A leaked NHS document reveals that plans to grow the number of nurses rely on using 10,000 cheaper and less qualified staff.
Even then, the health service will still be more than 20,000 nurses short of what is needed in five years’ time, according to the file seen by the Health Service Journal and The Independent, for the as yet unpublished NHS People Plan.
The projections could be problematic for Boris Johnson, who has promised 50,000 more nurses by 2024 – although 18,500 of these are existing staff he hopes to retain.
Although the NHS document says there will be 45,000 more full-time equivalent staff, this figure includes 10,200 nursing associates (NAs). Nursing associates were introduced into the NHS this year and include staff who have completed a two-year course.
They are less well trained than nurses, known as registered nurses (RNs), who have to complete a three-year degree.
Nursing experts have warned against the substitution of nurses with less qualified staff – research shows this increases the risks to patients.
The modelling report said the 10,200 figure does not represent additional RNs and is based on an assumption that “expansion in numbers of NAs can… help to reduce growth in demand for RNs”.
The document is part of internal calculations on how to fill the current 44,000 vacancies for registered nurses in England.
The report, dated October this year, reveals even with overseas recruitment growing by 4 per cent a year for the next five years, the NHS will still have a nursing vacancy rate of 8 per cent by 2024.
The document says: “The introduction of the NA role is designed in part to free up time for RNs and enable them to undertake more advanced roles… Expansion in numbers of NAs can therefore help to reduce growth in demand for RNs… Our skill mix assumption is that each NA in the workforce will reduce nursing workforce demand by 0.5 [full-time equivalent].” This means each NA could ease half the workload of a full-time nurse.
The document is marked: “Numbers are not finalised. Not for wider circulation.”
In its “modelling assumptions”, the leaked document says: “We assume that the NA pipeline will continue to recruit 7,500 trainees a year from 2019-20.”
Alison Leary, professor of healthcare and workforce modelling at London South Bank University, questioned whether the assumptions in the document were safe, “in particular the assumption that NAs would reduce RN demand by 0.5 full-time equivalents”.
She said: “This appears to support a fairly simplistic model in which nursing work is a hierarchy of technical tasks. This neglects the important aspects of the safety-critical and organisational nature of the work for registered nurses in handling risk and complexity.”
Professor Leary said the model also “supported the suspicion that many in the profession and safety researchers have had – that the intention of introducing a less educated and lower paid worker is to substitute for registered nurses”.
Several other major sources of nurses are mentioned in the NHS England and Improvement modelling, which have a “combined impact” of an additional 45,400 full-time equivalent staff by 2024.
These include overseas recruitment, retention, return to practice, an additional clinical placement drive, NAs training to convert to become registered nurses, and reducing attrition from training.
Health secretary Matt Hancock has said on Twitter the 50,000 figure promised by Mr Johnson “will be RNs” or registered nurses.
According to the leaked document:
- 12,500 nurses will come from overseas recruitment
- 12,400 existing nurses will be encouraged to stay in the NHS
- 3,030 nursing associates will train to become nurses
- 10,200 nursing associates will reduce demand for nurses
- 1,700 more trainees will stay as the university dropout rate falls
- 2,500 additional training places will be made available
The document also includes modelling of registered nursing supply and demand over the next 10 years suggesting the vacancy rate could grow from 11 per cent to 26 per cent by 2028-29.
A spokesperson for NHS England and Improvement said: “This story is based on old modelling which categorically does not reflect the current plan for expanding the registered nursing workforce.”