Action needed to address nurse shortages

In written evidence to the Commons Health and Social Care Committee inquiry into workforce, the foundation said the workforce gap was 115,000 FTEs in 2020/21, but this was projected to double over the next five years, exceeding 475,000 staff by 2033/34. The figure does not take account of the impact of the Covid-19 pandemic.

To achieve its 'modernised scenario', where rising expectations for the quality and range of care provided are met and technological advances adopted, the NHS in England is likely to require further workforce growth of 3.2% a year over the next 15 years. The foundation said this implied a projected gap of 179,000 staff by 2023/24, rising to 639,000 FTEs 10 years later.

Looking at specific staff groups, the charity said the English NHS faced a shortfall of 108,000 FTE nurses and 11,500 FTE GPs by 2028/29.

Together, the charity and Institute for Fiscal Studies (IFS) forecast that an additional 458,000 FTE social care staff would be needed in England by 2033/34, potentially taking the care staff gap to more than 1 million.

The government has pledged to employ 50,000 additional nurses by the end of the current Parliament (which is due in 2024), but the foundation said this will only be possible if investment is sustained and policies are introduced to improve domestic supply. The latter includes steps to produce a ‘marked improvement’ in retention of the current workforce’.

Anita Charlesworth (pictured), director of the Health Foundation’s Real (research and economic analysis for the long-term) Centre, said: ‘Years of under-investment in the workforce have made the NHS and social care less resilient to the pandemic than they might otherwise have been. Doctors, nurses, healthcare staff and care workers have been put under enormous strain over the last year, and the government now needs to take action to care for those who have cared for us.  

 ‘A fully-funded, national workforce strategy should be at the heart of plans to recover the NHS and put social care on a sustainable footing. The NHS and care system needs to recruit and retain enough staff to get services back up and running, but they also need to safeguard the wellbeing of those currently working on the front line. This can’t just be a one off — England needs a long-term approach to workforce planning that is transparent, accountable, and ensures we have enough staff with the right training to provide high quality care.’

A study from the IFS said the current national pay policy limits trusts’ flexibility to respond to the local labour market and exacerbated nursing staff shortages before the Covid pandemic.

Researchers found that nurses are more likely to leave an NHS hospital if the local cost of living increases quickly. Using house prices between 2012 and 2018 as a proxy for cost of living, they looked at areas of England where prices had increased rapidly. In these areas nurses’ relative earnings declined compared with peers who lived and worked in areas with slower growth in living costs. This led to increased movement of staff between hospitals, and to nurses leaving the hospital sector – more than 9,000 over the seven-year period.

In high-cost areas, trusts have responded in a number of ways to increase earnings, including faster promotion. But these measures did not come close to compensating nurses for higher living costs, the IFS said.

Isabel Stockton, an IFS research economist and an author of the report, said: ‘National pay-setting affords NHS hospitals little flexibility to respond to economic conditions in their local area. When, as a result, nurse earnings do not keep pace with local increases in cost of living, this prompts more nurses to exit NHS hospitals, particularly in expensive areas.

‘The existing system of supplements and retention premia is not fit for purpose. The pressures of the Covid-19 pandemic on staff, and the need to tackle a large backlog of NHS treatments in the aftermath, have only made the issue of nurse retention more pressing.’

Health Foundation senior visiting fellow James Buchan added that there were 35,000 nursing vacancies in England, while Covid led to one in 10 hospital nurses off work in January. ‘This [IFS] report provides further evidence that the government needs to urgently develop a comprehensive national workforce plan that enables the NHS to recruit and retain nurses where they are needed most.’