The Ward Round: Are 50,000 more nurses enough in a post-pandemic world?

Staffing is the issue keeping NHS leaders awake at night – and which consumes two-thirds of trusts’ spending. The fortnightly The Ward Round newsletter, by HSJ workforce correspondent Annabelle Collins, ensures you are tuned in to the daily pressures on staff, and the wider trends and policies shaping the workforce.

“There’s no point recruiting if you can’t plug the leak” — this was the response of an HSJ reader under our story on a progress report by the government about its ‘50,000 more nurses’ manifesto pledge.

The report. published last week, said there was a net increase of 27,000 nurses between September 2019 and December 2021, although this was mainly achieved because a smaller number of nurses left the NHS during the pandemic.

Billy Palmer, senior fellow at Nuffield Trust, also pointed out that although the headline numbers of nurses are “broadly positive”, certain groups of nurses will not be feeling as optimistic. Unsurprisingly, nurses working with patients with learning disabilities or in general practice, as well as health visitors, have all been in decline during the course of this Parliament

“Overseas recruitment has played a large part in delivering these increases, but this route has substantial upfront costs and administrative burdens. So, general practice and smaller, non-acute services will likely need support if they are to benefit from such inwards migration,” Mr Palmer said. “In part, this explains why not all regions of the country will have benefited equally so far.”

“Given the scale of ambition in the elective recovery plan, we also need to ask whether meeting the manifesto commitment alone will deliver the numbers, experience and skills the NHS will need,” he added.

Of course, the 50,000 figure was a political decision — not based on demand, which has substantially increased over the course of the pandemic. So, the NHS may well have 50,000 more nurses in 2024 but could still be a long way short in terms of what it needs to sustainably deliver services.

The retention risk

Indeed, the report calls retention “the most significant area of uncertainty” across the 50,000 nurses programme and acknowledges the “unprecedented factors causing the uncertainty”.

It sets out four slightly nebulous ways in which the Department of Health and Social Care and NHS England are looking to retain more nurses, which include ‘greater focus on career development’ and ‘health and wellbeing initiatives’.

Considering the health secretary confirmed just last week that the NHS workforce plan, another iteration of which is currently in production, will not receive any additional funding, will this focus on education and training even be possible?

Sajid Javid responded to a question asked by Rebecca Thomas, now health correspondent at the Independent but formerly of this parish, about how the plan would be funded. He said costs for the new plan would come from existing budgets and described how, because of the amount of money spent on health, “trade-offs” would have to be made in other areas, such as education.

For a government which appears to have rather short-term aspirations on this agenda, investing in education and training will never be appealing, but ensuring nursing is an attractive career will be vital if they want to hit the ‘50,000 more’ target.

And what about nursing associates? In the last Ward Round, I wondered how this would be reflected in this update document. In 2019, NHSE estimated recruiting more nursing associates would reduce demand for registered nurses by 10,000.

Although nursing associates working on a conversion course to become a registered nurse are counted in the domestic recruitment workstream, the document is clear about the “definition” of a nurse, and that nursing associates do not count towards the 50,000 target. However, decreasing attrition rates for nurses in training must also be a priority, if the ambitious targets for domestic recruitment are not to crumble away.

How the NHS staff passport is progressing

The Ward Round this week came into possession of a recording of an ICS clinical and care professional leaders’ network meeting, which has shed more light on the progress of the NHS covid-19 digital staff passport.

The presentation, given by Nicola Fowler, improving employment models lead at NHSEI, revealed the regional variation in the uptake of the staff passport. In terms of reach, the North West, North East and West Midlands regions are involving the highest numbers of staff in the passport scheme (approximately 300, 200 and 200 staff respectively), but with London furthest ahead with 32 out of a possible 36 organisations registered to provide the service.

In contrast, just two East of England organisations have registered out of a possible 27 and the system has never been used in the region. Meanwhile, in the South West, just eight organisations are registered out of a possible 25, and again, the passport has never been used.

Of course, it is easier to move between different NHS organisations in a big city with good transport links. But it is often coastal and rural parts of the country which face the biggest staffing challenges and could benefit from less bureaucratic staff-sharing arrangements.

It was also described as a “stepping stone” for the long-term NHS digital staff passport, which was first announced at the end of 2019.

Ms Fowler said the covid-19 iteration of the passport would be available until September, after which the longer-term product would be available. “We are currently in procurement for that and will start building this in the summer months,” she said. “The initial focus is for doctors in training and temporary staff.”

She also confirmed system leaders hoped, in time, the passport could be expanded to include primary and social care and enable staff to move between different health and care sectors.

This tool has been long needed in the NHS, and when fully rolled out it could revolutionise the experience of moving trust to trust, as junior doctors do every few months. But there is clearly much to be done in terms of persuading more organisations to sign up.