Tackling the NHS nursing crisis

More funding on its own is not enough to tackle the National Health Service’s nursing shortage – we must make a career in nursing attractive to people of all backgrounds again, argues Karin Smyth MP

There are some predictable responses to this week’s headlines telling us that, for the first time since 2008, more nurses and midwives are leaving the profession in the United Kingdom than joining it.

We can take it as another sign of the National Health Service’s ongoing crisis, calling for more funding, especially in the context of Brexit and the current pay cap debate. I am not about to disagree, but I hope the data can trigger a wider debate.

Before I come to that, let’s look more closely at this week’s figures. Many leaving the profession cited working conditions – a sign of deep and troubling issues across an NHS overstressed and starved of resources.

The government’s response followed the now-standard line that there are thousands more nurses working in hospitals in England than seven years ago. Make no mistake, however you look at the figures the reality is that there are many thousands fewer nurses actually in post than are required to deliver safe staffing levels in today’s NHS.

Some solutions to this crisis appear obvious, for example:

  • Sorting out the fragmentation and complexity around education training regulation and development in the NHS
  • Improving pay after years of pay caps
  • Improving conditions – a new scheme aimed at improving retention rates has been announced
  • Keeping the bursaries and offering other incentives to encourage recruitment
  • Offering guarantees to European Union workers


These are all right and proper – and to some extent predictable.  But there are deeper issues here, so I would like to see some new thinking to add new solutions.

I want us to explore how we can return to the idea of nursing as a highly attractive career for people from less affluent households who are well-equipped with aptitudes to do a great job in our NHS.

Let’s not be shy to say: the NHS is a terrific organisation to work for.

But I meet many Bristol South constituents in their thirties and older the like of whom in years gone by would have been well-set to join the NHS, using the range of skills they had acquired through family, caring and employed roles. Often they are not clear how to enter healthcare professions for which they had be very well suited. They know there is a range of secure, well-paid roles with significant benefits, pensions and flexible working options. They know the demand for healthcare will always be there. But they do not know how to find their way in.

Nursing has become a graduate-only profession. Paramedics too are now all graduate entry – whereas in the past a young person could start working as an ambulance driver and eventually become a highly skilled paramedic, learning other life skills along the way.

It is high time to take a good hard look at this. I am not advocating capping graduate-entry. But we could do with a proper informed debate about how we attract people from all backgrounds to enter these professions; how we nurture and support them through a challenging set of career journeys. Those journeys may have different end points for different people, but could significantly alter the profile of who is attracted to these professions. It could usher a wider breadth of people with the right aptitudes, developing their skills and boosting the healthcare system we all rely on.

We are starting to see some new thinking in some of the sustainability and transformation plans and in some care models where changes in the nature of the workforce are being considered.  We hear of nurse associates who may be non-graduates but are still highly skilled and regulated; and we should see an upskilling of the social care workforce as we eventually realise we must pay for decent care for those who need support. A mixture of roles and skills is needed that are a bit less constrained and rigid than we see now. A raft of measures is possible, but in the end we also have to rigorously focus on selling the significant benefits of a career in the NHS.

The longer-term future of care depends crucially on having a very large skilled and well paid army of healthcare staff. And they do not all need to be graduates. Let’s consider the wider workforce and see how non-graduate roles could be aligned with nursing and caring ones.

In my view all these things need to be considered. Until we do so, we are missing a trick.


Karin Smyth is member of parliament for Bristol South. She tweets @karinsmyth



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