Nursing supply has failed to keep up with ‘rapid growth’ in demand – NHS Improvement

Nursing numbers and consultant numbers in some sectors are significantly short of demand, leading to increased NHS spending on agency staff, according to a new NHS Improvement report.

The regulator, which officially starts operating from 1 April, noted that while the shortfall has led to increased agency costs “would be even worse were it not for productivity improvements made by trusts over the last two years”.

In its ‘workforce analysis’ NHS Improvement stated that in 2014 providers reported to Health Education England that they needed 189,000 adult nurses, a 24,000 rise from 2012. The increase in demand is thought to be caused by increases in the number of patients that hospitals admit and in the proportion of seriously sick patients, and an increase in safe staffing levels in light of the 2013 Francis report into failings at the Mid Staffs, which were caused partly by low staffing levels.

Between October 2012 and April 2015 the number of adult nurses employed grew by 10,000 full-time equivalents, but there were still 15,489 nursing vacancies as of April 2014, and trusts said that they needed to employ a total of 6,389 further nurses in 2014-15. In July 2015, 75% of NHS trust finance directors indicated they planned to increase their permanent nursing staff in the next six months.

The report also shows that NHS trusts increasingly rely on agency staff to fill nursing vacancies. For instance, agency staff accounted for 7% of the total staff bill for NHS providers in 2014-15, compared to 3.4% in 2011-12. They cost the NHS £3.3bn, of which 31% is spent on nurses.

Donna Kinnair, director of nursing, policy and practice at the Royal College of Nursing (RCN), said: “A shortage of full time staff has consequences for patient and hospital alike – fewer full time staff impacts on the patient experience whilst the costs of agency nurses soars.  The only long-term solution to dealing with agency costs is by training more full time nurses so that supply can meet demand.

“This report paints a picture of an NHS which has made some steps towards safer staffing, but still has a long way to go. It’s time to reaffirm that commitment in the best interests of patient care.” 

A recent National Audit Office report criticised the Department of Health, arm’s-length bodies, healthcare commissioners and providers for managing the supply of clinical staff ineffectively and increasing spend on agency staff.

Reasons for the high vacancy levels include the length of time necessary to train nurses, a drop in recruitment of nurses from outside the European Economic Area, with just 665 joining the UK nursing register in 2014-15, and a decline in the success of return-to-practice schemes. The report also found that demand is greater than supply in several sectors, including emergency medicine, clinical radiology and psychiatry, all of which are on the Home Office shortage occupation list.

NHS Improvement said its long-term actions to solve staffing shortages include supporting providers to improve productivity, pushing for the government to lift immigration caps on nurses, and imposing caps on agency spend and rates.

It also said that the decision to replace bursaries for student nurses with standard student loans, which has been criticised by the RCN, would “increase the supply of nurses and achieve a better balance between supply and demand in future.”

A new NHS Professionals campaign, ‘Love the NHS – Return to the Bank’ aims at encouraging former nurses to join staff banks that NHS trusts can use instead of agencies.

The report also found that consultant numbers have overall outpaced activity, which grew by 18% from 2007-12, compared to 22% growth in consultant numbers in the same period.

The Mental Health Taskforce’s report published yesterday also found that mental health services in the UK are severely short of requirements.




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