Nursing





As of 2018 the NHS has 40,000 vacant nursing posts. Despite the ending of bursaries it has not reduced the number of nurses entering the profession. Applications to train to be a nurse have always been over-subscribed, so the ending of Bursaries (putting aside the moral issue of making nurses pay to enter the profession) has meant that they have a smaller pot of applicants to choose from.

The key reason for the shortage is the number of nurses leaving the profession due to low pay and poor working conditions. Between July 2017 and July 2018, 1,584 more EU nurses and health visitors left their role in the NHS than joined. This could be due to Brexit or simply that these nurses can find better and work conditions in other EU countries. As can be seen in Figure 1, the drop in EU nurses has been offset to a small extent by an increase in non-EU nurses. Projections for nurse shortages predict that following present trends there will be a 100,000 shortfall by 2030 (extrapolated figure based on an expected 1.5 times increase in shortages across the whole healthcare sector). There is a large cohort fast approaching pensionable age. A third are aged between 45 and 54 and one in seven (13.6%) are between 55 and 64. In midwifery the position is even starker, with a third of midwives already over 50 and eligible to consider retirement at 55. The population is expected to increase by a further 11% to 62 million by 2041 putting further strain on the NHS and nursing.

Comparisons with other countries must be treated with caution due to differences in, for example, geographies, service design, and data. As shown in Figure 2, it appears the UK as a whole have relatively few staff in key groups compared to other developed countries. For instance, per head of population, the UK has fewer than half as many nurses as Norway (8 nurses compared to 18).

One of the ways that nurse shortages have been mitigated has been to use agency staff. According to HEE, around 33,000 positions are filled temporarily by agency staff a large extra expense for local NHS trusts. As at the end of 2018, NHS trusts were forecasting spending some £5.6 billion on temporary staff in 2018/19, compared to a planned spend of £5 billion. Using temporary staff can also be disruptive to health services and reduce the ability to deliver continuity of care to patients.

Fully qualified nurse starter salaries

When nurses qualify they start on Band 5 of the NHS pay scale. From April 2010, newly qualified nurses in England were paid a starting salary of about £21,200. From 2018, new nurses should start on £23,000. Taking into account inflation, new starter nurses are now earning around £1,900 less than they might have in 2010. That’s an 8% reduction in pay over eight years.

Nurses in the profession saw their wage rises capped at either 0% or 1% between 2010 and 2018. In real terms this represented a 10% fall in wages. In 2018 nurses received a 1.5% payrise as part of a new pay deal. A nurse entering the profession in 2010 would more than likely be at the top of their particular pay-scale by 2019 so will receive a payrise that should match inflation with the new pay formula. However nurses lower on the pay scale will see a slightly above inflation pay-rise. On average nurses are £2500-£3000 worse off per year since 2010. The Health Foundation forecast that this would lead to a 42,000 nurse shortage by 2020. Presently the nurse shortfall is 40,000 (2019) up from a figure of 25,000 in 2017. . The wage restraint has been a false economy as NHS trusts have needed to go out to agencies to make up the shortfall, with the additional costs that entails (see section Nurse Numbers).

The cut in salaries for nurses is against a backdrop of a large increase in house rental prices and house purchase prices since 2010. The situation is particularly difficult in London, where they have seen the highest rise in rent rates. But across the UK rental and house prices have risen much faster than inflation.

The Royal College of Nursing (RCN) has reported “growing numbers of nursing staff using food banks, taking on additional jobs and accruing personal debt”. According to the RCN Foundation it awarded over 500 financial hardship grants to working, retired, trainee, or unemployed nurses, midwives and healthcare assistants in the UK in 2016. The Foundation says that one in four grants went to a full-time nurse. They largely cover cost of living expenses. The RCN also awarded 6,500 hardship grants to trainee nurses over three years (2015-17).