A turning tide: is the fall in nursing vacancies cause for applause or anxiety?

Over the course of the last parliament, up until March this year, the number of nurses working in the NHS in England increased by nearly 61,000 to around 366,000. In the previous 18 months alone, the number in NHS hospital and community services increased by 33,000, so perhaps it is not surprising that the reported nurse vacancies – that is funded posts that are not filled with permanent staff – fell by 15,000 (to around 31,000), as the NHS was able to fill shortages while also increasing the overall number.

Uncertain times for new graduates

But this apparent good news story is not the complete picture. In particular, it has been reported recently that newly qualified nurses are struggling to find registered nursing jobs.

There was indeed a dramatic fall in around 2022 in the number of UK nationals joining the NHS as nurses at the typical graduate entry pay band. In fact, the number fell by a third from around 19,900 in the year before the pandemic (to March 2020) to 13,600 two years later. While the number of new nurses who are UK nationals joining the NHS has increased since, it still remains suppressed. In fact, since early 2021 there has been an increasing disparity between the number of UK-trained nurses joining the UK register for the first time (blue line below) and UK-nationals joining NHS hospital and community services at Band 5 (orange line). 

Comparing these two numbers should be done with caution – not all UK nationals are UK trained and vice-versa, for instance – but it does suggest there could be an increasing number of nurses choosing or having to take roles outside the NHS. In fact, national bodies have previously admitted that only 70% of nursing graduates join the NHS and that this has fallen by 10 percentage points, and that over 4,000 nurses graduating in 2022 joined the professional register but were not working in the NHS.

While it is not clear which careers these graduates are pursuing, the last NHS pay review body report included evidence of staff considering work outside the NHS “where higher headline pay was available, coupled with a working environment perceived to be less stressful”. There were opportunities mentioned within private health care providers and in the science and technology sector.

Nursing as a multitude of job markets

Data on vacancies also points to increasing challenges in finding nursing jobs. In addition to the fall in reported vacancies already mentioned, the last year has seen a sharp decline in the number of posts that NHS employers report they are trying to fill, and similarly in the number of advertised nursing jobs. All of these datasets have limitations, but they all point in the same direction. 

And the headline figures – which cover all nursing roles and are not limited to those appropriate for new graduates – might obscure some specific challenges in the job market, such as certain levels of seniority or within particular fields of nursing. The drop in reported vacancies varies by service, with the highest drop in acute services (26%) and specialist services (31%) in the last year, whereas vacancies in community services have remained similar (-1%). This reflects the trend in staff in post, with only a small increase in community health nurse roles in the last year (3.2%, compared to 7.0% across adult and children’s nursing).

The dynamic also appears to vary by region too, again reflecting the recent trend in staff levels. The south east has seen the smallest increase in NHS hospital and community nurses, but the various measures of vacancies have fallen least there, whereas the opposite is true for the south west where nursing numbers have increased by 8% in a year, while measures of vacancies are down by around 40%. Even the regional breakdown will likely mask some considerable variation in the extent of the more localised nursing workforce shortages.

Perils of training but not retaining

There have long been calls to get to grips with high levels of vacancies, and we are seeing that, at a national, service and regional level, an increase in nurses in post has reduced the number of vacancies. However, we must also be conscious that the most recent drop in recruitment efforts might also represent a tightening of NHS finances and perhaps constraints around capacity, which may include estates, other resources needed to deliver care such as beds, and supervision and management. 

While there have been financial commitments to meet the ambitions to increase places for clinical education, there has yet to be a compelling long-term commitment to increase the NHS budget to employ the resultant increased number of qualified clinicians (in fact, others have noted that the ongoing cost implications of the Long Term Workforce Plan on staffing budgets would be equivalent to raising VAT from 20% to 27% by 2036/37). Admittedly the picture is still somewhat unclear (and the numbers of registered and NHS-employed nurses are still rising), but it is possible that these indications of graduates increasingly not being employed in the NHS are a bellwether of a disjoint between the staffing ambitions and the realities of the NHS. 

Either way, there is a very real risk that allowing a peak in recruitment to be followed by a trough will create current and future anxiety among prospective and actual nursing students about their job prospects. Given the high ambitions to increase the domestic training pipeline of nurses, allowing such a reality would represent a profound own goal.