Nursing shortages leading to reliance on less qualified staff to plug workforce gaps
The NHS is relying on less qualified staff to plug workforce gaps due to a huge shortage of nurses, a new report says.
Support staff, such as healthcare assistants and nursing associates, have been used to shore up staffing numbers, according to the Health Foundation charity.
The NHS has relied upon overseas recruitment, but a lack of EU nurses due to Brexit means it is now taking more nurses from countries including India and the Philippines.
At present, there are almost 44,000 nursing vacancies across the NHS (12% of the nursing workforce), but this could hit 100,000 vacancies in a decade, the report says.
The analysis comes after the main political parties pledged to increase the number of nurses if they win the election.
The Tories have promised 50,000 more nurses, with 18,500 of these coming from retaining existing nurses, 12,500 from overseas, 5,000 via nursing apprenticeships and 14,000 through training.
Labour has said it will employ 24,000 more nurses and pledges to spend more overall than the Tories on the NHS.
Between March 2018 and March 2019, the NHS saw the biggest annual increase this decade in its overall workforce, the new report says.
But, it argued, this masks an ongoing shift in the mix of clinical staff employed in the NHS.
In 2018/19, while doctor numbers grew by 2.5%, the number of full-time equivalent nurses grew by just 1.5% (4,500 nurses).
Meanwhile, the NHS employed 6,500 more full-time equivalent support staff for doctors, nurses and midwives – a 2.6% increase.
The report said: “The last decade has also seen a major change in the mix of nurses and clinical support staff (including healthcare assistants and nursing assistants).
“In 2009/10 there were equal numbers of nurses and support staff, with one clinical support staff member for every full-time equivalent nurse in the NHS.
“By 2018/19, the number of support staff per full-time equivalent nurse had risen 10% to 1.1 full-time equivalent per nurse.”
The report said most changes to the skill mix – meaning the ratio of fully qualified to less qualified staff – are implemented well and led by evidence, but added: “It is important that quality and safety are at the forefront of any skill mix change.”
The Health Foundation says the NHS will need to recruit at least 5,000 more international nurses a year until 2023/24 to prevent nurse shortages from impacting on patient care.
In response to a severe drop-off in the supply of EU nurses since the 2016 EU referendum, there has been a marked increase in the number of nurses joining from outside the EU, including 1,791 from India and 3,118 from the Philippines in 2018/19.
The report found that the biggest increase in NHS staff in 2018/19 has been among managers (6.2%) and senior managers (5.7%).
And on GPs, it says a Government target to recruit 5,000 more GPs by 2020 is “impossible” to meet, with bosses now saying the target will just be met as soon as possible.
The number of full-time equivalent GPs fell 1.6%, from 27,834 in March 2018 to 27,381 in March 2019.
The study said temporary staff and GPs in training are making up a greater proportion of the GP workforce than ever before, “and non-GP clinical staff are playing an increasing role in the delivery of care”.
For example, the number of pharmacists in primary care grew from 743 to 1,137 in the last year – an increase of more than 40%.
Anita Charlesworth (pictured), director of research and economics at the Health Foundation, said: “Nursing shortages continue to deepen and are inevitably impacting on the frontline.
“Services are being forced to make do with shortfalls of increasingly pressurised nurses and rely on less-skilled support staff to pick up the slack.
“Clinical support staff play an incredibly valuable role in the NHS if they are supported in a well-planned way, but these trends appear to be largely unplanned, reflecting the failure to recruit enough nurses.”
Dame Donna Kinnair, chief executive of the Royal College of Nursing, said: “The danger to patients is not from the increase in support workers, but the absence of nurses.
“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.
“The evidence demonstrates that where more registered nurses are on shift, patient outcomes improve – it is essential that employers use vital 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.”
A 2016 study from the University of Southampton warned that, for every 25 patients, substituting just one qualified nurse for a lower-qualified member of staff was associated with a 21% increase in the odds of dying.
Copyright (c) PA Media Ltd. 2019, All Rights Reserved. Picture (c) The Health Foundation.