From the editor
Nursing – the supply side
Who would be a social worker, many of us must have asked, when that profession was buffeted by the full force of the Victoria Climbié affair and the Baby P scandal? Consequentially or otherwise, during 2012 some English regions reported social worker vacancy rates of over 30%,1 and social workers in child protection constitute the only social worker category for which the UK Immigration Department will issue work permits.2 Should we be asking the same question about another profession, even nearer to the interests of hospital patients and physicians? What is likely to be the cumulative effect of current adverse comments on the quality of nursing in English hospitals? The tenor of the media coverage following the two Francis enquiries3 and the Keogh report4 is scarcely conducive to encouraging recruitment to this most vital of callings.
A recent report by the Royal College of Nursing (RCN) – Frontline First: nursing on red alert5 – paints a stark picture of the demography of, and recruitment to, the profession in the UK. Some of the picture derives from the ‘Nicholson challenge’ and the £20 billion efficiency savings demanded by 2015, with warnings of a further £30 billion by the end of the decade. The RCN reports that nearly 5,000 registered nursing posts have disappeared since 2010. (Inevitably, but reasonably, they comment that over the same period the medical and dental workforce has expanded by over 6,000.) However, less obvious, but potentially of far greater impact, is the issue of the workforce potentially available to staff the NHS.
First – and perhaps surprisingly – a long-term risk is age profile: the nursing workforce is an ageing workforce, again in contrast to the medical workforce. In England 45% of nurses are aged over 45 years, compared with less than one-third of the medical workforce. Second, and impacting over a shorter time frame, there has been a sharp fall in the number of nurse training posts: 13% between 2010 and 2013. Third – a problem that is affecting us now – the international mobility of nurses has quietly changed from a net inflow to a net outflow from the UK. Other anglophone countries provide a strong pull both for UK-trained nurses and for overseas nurses who otherwise might consider the UK for work. As a consequence of these and other issues, some projections suggest a shortage of 190,000 nurses in the UK within 3 years.5 Certainly the moves towards a more community-based system of care ‘closer to home’ (while having a number of advantages, as discussed in Patrick Cadigan's editorial in this issue),6 will require a more dispersed nursing workforce that will not mitigate this shortfall.
Solutions? Much clearly depends on government action. Buchan and Seccombe7 point out that the future number of UK-trained nurses can be readily increased if more training posts are made available as there remains an excess of applicants over places in British nursing schools. Indeed this was the pattern in the 1990s in response to a shortage, and in Scotland a reduction in nurse training posts has recently been reversed. Calculations become more difficult within the context of the European Union (EU) as it enlarges further to the east. Although the influx of trained staff from some eastern European countries has waned recently, the further expansion of the EU may reverse this trend. Calculations have become even more difficult as decisions on training levels rest with local education providers, even if they are under the umbrella of bodies such as Health Education England (HEE) – covering England but not the devolved administrations. However, any approach to increasing the nursing workforce will require both funding and encouragement.
It is reassuring that the new inspector of hospitals has already pointed out the need for increased levels of nurse staffing,8 just as the Francis report highlighted the role of low nurse–patient ratios in disaffecting ward staff and lowering the quality of care.3 But encouraging and nurturing the future nursing workforce, as well as retaining the current cadre, also need action to lift morale. In the context of medical staffing, physicians have become very aware of the disenchantment felt by some doctors in training. Clinical Medicine and other RCP publications have highlighted the particular crisis at the medical registrar level and the difficulties of encouraging and retaining trainees in general medicine. When it comes to encouraging and retaining nursing staff, the stakes are arguably even higher for the hospital service. More vocal support from doctors for the nursing profession, as well as more good-news stories in the media to balance hand-wringing over compassion levels, might make a productive start.
- © 2013 Royal College of Physicians
References
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- Community Care. Social worker vacancy rates in the UK: a special report
- ↵Tier 2 shortage occupation list – government approved version – valid from 6 April 2013. www.ukba.homeoffice.gov.uk/sitecontent/documents/workingintheuk/shortageoccupationlistnov11.pdf [Accessed 1 August 2013].
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- Francis R.
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- Keogh B.
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- Royal College of Nursing
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- Cadigan P
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- Buchan J,
- Seccombe I
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- Whipple T.
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