The dire nursing shortage in the UK is not news. There are 23,400 vacant NHS nursing posts – 9% of the workforce. Plus, there are shortages in nursing homes and GP practices. Despite increasing training numbers, enthusiastic overseas recruitment and student loans, the fact remains: the availability of nurses still does not meet the need – and is unlikely to for the next five years. Health Education England only commissioned 331 extra nurse training places for 2016/17, 10% of their target. Oh dear, this does not auger well.
So I have a radical but obvious suggestion – increase nursing salaries. Pay nurses the market rate because there is a shortage of their skills and accept variable national pay rates across the country. We should ditch the NHS pay structure that determines all nurses are paid the same wherever they work. Many NHS managers have eye-watering salaries justified by the ‘need to attract talent’. Well, it should be the same for nursing: we need to attract talent and reward nurses accordingly.
The long held assumption by employers and government that nurses are not incentivised by more money has been criticised by an independent advisory committee who suggested the Department of Health should at least explore whether higher pay would improve retention. Keeping pay increases at 1% seemingly indefinitely is not helping recruitment and retention.
Can the NHS afford it? It is estimated the 2016/17 NHS spend on agency staffing of doctors and nurses will reach £4 billion. To ensure patient safety, 85% of NHS trusts on 60,000 occasions over November and December 2015 breached the government cap on agency spending due to nursing shortages. Should the funding of agency fees be redirected and invested in a better paid workforce? Estimates indicate £980m per year spent on agency nurses could fund 28,000 permanent posts. Increased pay levels for permanent nurses could be made from the agency fees charged – making agency working far less attractive.
Are there nurses available to recruit? Yes – tens of thousands of qualified nurses are not practicing. They have let their registration lapse and are undertaking other careers and pursuits. Cumulatively these nurses could fill the shortages that exist if they could be attracted back into the profession.
How can we get nurses to come back? They need incentives and opportunity. Returners need flexible working schedules that recognise that 90% are female with caring responsibilities as many cite shift rigidity and rotation as a reason for their leaving nursing. They need more locally based ‘Return to Practice’ schemes which trusts could provide by redirecting time, funds and energy away from overseas nurse recruitment. Overseas recruitment is not the long term solution: we need to grow our own workforce and indigenous returners are likely to remain in post for longer.
We could redirect the millions paid to agencies and overseas recruitment into a major national recruitment drive with financial incentives such as repaying a portion of nurse training loans or paying relocation costs. Some trusts fast track newly qualified nurses to Band 6 after one year if they work in hard-to-fill posts such as elderly care. Am I being simplistic and naive to think improved pay might attract nurses back into the workforce? We’ve tried everything else!