per cent of those on the register are under 30, the smallest proportion since records began in 1984.

And the over-50's were at their highest ever level, at 23.3 per cent (see table).

The proportion of men on the register was at its highest ever level at 9.4 per cent, a small increase on the previous year .

The drop in the overall number of registered practitioners was expected, says a Department of Health spokeswoman.

The impact of the new post-registration education and practice requirements was always expected to lead to lots of nurses who had not maintained their practice dropping off the register, but we expected the drop to be much larger, she says.

The PREP requirements have provided a cleansing operation for the register. The fact that there are now more nurses registering is very encouraging.

The UKCC figures are also only one set of data, the spokeswoman stresses. The big picture involves the NHS hospital and community health services non-medical workforce census, which will be coming out in March.

This will give a truer picture of the number of whole-time equivalents working in the NHS, and that is what we will measure our target of 15,000 more nurses over the next three years against.

She is also encouraged by new figures from the Universities and Colleges Admissions Service, which show that the drive to recruit student nurses has led to a 24 per cent increase in the numbers taking up places on degree courses and an 18 per cent rise in those accepted for nursing and midwifery diploma courses.

The number of midwives who indicated that they intend to practise in the year to March 2000 rose by 1,000 to 33,803 - the first increase for five years and the highest level for three years.

But a frighteningly small proportion of practising midwives are under 30 - just 7.8 per cent.

It is the over-50's who are gaining ground, making up 18.7 per cent of the whole.

The proportion of midwives working part-time also rose to 48.4 per cent, its highest ever level. Both these trends are causing concern for the Royal College of Midwives.

The statistics reveal an ageing profession, which is very worrying, says RCM spokeswoman Pam Mead, and, while we are pleased the overall number of midwives has increased, the fact that almost half the profession is now registered as part-time detracts from this.

And the growing dependence on overseas nurses is highlighted by a new analysis from the UKCC, which shows that only a third of those applying from overseas for registration were accepted first time. Many were asked to undertake additional training before they could be admitted.

The number of applicants trained outside the UK and the EU has more than doubled since 1994-95.