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Staff with fewer qualifications are making up for empty nursing posts, according to a new report that reveals the current extent of the NHS’s workforce crisis.
Data from the Health Foundation found that, while more doctors and support staff have joined the NHS in 2018-19, not enough nurses have.
“The danger to patients is not from the increase in support workers, but the absence of nurses”
In the first quarter of 2018-19, nurse vacancies reached 44,000. According to the report, this number could spiral to 100,000 in a decade.
The nursing crisis has been a major point of interest for political parties in the run up to the general election.
The Conservatives have promised 50,000 new nurses and Labour are committed to reinstating the nursing bursary.
The Health Foundation report found that the overall workforce has seen the biggest annual growth since 2010.
But the charity warned that this was masking an ongoing shift in skill mix because support staff, such as healthcare assistants and nursing associates, were being brought in to compensate for the nursing shortage.
While registered nurses undertake a three-year degree, there are no set entry requirements to become a healthcare assistant, it noted.
According to the Health Foundation, this has effectively caused a “hollowing out” of the NHS workforce, as there is growth in both the most- and least-clinically skilled workers – leaving a gap in the middle.
The report, called Falling short: the NHS workforce challenge, revealed that between March 2018-19 there has been a small increase of 4,500 full-time equivalent (FTE) nurses – a rise of just 1.5%.
However, the number of healthcare assistants has gone up by 6,500 – an increase 2.6%.
The number of nurses working in the community, not including health visitors, grew by just 0.7% and mental health nurses went up by only 0.6%, but both groups remain below 2014 levels.
The NHS is also missing its target to recruit at least 5,000 overseas nurses a year until 2023-24 – in 2017-18 only 1,600 joined the service.
The charity noted that global shortage of nurses was making an impact and just because nurses signed up to the NHS it does not mean that they will choose to work and stay there.
“Two obvious solutions to the nurse staffing crisis would be to train more nurses in this country and retain more existing staff”
Dame Donna Kinnair, chief executive and general secretary of the Royal College of Nursing, said: “The danger to patients is not from the increase in support workers, but the absence of nurses.
“The shortage has reached record levels – 43,000 nurse jobs in England are unfilled and it is patients that can pay the heaviest price.
“It is unfair on healthcare assistants to ask them to take on work they aren’t trained or paid for in a desperate bid to plug gaps.”
Dame Donna highlighted research evidence cited in the Health Foundation report that showed that when a registered nurse was on a shift, patient outcomes improve.
Therefore, she said, it was essential that employers used support staff to supplement the work of nurses, not replace them.
“All the election pledges we’ve heard on boosting nursing staff must be about registered nurses, educated to degree-level – this report shows why that is vital. It must become the top priority for the new government.”
There has been an 85% fall in the number of EU nurses coming to the UK since the Brexit vote in 2016 – this can also be attributed to changes in English language testing, which are only now being loosened to encourage overseas recruitment.
A total of 6,382 nurses came to the UK from the EU in 2016-17, but this has dropped to just 968 in 2018-19.
The NHS is currently relying recruiting from other countries, but the fall in EU nurses has resulted in more nurses coming from countries such as India and the Philippines.
In 2018-19 there were 1,791 nurses recruited in India and 3,118 from the Philippines.
Data released by NHS Digital today showed that, as of September, the highest number of vacancies in the NHS was found in nursing and midwifery – which made up 40% of all advertised FTE vacancies in England.
Anita Charlesworth, director of research and economics at the Health Foundation, said: “Two obvious solutions to the nurse staffing crisis would be to train more nurses in this country and retain more existing staff.
“But the UK is struggling to grow the numbers starting nursing degrees. and while there must also be action to address this – for example, by giving nurse students the cost-of-living support that they need – it will take time to have a significant impact on the numbers of nurses.”
Projections show that the NHS might be able to retain around 11,000 more nurses by 2023-24 if action is taken now, explained Ms Charlesworth.
She said: “The reality is, whatever happens with Brexit, we will need more nurses from abroad than we are currently attracting to keep the NHS running. The incoming government must therefore ensure that our migration policy does not put barriers in the way of recruiting them.”
Also commenting on the report, Sean O’Sullivan, head of health and social policy at the Royal College of Midwives, said: “England is around 2,500 full time midwives short of the number it needs.
“The report shows that the NHS in England only gained 80 new midwives in the past year. This is not good enough. The government have committed to giving England’s NHS 3,000 more midwives by 2024.”
Niall Dickson, chief executive at the NHS Confederation, which represents health service organisations, said: “This report makes for sobering reading and shows how precarious the NHS staffing situation is. With over 100,000 vacancies, additional pressure is being heaped on support staff to plug the gaps – this is neither fair nor safe.
“Workforce is the number one concern among health leaders, and for good reason. What we need to see from an incoming government is urgent action to address what are now widespread shortages among doctors, nurses and other key staff.”
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