Supply and demand
The 50,000 target is time specific, running from September 2019 to March 2024. Since September 2019, the full-time equivalent number of nurses working in the NHS has risen by more than 26,000. If this trend was to continue up to March 2024, then there would be more than 50,000 extra nurses working in the NHS and the target will have been met.
A recent government policy paper sets out a clear route map to sustain this progress – success, they say, will come from a blend of increased domestic and international recruitment, increased training capacity and by improved retention rates.
The headline data suggests that this approach is delivering positive results in that the number of nurses working in the NHS has been increasing. However, when we look beyond this, at the impact increased recruitment is having on number of vacancies we find a more concerning trend; recruitment is having no clear impact on actual vacancy numbers or on the shortfall of nurses in the NHS.
This trend is not explained by worsening retention rates, data shows that the proportion of nurses leaving the NHS remained steady throughout the Covid-19 pandemic, although a substantial group left or were re-deployed to other parts of the NHS when the pandemic began in March 2020. It is also anticipated that retention rates will begin to deteriorate over the coming months as the impact of demand-driven pressures, exacerbated and intensified by Covid-19, takes its toll on staff wellbeing.
Given this, we can infer that the problem is that demand for nurses is increasing more quickly than supply. The government is not getting enough nurses into the NHS, even though it is making good progress towards hitting its 50,000 target. The factors behind this are complex, longstanding and varied. The Covid-19 pandemic and new targets to increase diagnostic and elective activity have created new demands and exacerbated the workforce shortages that long pre-date Covid-19.
At the national level there is a clear story: overall nursing numbers are going up, but the number of vacancies has flat-lined at around 40,000. Supply is not keeping pace with demand. However, when we look at the regional picture, our analysis shows a far more complex picture.
Some parts of England have seen greater success in increasing their nursing workforce. The South East, South West and East of England have increased their nursing workforce numbers at a significantly higher rate than Greater London, the Midlands and the North East and Yorkshire.1
However, success in recruitment has not always translated into a reduction in workforce shortages. For example, the South East grew its full-time equivalent workforce by 17 per cent, yet its vacancy rate grew by more than 12 per cent. While the East of England grew its workforce by more than 20 per cent and its vacancy rate still grew.
It is only the North West and South West that have seen real progress in addressing their nursing workforce shortages, seeing their numbers of vacancies decrease. The factors driving these regional differences are complex and varied. Prevailing labour market conditions will often make recruitment more challenging in some areas, but we also know that nurses tend not to travel far from where they trained to begin their career. As such it is likely that variation in supply is the key cause, not individual employer practice.
- 1The government baseline is September 2019, however, because of how nurses move in and out of the NHS work and seasonal variations in demand, we can only compare the same month in each year. We have used the most recent data (December 2021) and compared it to the same period in December 2019.
The key takeaway from our analysis is that even though the NHS is currently on course to hit the central target of 50,000 more nurses by 2024, current recruitment doesn’t seem to be having any meaningful impact on the true scale of nursing shortages. There is a fundamental question about whether meeting the target will achieve meaningful change when the data suggests that hitting the target will not solve the issue of workforce shortages. Is there, as the Chief Nursing Officer noted, a need to go back to the drawing board to ensure future targets achieve meaningful change?
A regular assessment of demand for and supply of nurses in the NHS, to assess any shortfall or surplus to allow the NHS to adjust its workforce and activity plans accordingly, would help. Without this, long-term workforce shortages will continue and demands on the NHS will grow ever more severe, long waits will persist and the recovery from Covid-19 may well falter.