NHS: No Quick Fix to Nursing Crisis

The UK is losing its nurses and midwives, and British staff are leaving even more quickly than their EU colleagues, who have been deterred by Brexit and the subsequent fall of the Pound. The top reason they give for leaving, apart from retirement, is their working conditions. Those working conditions are of course exacerbated by the existing shortage of staff, suggesting that things are going to get a lot worse because a sustainable solution will require more than just a pay rise.

A significant 20% more people left the Nursing and Midwifery Council register than joined it in 2016-17, which is the first time that more nurses and midwives have left the register than joined it. About a third more UK nurses and midwives left the register than four years earlier.

Jackie Smith, the chief executive of the NMC, said that “at a time of increased pressure on the healthcare workforce to deliver quality patient care, we hope our data will provide evidence to support government and employers to look in detail at how they can reverse this trend.”

The register maintained by the council, the independent professional regulator for nurses and midwives, includes all the nurses and midwives registered to practice in the UK and does not mean they are currently working for the NHS or in private healthcare.

Who’s going and why?

An NMC survey of 4,500 midwives and nurses who left the register in the past year found retirement was responsible for half of their departures. The rest were asked to cite their top three reasons for leaving the register.

Forty-four percent named working conditions, including poor staffing and a heavy workload. Disillusionment with the poor quality of patient care (27%) was just behind a change in personal circumstances such as poor health or childcare (28%) as the next biggest reason for leaving.

Poor pay and benefits was cited by 16% of respondents while 18% said they were leaving to go abroad, reflecting other NMC figures that show foreign licensing authorities mainly in Australia, the US and Ireland are making more verification requests about UK nurses.

A Poor Career Choice

The average age of departure has fallen from 55 four years ago to 51 now while the number of those leaving between the ages of 21 and 30 doubled, suggesting that pay restraint and working conditions may be putting off younger staff even before the withdrawal of government-funded training bursaries from this August.

While the removal of Government bursaries is intended to open up 10,000 more places on over-subscribed nursing courses over the next three years the financial burden of training will then be passed onto the students who may be put off by the weak financial prospects of the career.

“Far from creating 10,000 additional training places as claimed by the Government, the changes will reduce current participation levels by 6-7% (or almost 2,000 students),” said the public services union UNISON. “Fewer nurses qualifying in 2020 will have disastrous consequences for patient safety and exacerbate the current recruitment crisis in the health and social care sector.”

More than a pay rise

What is clear from these figures is that even if there is a rapid easing of the 1% cap on public sector pay rises there are other problems with working in health that will take a long time to fix. The NMC report admits that nursing is an ageing profession likely to see more retirements without younger replacements.

The problem of staff leaving because of under staffing and high workloads will obviously become self-perpetuating if new replacements are not quickly brought in from big NHS recruitment countries like India and the Phillipines.

Such recruitment by the UK has already been blamed for drawing health workers away from poorer countries which have paid for their training and desperately need their skills.

The EU is unlikely to fill the gaps because even before Brexit it trained just 5% of the NMC register compared to 10% from other countries and 85% from the UK. The council’s classifications are based on where staff first registered so EU students who studied in the UK and registered here are regarded as coming from the UK.

Some 32% of EU staff who responded to the survey of nurses leaving the register said that Brexit had encouraged them to work outside the UK while an equal percentage cited their working conditions as one of their top complaints.

That workload is only going to rise with an ageing population placing intense demand on healthcare quite apart from such problems as Brexit, the public sector pay cap and this newly-demonstrated staff exodus. The solutions to retaining staff and making nursing a career that is attractive enough to justify going through intensive training will be expensive and complicated but those solutions are absolutely vital for both the NHS and private healthcare providers.

by Stewart Vickers @VickHellfire

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