A shortage of more than 14,000 nurses by 2011 could cripple NHS organisations as they struggle to meet patient demand for services.

The document by the Department of Health's workforce directorate shows that by the end of the period covered by the three-year comprehensive spending review (CSR) the NHS will be left desperately trying to fill the equivalent of over 14,000 whole-time equivalent posts.

The DoH proposes several ways to plug the gap in the short term, including increasing the use of bank nurses as an 'efficient way to manage temporary fluctuations in staffing levels'.

'This would be the most cost-effective way of increasing marginal supply from the existing, experienced workforce,' it says.

The directorate believes there could be enough temporary nursing staff capacity to meet demand, highlighting evidence that NHS Professionals has seen a 20 per cent drop in the number of shifts worked by nurses on its books over the past year 'as trusts bear down on temporary staffing costs to save money'.

Other options, such as the use of overtime, incentives, and greater use of agency staff are dismissed as 'costly', while international recruitment is perceived as 'tricky to do quickly and for short periods', given that most staff are on two-year contracts. However, the document does suggest that it might be possible to slow down the return of existing staff brought here through international recruitment, reversing existing policies.

The document also stresses that strategic health authorities must be pushed to restore recent cutbacks in nurse training.

It suggests the DoH's role is to 'set a clear strategic direction' for workforce development, and communicate it to SHAs. With nursing, this means ensuring the underlying level of nurse training provided is set at a level which avoids the re-emergence of shortages over the CSR period, it says.

According to the document the government expects current cuts in nurse training as a result of financial pressures to be 'felt in the workplace in the next few years'. This would mean that the number of newly trained staff would be insufficient to replace those leaving the profession.

Other pressures arise as a result of the ageing workforce and the recruitment of fewer international staff as nurses have been taken off the Home Office 'shortage occupations list'.

The document concludes that if the NHS fails to 'secure' an adequate supply of nurses over the next few years, wages could rise as a result. 'This reinforces the case for encouraging SHAs to take a strategic view and restore the recent reductions in nurse training commissions,' it adds.