Staffing is the issue keeping NHS leaders awake at night - and which consumes two-thirds of trusts’ spending. The fortnightly The Ward Round newsletter, by HSJ workforce correspondent Annabelle Collins, will make sure you are tuned in to the daily pressures on staff, and the wider trends and policies shaping the workforce. Contact me in confidence.
Could the latest NHS workforce data be a reason for cautious optimism? According to NHS Digital, the number of nurses in the English NHS has increased by 13,840 compared to last year and the number of doctors has risen by 9,306.
The health and social secretary said the new data, along with the recently reported rise in UCAS acceptances for nursing courses in England, show the government is “well on our way to delivering 50,000 more nurses by the end of this Parliament”.
While this uplift in nurses is of course welcome news, it is not the full picture and by no means a sign the NHS workforce crisis is nearly over.
Firstly, its important to note the nursing figures for May included some former healthcare professionals who volunteered to return to the NHS during the coronavirus peak. During this month, according to the Department of Health and Social Care, 592 returners were identified, of which 157 were nurses and 102 were doctors. It will be interesting to compare how the figures for June and July 2020 differ as more data is available later this year, and we perhaps begin to see returners choosing to leave the health service once more.
It is also important to note what is happening within specific staff groups, which might not command the same attention as adult nurses and medics. For example, the latest data shows a continued decline in the number of health visitors, falling by around six per cent between May 2019 and May 2020.
Another worrying figure is there has been an increase of just two community and learning disabilities nurses during the same period.
And the number of diagnostic radiographers has also been shown to be in decline since November 2019. This, in combination with recent Royal College of Radiologist figures, which have shown the NHS has just five more clinical oncologists than it did in 2018, does not bode well for the backlog of over two million people waiting for cancer care after the disruption of the covid peak.
It is also worth noting a few days later, NHS vacancy data was published, and set out a slight increase in the number of nursing vacancies between quarter four of last year and the first quarter of this year. It is important to stress the increase in vacancies was by less than one per cent, with some parts of the country noticing a reduction in vacancies, but this data is symptomatic of the pressure covid-19 has put on the system over the last six months.
Nuffield Trust senior research fellow Billy Palmer said of the vacancy data that the “incredibly challenging spring months will have piled on undeniable pressure onto frontline staff”.
“This is likely to have some influence on decisions made by some to leave the profession,” Dr Palmer sad. “NHS hospitals will want to ensure that they are plugging these gaps to gear up for what could be a very testing winter.”
Of the increase in nurses overall, Dr Palmer said although the direction of travel is positive, there is a while to go yet. “To meet the government’s nursing pledge and address the growing backlog of unmet need caused by the pandemic much more still needs to be done to not only keep recruiting but also keep nurses wanting to work within these services,” he added.
The point about keeping nurses – and of course other staff – in the system is crucial. The Ward Round has written before about the need for the NHS to become the best place it can be for all its staff to work in, and boosting retention will become a key factor in whether the government’s ambitious workforce targets are met. With a challenging winter ahead, now is not the time to be complacent, but instead for the government to double-down on its efforts.
The right investment?
The pressure on international recruitment continues – although well-placed sources have suggested that nurses recruited before the covid restrictions were put in place are starting to be able to travel from India and the Phillipines via the Middle East to the UK. Despite this glimmer of hope, the need to strengthen domestic recruitment pipelines remains imperative.
As set out in the first installment of the People Plan, more clinical placements and more nursing university places are important to growing the domestic workforce, but separately to this the government also announced a £172m package to train more nursing apprentices. It said this should result in up to 2,000 nursing apprentices being trained every year for the next four years – resulting in a potential for employers to double the number of apprentices they train.
Some workforce experts have questioned why this investment in apprenticeships, when the scheme has not been particularly successful in the NHS and there is much criticism about its lack of flexibility. When it comes to retention, nurses often report leaving the health service because of lack of opportunity and training opportunities. If retention is the top priority, should this money have been invested in continuing professional development training instead?