A third of nurses due to retire in the next 10 years. Who is going to plug the gap?

8 Jul 2016

Rachel Marangozov, Senior Research Fellow

IES research for the Migration Advisory Committee (MAC), published yesterday, reveals the scale of challenges facing the NHS nursing workforce. It reveals that the current shortage in nurses has been caused by three key factors: the Francis Report’s emphasis on safe staffing levels, which has pushed up the demand for nurses, the inadequate number of funded student nursing places in recent years, and an ageing workforce. It is perhaps the last issue which is most worrying because our report found that one in three nurses are due to retire in the next 10 years.

This poses an urgent question for Government, healthcare providers and workforce planners around who will fill this gap in the workforce. There are three realistic possibilities for filling this gap.

First, we could recruit more nurses from outside the European Economic Area (EEA). (The EEA includes all European Union (EU countries) and also Iceland, Norway and Liechtenstein.) International nurses, from countries like India and the Philippines have always played an important role in the NHS, and continue to do so, making up 8 per cent of the total nursing workforce in England. Trusts told us that these nurses have played a key role in easing pressures on their services. In March 2016, the MAC recommended that the Government grant up to 15,000 visas over the next three years to non-EEA nurses in order to ease the current nursing shortage. This will ease the immediate to short-term pressures on the NHS but it is questionable whether this will be enough to make up for the loss of a third of the nursing workforce over the next ten years – particularly if the Government is keen on sticking to its target of getting net migration down to the tens of thousands.

Second, we could look to recruit more nurses from the EEA. EEA nurses constitute 4.5 per cent of the total nursing workforce in England (up from just over one per cent in 2009), mostly from countries such as Spain, Portugal and Ireland. Trusts we spoke to, particularly in London and the South East, were reliant on this pool of labour to help address their nursing shortages and their difficulties trying to recruit British nurses. Again, however, it is questionable as to whether this route alone is enough to plug the gap in the workforce over the next ten years. Trusts we spoke to as part of this research pointed out that they struggled to recruit nurses from Europe in sufficient enough numbers. As one Trust said, ‘In Europe, we might look to get a maximum of 20 [nurses] now, whereas in the Philippines, you could get 80-100.’ There are also the implications of Brexit to consider. With the uncertainty around the status of EEA workers in the UK, the recruitment pipeline from Europe is likely to be hit hard. Many nurses already in the UK, as well as potential recruits in countries like Spain and Italy, will be concerned about their future prospects if their status in the UK remains uncertain.

Lastly, the Government could act now to ensure that we have a ‘homegrown’ domestic supply of nurses. This will require adequate and sustained investment in workforce planning, but this is likely to be the most sensible way of addressing a potentially gaping hole in our future nursing workforce. For too long now, there has been a lack of long-term, strategic workforce planning that offers oversight, coordination and alignment of the different dimensions of the nursing workforce (financial, education, employment and international recruitment). For example, workforce planners have known for several years now that the ageing nursing workforce is a problem, and yet very little, if anything, has been done about it; and in recent years there has been a lack of student nursing training places despite demand for nursing courses outstripping supply. In 2014, some 30,000 applicants, or more than 60 per cent of total applicants, were not successful in obtaining a funded place on pre-registration courses, so we are not short of people interested in becoming nurses! It is time that workforce planners in the Government make the most of this potential and avoid using international recruitment as a ‘quick fix’ to nursing shortages in the UK, while ignoring more systemic workforce planning issues. For example, having recently scrapped the student nurse bursary, workforce planners need to monitor the impacts of this decision closely in case it puts people off training to be a nurse, thus reducing the potential pool of new recruits.

One last sobering thought: the one-in-three figure is good at highlighting the extent of the problem of ageing in the nursing workforce. But this issue is not just about numbers. Workforce planners need to consider the years of experience, skills and expertise that these nurses take with them when they retire. Replacing that will be an altogether more challenging task.

Subscribe to IES blog posts

Any views expressed are those of the author and not necessarily those of the Institute as a whole.