1. Nursing shortages aren’t what they used to be……. Professor James Buchan QMU jbuchan@qmu.ac.uk

2. Nursing shortages…..what we know How UK has responded in the past Current UK situation International context What next?

4. Shortages: what we know There is no universal definition of a nursing shortage; increasing evidence of nurse supply/ demand imbalances in many countries. Imbalances can be organisational, specialty based, regional, national ……(cyclical-”boom and bust”) Supply of nurses in many countries, low income and high income, is failing to keep pace with increasing demand [e.g. Sub-Saharan African countries = shortfall of + 600,000 nurses in relation to Millennium Development Goals targets] Gender-based discrimination continues in many countries = nursing undervalued as “women’s work”. There is a link between adequate nurse staffing levels and positive care outcomes..

5. UK and nursing shortages National policy control [£] of “supply”= =How many “new” nurses to train =What they are trained in…… =How many nurses to employ in NHS/ how much to pay them =How much £ to invest in their re-skilling =How many non EU nurses to allow into UK =when NHS nurses can retire…….

6. UK: history of nursing shortages 1932: Lancet Commission on Nursing 1939: Inter-Departmental Committee on Nursing Services 1947: Ministry of Health Working Party on the Recruitment and Training of Nurses 1972: (Briggs) Committee 1975 (Halsbury) Commission 1983 onward: - Nurses pay review body 2009: Prime Ministers Commission Nursing

7. UK: report on nursing shortages demand for care outstripping supply nurse staffing difficulties in some regions/ specialties increasing competition from other employers “unjustified”/biased news coverage of conditions in hospitals need for increased use of support workers to “free up” nurses need for increased emphasis on staff retention, attracting “married nurses” back to the health workforce

8. UK: report on nursing shortages demand for care outstripping supply nurse staffing difficulties in some regions/ specialties increasing competition from other employers “unjustified”/biased news coverage of conditions in hospitals need for increased use of support workers to “free up” nurses need for increased emphasis on staff retention, attracting “married nurses” back to the health workforce (MINISTRY OF HEALTH, 1947)

9. Previous UK “solutions” to shortages: Managing Supply Increase numbers in training Improve retention (and return) International recruitment Skill mix change- more support staff

10. UK- “new “ nurses from UK based training

11. UK Trends: Number of new nurses registering from European Economic Area (EEA), and “other” countries 1993-2010

12. NHS Scotland- total (wte) Nursing and Midwifery workforce 2001-2010 (ISD)

13. Staffing numbers, NHS England 1997 and 2009 (wte)

14. Trends: % change in staffing numbers, NHS England 1996-2009 (wte)

15. Nurses per 1,000 population, OECD countries

16. OECD countries: Increase in nurse headcount 2000-2008 (compound annual rate) 1.Data include practising nurses and nurses working in the health sector as managers, educators, researchers, etc. 2.Data refer to all nurses licensed to practice. Source: OECD Health Data 2010.

17. Hospital nurses wages: PPP comparison, 2008- $US (OECD data)

18. What next? 1970’s-2000’s- Focus was on supply of nurses Supply side now not the priority (a risk) Focus now is on Managing demand and on Skill mix change

19. Applicants for pre-reg nursing education at HEI, 2000-2009

20. Projections: % Change in NHS nurses 2006/7 to 2015/16, England (wte) ( sources: Buchan and Seccombe /RCN Policy Unit,2007; WRT 2008 )

21. Skill mix change: UK does not have the second level nurse option …… Second level nurse? UKNO…….so focus will be on the assistant practitioner IrelandNO AustraliaYES USAYES CanadaYES New ZealandYES (restarted)

22. What next?: Managing demand Emphasis on labour cost containment with no reduction in quality of care Different working patterns: e-rostering Adaptive/ flexible staff: re-skilling (CPD) Differentiated pay/reward?

23. What next? Skill mix change (Fewer?) graduate nurses, in “advanced” roles, managing cases and teams, diagnosing and prescribing Increased use of HCA and AP Increased emphasis on self care = will challenge what we mean by “nursing”

24. In conclusion….. In the past, nursing shortages have been “solved” by having “more nurses” Over the next 10 years the emphasis will shift to having “more effective nursing”