Blog: What do the latest figures from the NMC register tell us?

Earlier this year, I was part of the team behind the Closing the Gap report.

Our modelling showed that in England, based on current trends, the shortfall in NHS nursing would grow to 70,000 in five years and 108,000 in ten years, leaving one in four nursing posts vacant. In addition, we expected there to be continuing shortfalls of nursing in social care.

Workforce shortages are already having a direct impact on patient care and staff experience. Urgent action is now required to avoid a vicious cycle of growing shortages and declining quality.

We set out a range of policy action that could help bridge the workforce gap. This included incentives for 5,000 more nurses to start training each year by 2021, reducing the drop-out rate during training by a third and encouraging more nurses to join the NHS once they qualify. In addition, 5,000 more internationally recruited nurses would be needed each year.

The latest figures from the NMC register provide some positive signals for the strategy proposed in Closing the Gap, but also suggest that there is no room for complacency.

For the first time in three years there has been growth in the number of nurses on the NMC register. In the year to March 2019 the number of nurses grew by 1 percent, over 6,000. The midwifery workforce grew, by a similar proportion, 1.3 percent, just over 500 midwives.

The growth on the register has in part been fuelled by increasing numbers of nurses and midwives from outside the European Union, where the number joining the register for the first time grew to 6,157 for the year to March 2019, compared to 2,724 in the previous year.

This is potentially a consequence of government easing visa restrictions and a number of changes made by the NMC, to streamline its processes and better support applicants. Comparing these numbers to those from Closing the Gap,  suggests that, despite Brexit, nurses from overseas could potentially match the numbers we modelled.

The number of nurses, midwives and nursing associates from the UK on the register has also grown – an increase of 5,169 or 0.9 percent.

However this growth is threatened from a number of quarters. The data from our leavers’ survey underlines and echoes other evidence from NHS Digital  that work pressures are a growing driver for people to leave the NHS workforce - the vicious cycle described by one interviewee in Closing the Gap:

I worked in the NHS for a brief time after completing a ‘return to nursing’ course but I found the responsibility, workload and stress was too great. Coupled with poor pay that meant I was not able to pay household bills whilst supporting my family pushed me into resigning from my permanent contracted post within eight months of joining the NHS.

And, with retirement the number one reason for leaving the register, the rising numbers of registrants over 60 presents an ongoing challenge.

Overall growth in registrants also mask continuing problems for mental health and learning disability nursing. The numbers of learning disability nurses on the register fell for the fourth year in a row and while the number of mental health nurses grew by just over 500 to 88,944, and 2,000 below the numbers on the register in 2015. In England, where there has been a sharp decline in the numbers of people applying for learning disability and mental health nursing , this suggests that numbers could fall even further in the future.

While we don’t yet break down at a local level where people are working, we can look at people’s registered address, and that gives a pretty good indication of where they’re likely to be working.

What that shows is that each of the four countries of the UK is seeing an increase in numbers, but percentage-wise, some are seeing a more significant rise than others. Northern Ireland sees the biggest percentage jump of 1.5 percent – or 363 people. While Scotland is showing a very modest rise of 0.2 percent or 138 people. Somewhere in the middle are Wales and England – with a 0.8 percent and 1 percent increase respectively.

Of course, health is a devolved matter which means each of the UK Governments are responsible for the provision of health and care services in their own country. They will no doubt be interested in these figures and how they can feed into their own local long-term workforce plans.

Data on the settings people are working in, is also an area that we know we can improve. Thus, while one can make broad comparisons, as I have done in this blog, it limits the insight we can achieve. For example there are many more nurses on the register than there are working in the NHS and social care. Why are they not filling the vacant posts? How are nurses moving across the sectors over time?

Deficits in workforce planning, particularly in England, have traditionally been mitigated by reliance on recruitment from overseas and the latest numbers from our register suggest a repeat of this pattern. However, an ageing workforce, rising numbers of staff leaving due to work pressures, and uncertainty around growth in the training pipeline suggest the forecast shortfalls in the nursing workforce could become a reality without significant additional policy action.

Postscript

We're currently refreshing our strategy at the NMC. One of the early pieces of feedback we received is a desire for us to have a louder voice on wider system issues like the one covered by this blog.

Tell us what you think. Should we use and improve our insight and data to talk more about wider system problems? What other issues should our strategy be addressing? 

Give us your feedback. 

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