Shortages of staff are widespread within the NHS and exist across all disciplines. The NHS is on the brink with too few nurses, midwives, GPs, hospital doctors and mental health workers. Staff are leaving the service due to low job satisfaction whilst recruitment and retention continues to be a growing problem.
To protect the patients the NHS must have the right number and mix of staff, with the right level of education, qualification and experience. Numerous studies show that low nurse staffing levels were associated with higher rates of falls and deaths. These include The Keogh review and the Berwick review.
The Health Foundation report into NHS staffing trends in February found:
- 100,000 staff vacancies reported by trusts.
- The number of FTE number of GPs has fallen by 1.6%, despite Government pledges for 5,000 extra GPs by 2020.
- There are more than 41,000 registered nursing posts reported vacant in the NHS in England – more than 1 in 10 posts.
- The number of nurses and health visitors working in community health services has continued its long-term decline, falling 1.2.
A shortage of nurses
There is a major issue with nurse recruitment and retention. The overall number of nurses employed has increased but this doesn't meet the increased demand. There are 36,000 nursing vacancies in England and 33,000 of these are filled by expensive agency or temporary staff. These shortages mean that many NHS nurses “don’t feel able to provide the level of care they should be”, according to leading nurses.
Retention is a growing issue with increased pressures on the workforce. Research suggests 70% of nurses leave the NHS within their first year of qualifying. Additionally, 28% of EU nurses have quit since the result of the Brexit referendum and overseas applications have halved. Cuts to nursing bursaries has also led to 33% drop in university applicants.
Not enough midwives
There is a serious issue in the NHS with the shortage of midwives. According to the latest survey by the Royal College of Midwives (RCM), 79% of HOMs reported vacancies in their unit and 48% said that they did not have the funding for the right numbers of staff to meet the demands on services.
As a result of staff shortages and increased demand temporary unit closures are common. In the last year 40% of HoMs said their units have had to close for a temporary period. 13 units reported closing up to 8 times. Four units closed more than 10 times. One unit closed 28 times and another 34 times.
In addition, staff shortages, as well as inadequate funding, is leading to a reduction in services and the number of specialist midwives. Two thirds (69%) of HOMs said they did not have a smoking cessation specialist midwife. Nearly half (44%) reported not having a consultant midwife.
One consequence of the shortage of midwives is the increased use of agency staff. A report published by the RCM in October 2017 revealed that the previous year the NHS spent more than £97 million on agency, bank or overtime staff. This expenditure could pay for 2,731 experienced full-time midwives or 4,391 newly qualified full-time midwives.
A lack of GPs
There are widespread problems with both the training and recruitment of new GPs and the retention of current GPs. In 2014 the Government promised 5,000 extra GPs by 2020, however it is highly unlikely that anywhere near this number will be added to the workforce. In March 2016 an analysis by Pulse found that not even half that number will be added to the workforce.
Latest official figures show that the number of full-time equivalent GPs fell by 1,340 between March 2016 and March 2018. Alongside this, figures show that around a third of GPs are over 50 years old and GP early retirements have doubled since the start of the decade.
Between December 2017 and 2018, a further 27 full-time equivalent GPs had been lost and 593 less fully qualified GPs.
Over the last three years the GP sector has been characterised by practice closures and increasing difficulties of recruiting staff. BMA estimates that from 2018 England is set to lose between 618 and 777 practices in the next 4 years. So far, closures have seen more than a million patients displaced since 2013.
To make matters worse a record 15.3 per cent of GP posts in the UK are unfilled. Currently in England there are more than 6,000 full-time GP posts unfilled.
Too few hospital doctors
7 in 10 hospital doctors reported gaps in their shift rotas in 2017/18. This data comes with concerns from doctors that quality of care has deteriorated in the past 12 months.
The Royal College of Physicians (RCP) reported in June 2018 that there is a current shortage of 2,330 of consultant physicians. This means that an extra 2,840 medical students would be required each year for the next 5 years to fill the gap.
Emergency medicine is regularly listed on the Government's occupation shortage list. Compounding this, more than four in 10 doctors at work in the UK are considering leaving following the EU referendum result, according to a BMA survey.
According to the latest BMA pay review, declines in doctors pay has had a damaging impact on the morale of frontline NHS staff. This has contributed to a workforce crisis in the NHS and has had a detrimental effect on its ability to recruit and retain doctors.
In June 2017, the A&E department at Weston-super-Mare's general hospital announced a 'temporary' nightime closures between 10pm and 8am following a CQC report that required 'significant improvements' to be made. The report identified a lack of senior doctors and over reliance on locum staff as part of the problem. However, a year on in July 2018 it is reported that there are no prospects of the department reopening full-time again any time soon, with recruitment issues remaining problematic.
Not enough mental health professionals
Mental health services are experiencing staff shortages across the board - nurses, therapists and psychiatrists. In 2017 it was revealed that NHS mental health nurses had dropped by 15% since 2010 in England.
Worringly, the number of NHS mental health staff who have had to take sick leave because of their own mental health issues has risen by 22% in the past five years. Those taking long-term leave of a month or more rose from 7,580 in 2012-13 to 9,285 in 2016-17. Ths can be related to the fact that more than 40,000 mental health staff are assaulted every year and little action is taken to protect them from this.
The number of mental health nurses is down by thousands, and the number of fully-trained doctors in psychiatry and psychotherapy is down slightly since 2010. There has been an overall increase in the amount of mental health staff but this comes from scientific/technical staff, support staff or management positions rather than trained profesionals.
A UNISON survey of its members reveals that more than a third (34%) are thinking about leaving their jobs in mental health, and 14% are actively planning on doing so.
Shortage of radiologists
A UK wide shortage of radiologists is now causing treatment delays for patients in cancer care and other medical care. Figures published in August 2018 suggest a 30% increase in the workload of reading and interpreting scans between 2012 and 2017. In the same period, the number of consultant radiologists in England has only risen by 15%.
The Royal College of Radiologists have reported that NHS hospitals are increasingly having to pay for staff to do overtime or outsource the analysis of complex scans to private companies to cover the shortfall.
The vacancy rate of consultant posts in the UK has risen from 9% to over 10% in less than 2 years, with the rate hitting 18% in Northern Ireland.
Radiologists work is a central component to a lot what the NHS treats and so these staff shortages can have a substantial impact on the NHS by prolonging waiting times.
Nuffield Trust produced a report on the NHS workforce in numbers in May 2019 with infographics and data from across the NHS. Find that here.