Author Mark Richards

The number of nurses in the NHS has fallen. What are the reasons? And what does it mean for patient care?

Let’s start off with the bad news: the number of nurses employed by the NHS has fallen for the first time since April 2013.

Figures from the King’s Fund show that there were fewer nurses in a post this summer than in 2016 – not by a lot, but by enough to make a difference if your mum needs someone in the middle of the night. In June 2017 there were 316,275 nurses in a post in the NHS – 703 down on the previous year.

703 out of more than 300,000 does not sound much. In round figures, it is a quarter of one percent. It is the reasons for the fall that are worrying – and the situation looks like it is only going to get worse.

The good news? As far as the number of nurses goes, there isn’t any.

Why has the number of nurses declined?

There seem to be three reasons for the fall. More stringent language testing is a contributory factor, and there appear to be more nurses leaving because of ill-health and a need to address ‘work-life balance.’ The King’s Fund suggests that work-related stress has played a major part in this, with the recent funding squeeze and pressure for fewer staff to do more work not helping matters.

The biggest factor though appears to be a sharp fall in the number of EU nurses registering to work in the UK. It is difficult not to lay the blame for this at Brexit’s door: in April 2017 just 46 nurses from EU countries registered with the Nursing and Midwifery Council:  in July 2016 the number was 1,304.

On top of this, the Government announced plans to scrap bursaries for student nurses: early indications are that this is leading to a fall in successful nursing applicants.

Can the NHS do anything about this?

Well, the NHS cannot do anything to kick-start the Brexit negotiations: but could it do more to tackle stress within the workplace and help to retain staff that way? There is increasing evidence from the private sector that tackling stress and discussing mental health in the workplace can lead to a significant increase in profits. Clearly, the NHS is not concerned with making a profit, but a significant move towards tackling mental health problems could pay dividends in staff retention. “Business that openly address the issue of mental health appear to perform better than those that don’t,” said Johann Huber, boss of Soma Analytics, the firm that carried out the private sector research.

For many companies, one of the key factors in tackling stress and mental health issues has been the introduction of more flexible working patterns. Unfortunately, this may not be an option for the NHS: there are inevitable peaks in demand, especially in the winter. And when your waters have broken the last thing you need is a midwife who is working flexibly…

Will the NHS still provide safe care?

Inevitably, worries about declining numbers of nurses lead to worries about the ability of the NHS to deliver adequate care. Richard Murray, Director of Policy at the King’s Fund, said,

“There is good evidence that having enough nurses is essential for delivering safe care: it is worrying that the number of nurses is going down at a time when the demand for services is going up.”

Amen to that: give me the advice of an experienced nurse over the hopeful guess of a newly qualified junior doctor any day.

These views were echoed by Saffron Cordery, director of policy and strategy at NHS Providers. “This is deeply worrying,” she said.

“The fall in numbers comes as demand for care continues to grow. Staff are overstretched and performance is slipping, a point underlined by the Care Quality Commission in its ‘State of Care’ report.”

The Department of Health responds…

By Salim Fadhley from London, UK (Sarah the Nursey Nurse) [CC BY-SA 2.0], via Wikimedia CommonsInevitably the Department of Health countered these charges, saying that the figures referred to nurses and health visitors and that there were now more nurses on hospital wards than in April

2016. The Department also stated that there were now 3,193 more EU nationals working in the NHS than at the time of the referendum – but whether they were working as nurses or ancillary staff was not made clear.

The Department also stressed that they had just sanctioned the biggest ever increase in nurse training places – but all sides admit that this will take time to translate into nurses on the wards.

Winter is coming

As you may have noticed, winter is coming – and with it, the inevitable NHS facing winter crisis, say health experts newspaper headlines. Last year a third of hospital trusts warned that they needed ‘urgent action’ to help them manage patient demand in the four-week run-up to Christmas, with 50 of 152 English trusts at their highest, or second-highest, level of pressure.

Speaking last year, Nigel Edwards, Chief Executive of the Nuffield Trust, said that the real crunch point for hospitals came in the month immediately after Christmas. Last year saw a significant increase in visits to A&E and increasing problems with freeing up hospital beds. We have written previously about the escalating demand for care for our ageing population: all too often old people have to stay in hospital beds as there is no-one to care for them at home.

Is technology the answer?

It is tempting to think that tech could solve our problems in the future. After all, it will change the face of shopping, see us all sitting in driverless cars and leave us with more leisure time than our parents’ generation could have ever imagined. Could it also radically alter healthcare?

Technology will unquestionably improve diagnostics: we will all have wearable tech and in theory, we should be able to prevent many of the conditions that currently lead to hospital admissions. Advances in tech will lead to cures for ongoing conditions and more rapid treatment. Apps on our phones will diagnose and help to treat mental health problems.

But are we our own worst enemy? Will we continue to be ill despite the advances in technology? After all, Type 2 diabetes is largely preventable – but it now costs the NHS £25,000 a minute: roughly the salary of the nurse you will need.

The solution to the shortage of nurses may well be in our hands. Hopefully, we will take it – and the NHS can go back to a time when going into hospital was not such a serious business…