Nursing numbers down but don’t panic (yet)
“Four thousand nursing jobs have already been lost since the general election – a number set to increase to twelve thousand by May 2015 if the current trend is not reversed.”
Labour Party press release, February 26 2013
Labour released its seventh NHS Check report today. It’s the latest broadside in a campaign to discredit the coalition’s management of the health service.
But we’ve also called Labour out on using misleading statistics to try to make waiting times look worse than they are. Is today’s report more spin?
Shadow health secretary Andy Burnham is concentrating on nursing staff numbers today, saying there are more than 4,000 fewer nurses now than there were when the coalition came to power.
If current trends continue the NHS will lose 12,000 by the end of this parliament, Labour claims.
The first thing that needs to be said is that 4,000 fewer nurses is better than 6,000 fewer nurses, which is the figure still being quoted on the party’s campaign website yournhs.com.
That claim of 6,000 nurses cut since the election is now several months out of date. It reflects the fact that nursing numbers hit a low last summer, but have climbed since then.
The latest health service workforce figures were published last week on the NHS Information Centre website.
When is a nurse not a nurse?
Mr Burnham has zoomed in on qualified nurses, calculating their number by subtracting midwives, health visitors and school nurses from the overall figure for nursing staff.
In May 2010, the month of the general election, there were 281,430 qualified nurses and in November 2012, the latest month we know about, there were 277,378.
That’s a fall of 4,052 full time equivalent (FTE) nurses, a big headline figure, although since the size of the workforce for the whole of England is so big, it’s a fairly small percentage – 1.4 per cent.
What about if we broaden the definition of “nurses” by putting midwives, health visitors and school nurses back in the equation?
Now the cut is from 310,793 full time equivalent staff when the coalition came to power to 308,822 in November last year. We’re only talking about the loss of 1,971 people, or 0.6 per cent since the 2010 election.
Fewer nurses but more doctors
And what’s the overall picture? Well, there has been a cut in the overall NHS workforce, of just over 16,000 FTE posts or 1.5 per cent.
But it’s the managerial side of the organisation that is bearing the brunt of the cuts.
Without drowning in numbers, the basic position is that nursing numbers are down slightly but doctors are on the increase, so the overall number of clinical staff has risen since the election, by about 1.5 per cent too.
This is all handily summarised by the King’s Fund, the NHS think-tank, in its latest quarterly overview of the state of the health service.
Will we lose 12,000 nurses in this parliament?
This prediction is based on an extrapolation in the fall in nursing numbers that have already happened since May 2010.
It’s not mathematically wrong but it depends on the assumption that NHS employers will continue to lose nurses at the same rate they have done for the last two years.
There’s no hard evidence here that this will happen. It’s not as if the loss of another 8,000 nurses is written into NHS trusts’ budgeting plans.
On the other hand, pressure on budgets will undoubtedly continue.
And Labour’s warning that the numbers of nurses in training places is also falling chimes with analysis carried out by the Royal College of Nursing, raising concerns that the profession will not be able to replenish its ranks in the long-term.
Is the NHS in good health?
Yes and no. Inevitably, given the size and complexity of the organisation, there are many other ways of measuring its performance than just tracking the numbers of nurses.
Some of those indicators are positive at the moment, and others are negative.
The latest King’s Fund report notes that patients are waiting longer for treatment in accident and emergency departments.
And we know from government data that there have been recent rises in the number of urgent operations cancelled and in the percentage of the critical care beds occupied by patients.
On the other hand, the King’s Fund points out that rates of hospital-acquired infections like C. difficile and MRSA continue to fall year-on-year, and that waiting times “remain generally constant despite fluctuations”.
And despite high-profile cases of very high patient mortality at some hospital trusts like Stafford, mortality rates across the NHS as a whole continue to fall, as they have done for more than a decade, according to Dr Foster Intelligence.
A technical pass for Labour here, but they certainly are not telling you the whole story.
Labour are right to say that there has been a fall in the number of qualified nurses. What they don’t tell you is that numbers of school nurses and health visitors in particular means that the broader nursing workforce is only 0.6 per cent smaller than it was in May 2010.
And while nursing numbers are down, there are more doctors now, so the overall number of clinical staff has gone up.
Essentially, without wishing to play down the importance of qualified nurses, Labour are seizing on the only part of the clinical workforce where there has been a significant cut.
As for the claim that 12,000 nurses will go by 2015, it all depends on whether you think current workforce trends will continue for the next three years. They might or they might not.
And as far as the overall health of the NHS is concerned, there is a mixed picture, with no clear statistical evidence of either a sharp decline or an improvement in standards on the current government’s watch.
By Patrick Worrall