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, ensures you are tuned in to the daily pressures on staff, and the wider trends and policies shaping the workforce.

The number of nurses on the UK register has risen again, according to latest Nursing and Midwifery Council data, which covers the 2020-21 year. Andrea Sutcliffe, the NMC’s chief executive, said this paints a picture of “cautious optimism”, in the context of a truly awful year for NHS nurses.

In an interview with HSJ shortly after the report was published, Ms Sutcliffe said there was a worry that some nurses “may well have delayed leaving the register because of covid”, which contributed to “sustaining the register over the last year”.

“Will we see those people leave over the next couple of years?” she asked. “We should not be complacent. We need to understand the huge pressure professionals have been under over the last year.”

Ms Sutcliffe also pointed to the NMC’s leavers survey (from a sample of just over 6,000 nurses) over half gave “retirement” as their reason for leaving the register. This, in combination with the age profile of nurses on the register – approximately a third of the register is aged over 51 – highlights how employers need to be particularly mindful of the retirement risk. In addition, The Royal College of Nursing has argued there is a real risk that around a fifth of the register could retire over the next few years.

“You may well have caring responsibilities for children or parents and not want to spend 12 hours on your feet,” Ms Sutcliffe said. “That is one of the things we really need to think about… what flexibility can we introduce?”

The NHS’ workforce’s vulnerability to world events

Although the NMC suggested the figures from its register “signalled optimism”, the data highlighted how vulnerable NHS nursing recruitment is to world events.

Growth in nurses joining the register has been much slower this year than the year before. The change was particularly dramatic when looking specifically at the English register; a 2.3 per cent rise in the total number of nurses on the permanent register, compared to 11 per cent rise the year before the pandemic hit.

The number of people who joined from beyond the European Economic Areas fell by 24 per cent, fuelled by a three-month period at the beginning of the pandemic when the number of joiners “collapsed” to almost zero. There has also been a decline in nurses trained in the EEA, a trend since the Brexit referendum.

And covid disruption was also reflected in a decrease in the number of new joiners to the register; the effect on registrants from England was particularly clear, with just 260 joining, compared to over 2,000 the year before. In fact, the number of new joiners was bolstered by Northern Ireland, which saw over 1,000 new nurses join the register.

Health and social care secretary Matt Hancock was quick to celebrate the increase. He said it was a sign the government was moving to fulfil its “manifesto commitment” to increase the nursing workforce by 50,000 by 2024-25.

But looking beyond the headline figures highlights just how fragile this progress is, and as Ms Sutcliffe stressed: “We don’t know what the pandemic is going to do to us over the coming months and years”.

Playing catch-up

Previous Ward Rounds have discussed the impact covid has had on medical training. This has included warnings from trainers and employers that without additional funding they might be unable to recruit enough new middle grade and registrar doctors, as other doctors may need to extend their training after months of redeployment.

To try to help with the pressures on medical training, the government last week announced a further £30m to be spent on medical training recovery.

Sheona MacLeod, deputy medical director of education reform at Health Education England, said the money would be spent on supporting trusts to identify individuals’ training needs and explore a “tailored way” of enabling trainees to catch up on their competencies.

However, as first reported in HSJ a few weeks ago, the pandemic’s impact on training is unlikely to be fixed by a one-off stop-gap fund.

There remain almost 700 anaesthetists in training without a job, due to more applications this year and a perfect storm of other factors. The Royal College of Anaesthetists has written to the health secretary calling for an immediate increase in training jobs, and trust grade jobs too.

This particular workforce group is crucial if the elective backlog is to be tackled and the NHS can’t afford to lose a single one – I’ve already spoken to multiple trainees who have already decided not to progress their anaesthetics career in the NHS.

Mr Hancock talked about the “formula for beating the backlog”, but this must also involve recognising that the workforce needs long-term investment, not a one-off plug.