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The UK’s nursing and midwifery workforce has grown by more than 18,000 in the past year – the largest annual increase on record, according to data released today by the Nursing and Midwifery Council.
The number of nurses, midwives and nursing associates on the NMC’s permanent register has risen from 698,237 in April 2019 to 716,607 in March 2020, with a large proportion of the new registrants coming from overseas.
“Going forwards, the significant growth we’ve seen recently may not be sustained”
Over the year period, registrations from international nurses and midwives from outside of the European Economic Area (EEA) increased by 11,008 (15%). The NMC said the spike had been driven by a “surge” in first-time joiners from these countries.
Overall, almost half the NMC’s permanent register growth came from people who had originally trained in the Philippines and India.
The number of registrations from nursing and midwifery professionals who trained domestically in the UK increased by 9,012 (1.5%).
While the growth has been welcomed, the figures lay bare the extent of the UK’s continued reliance on overseas recruitment to shore up its nursing and midwifery workforce.
In the wake of Covid-19, the NMC warned of “potential storm waters ahead” as travel restrictions and other protective measures make it more difficult for recruits to migrate.
In its new report, the regulator said that “because so much growth came from overseas professionals joining our register, we need to consider carefully what will happen to the size of our register over the next six to 12 months”.
The new challenges around international recruitment introduced by the Covid-19 outbreak “needs to be factored into workforce planning”, noted the report, adding that “focusing on the retention of our existing workforce will be ever more important”.
NMC figures seen by Nursing Times last month showed permanent registrations from overseas nurses and midwives outside of the EEA plummeted from 1,348 in March 2020 to just 35 in April 2020, as the coronavirus crisis peaked in the UK.
Andrea Sutcliffe, pictured above, NMC chief executive and registrar, said the pandemic had meant the “vital skills, specialism and resilience of our nursing and midwifery professionals have never been more publicly recognised and valued”.
“It’s therefore great to celebrate record numbers of people on the NMC register,” she added.
However, whilst the rise in nurses and midwives from within the UK and overseas was “very welcome for everyone working in and using health and care services”, Ms Sutcliffe warned that there were “potential stormy waters ahead”.
“As a result of the pandemic and subsequent travel restrictions, we may no longer be able to rely on the flow of professionals joining our register from overseas in the same way,” she said.
“Going forwards, the significant growth we’ve seen recently may not be sustained.
“Nor can we afford to ignore existing pressures, exposed and exacerbated by Covid-19, which may challenge employers’ ability to retain our essential nursing and midwifery professionals as health and care services seek to recover.”
She stressed that the “insight” the new data revealed needed to be used to “focus on creating the right environment, conditions and incentives to support the sustainable recruitment and retention of nursing and midwifery staff now and for the future”.
Overall, the number of nurses on the register had increased from 653,544 in 2019, to 669,854 in 2020.
The number of midwives had gone up from 36,916 to 37,918, and the number of nursing associates in England had risen from 489 to 1,693.
The nursing regulator made clear that the staff who signed up for the Covid-19 temporary register were not counted in the overall numbers on the permanent register.
Other figures from the data showed the number of nursing and midwifery professionals from within the EEA continue to decline, with the number this year reducing to 31,385 – a 5% drop on the previous year.
Meanwhile, data showed that 21,306 people from the UK had left the permanent register in 2019-20. The number of annual leavers peaked in 2016-17 and has decreased year-on-year since then.
As part of today’s report, the NMC also revealed findings from an annual survey of professionals who leave the register, which ran in October 2019, before the pandemic, and received 1,626 responses.
The top three reasons for leaving were because of “too much pressure”, retirement and because personal circumstances had changed.
“Too often people quit nursing because of the level of pressure, making shortages even more acute”
Those who had cited feeling too much pressure noted that “highly demanding work environments arising from a combination of high expectations, pressure of responsibility and volume of work, contributed to high stress levels”.
Several respondents had also made comments about “feeling under-supported, particularly around their concerns not being addressed by management, for example around bullying”.
The NMC noted that the impact of Covid-19 had “exposed and exacerbated some of these pressures, which may challenge employers’ ability to retain these essential professionals as services recover and restore”.
Responding to the new registration figures, Royal College of Nursing chief executive and general secretary Dame Donna Kinnair said: “We celebrate the diversity of our global profession and numbers are slowly moving in the right direction.
“But UK government needs to do everything within its gift to help our existing workforce and ensure that nursing is attractive, well-paid, and meaningfully supported. This is how to equip NHS and care services to help keep patients safe.”
Dame Donna reiterated that the data showed “that too often people quit nursing because of the level of pressure, making shortages even more acute”.
“It’s tough going to work every day when there aren’t enough of you and there is seemingly little light at the end of the tunnel,” she said.
“Breaking this cycle through investment in domestic supply and action is about both patient safety and the health of our workers.”
Meanwhile, Unison’s national nursing officer Stuart Tuckwood said: “Although staffing numbers are heading in the right direction, there’s a long way to go before the 100,000 vacancies across the NHS are filled.”
He said that health staff were “facing burnout from the colossal pressures of the past few months”.
“It’s time for proper investment in the NHS with better pay, safe staffing levels and increased emotional support,” added Mr Tuckwood.
Policy analyst and head of public affairs at the Nuffield Trust, Mark Dayan, said the “largest-ever jump” in staff on the register was “good news”.
Mr Dayan said the growing numbers of nurses and midwives joining from outside the EEA and more people from the UK were “welcome steps” towards meeting the government’s pledge to deliver 50,000 more nurses.
“But these gains could be a false dawn,” he warned.
“Not least because of the overwhelming burden on health and care staff as the country battles through the coronavirus pandemic.
“International staff might look more askance at the UK if it seems to have let a disproportionate number of BAME workers die from the disease.”
He also reiterated that even before coronavirus, “the pressure and the toll on the mental health of staff was propelling people to leave the service”.
“Covid-19 has emphasised many of these issues, and staff will continue to weigh up the benefits vs the pay, reward and working environment they will face,” added Mr Dayan.