In England alone, the Royal College of Nursing (RCN) has identified 40 000 nurse vacancies, with cancer centres struggling to recruit specialist cancer nurses, 5000 mental health nurses' posts lost since 2010 and a 50% fall in district nurse numbers (RCN, 2019). The Cavendish Coalition says this is the equivalent of 45 hospitals' worth of nurses and it has urged the Government to step up recruitment to mitigate the loss of EU staff (National Institute of Economic and Social Research (NIESR), 2018). These gaps are set to be exacerbated 3 years hence by Brexit, with as many as 10 000 additional nursing vacancies feared, mostly in the harder-to-fill specialties.
The numbers of students applying to start nurse education in September 2018 dropped by 12% compared with 2017: a total decline of 16 580 since March 2016 (RCN, 2018). Universities and Colleges Admissions Service (UCAS) data show applications to study nursing peaked in 2014 and sharply declined, particularly in 2017; in England, this coincided with the removal of the NHS bursary (NIESR, 2018).
Policy decisions, such as replacing the bursary system with student loans and the impact of the nursing vacancies, have created the perfect storm. Measures need to be taken to monitor the impact student loans have had on recruitment; there may be a need to review this decision. Increased efforts should be made to encourage back those who have left our profession, such as formal return-to-work schemes, by encouraging agency workers to move into permanent roles, or by offering more flexible working.
International recruitment should form part of a costed, holistic workforce strategy. Occupations in health should be acknowledged—nurses must remain on the shortage occupation list—as being in shortage and because of this, any future immigration system has to cover recruitment from the European Economic Area and outside, at all levels of skill.
The Nursing and Midwifery Council (NMC) has announced changes to help boost the nursing workforce. As of 1 April 2019, the cost of the professional test of competence overseas nurses and nursing associates have to take was reduced by more than 20%. The cost of the computer-based test drops from £130 to £90; the full cost of the practical examination goes from £992 to £794 and, if a resit is required, this falls from £496 to £397.
The NMC is also proposing to enable those who are wanting to re-join the register after a career break to choose a test of competence, instead of having to go on a course, that could take between 3 and 12 months to complete. As well as this, where people do choose a return-to-practice course, the NMC will no longer prescribe the minimum length of the course. Educators will consider the skills and experience of the applicant and design the courses accordingly; the aim is to increase flexibility. The changes being proposed to return to practice were discussed at NMC Council in March 2019.
The NMC has demonstrated it is playing its part in positively addressing the nursing shortages across the UK. This is welcomed, as the regulator is demonstrating flexibility in its approach to registration, while still ensuring entry to the register remains rigorous. The actions taken by the NMC are part of a number of proposed measures to make it as straightforward and cost-effective as possible for people with the right skills to (re)join the register.
These are indeed challenging times for health and social care. With the high vacancy and turnover rates, coupled with the removal of the bursary, as much as possible needs to be done to increase the numbers of professionals with the right skills going onto the NMC register.