the uk nursing labour market review 2016

Unheeded warnings: health care in crisis The UK nursing labour market review 2016

R C N L A B O U R M A R K E T R E V I E W

Unheeded warnings: health care in crisis The UK nursing labour market review 2016 2

Contents

1. Introduction and commentary 3

2. The UK nursing workforce 5

3. Immigration 9

4. The nursing workforce in NHS England, Scotland, Wales and Health in Social Care in Northern Ireland 14

5. Nursing and earnings 29

6. Nurse education and graduate earnings 33


1. Introduction and commentary

This report provides a review of the UK nursing labour market, looking at recent data and trends for nursing staff working in the health sector across the UK, drawing out differences and similarities across the four UK countries. The review uses national data sets to estimate the size, shape and composition of the nursing workforce. The review covers:

• theUKnursingworkforceacrossthewholeUKeconomy

• immigration

• thenursingworkforceinNHSEngland,Scotland,WalesandinHealthandSocialCare, NorthernIreland

• nursingearnings

• pre-registrationeducationandgraduateearnings.

Thepublicationofthisyear’sLabour Market Review (LMR) comes just a few months after the decision wasmadebytheMigrationAdvisoryCommittee(MAC)toplacenursesontheShortageOccupationList1.Whenoccupationsareplacedonthislist,fewerrestrictionsareplacedonUKemployersrecruitingcandidatesdirectlyfromoverseas;specificallyfromoutsidetheEU.Theywouldnolongerneedtocompletearesidencytest,whichinvolvesdemonstratingthatasearchforsuitablecandidateswithintheUKinthefirstinstancehasbeenunsuccessful.

Thisdecisionandthereasonsfordoingso,encapsulatetheriskstakenwithsecuringsufficientsupplyinthenursingworkforce.TheRCNhasbeenwarningabouttherisksofwoefullyinadequateworkforceplanninggoingbackatleasttwentyyears.

TheMAChasstatedclearlythatthereisanursingshortageintheUKandhasexplainedthatthecurrentshortageismostlydowntofactorswhichcould,andshould,havebeenanticipatedbythehealth, care and independent sectors. These issues include an ageing population, problems with staff training,payandrecruitment,compoundedbyasqueezeonbudgets.

MuchoftheMAC’sanalysisresonateswiththeRCN’swarningsinourLabour Market Review and elsewhere.Theanalysispointsoutthatdemandfornursingstaffhasgrownduetotheageingpopulation,reformstothedeliveryofhealthandsocialcare,thepushtoincreasenursetopatientratios in the wake of the Francis Report and staffing guidelines, as well as the changing role of the profession,withnursingstafftakingonmoredutiespreviouslycarriedoutbyothers.Thisgrowthindemand for nursing staff should and could have been predicted through workforce planning.

Theanalysisalsorepeatsourconcernsabouttheuncoordinatedapproachtomanagingthesupplyofqualifiednurses,withfragmentedworkforceplanningstructures,cumulativereductionsinthenumberoftrainingplacesfornursesandthemoveawayfrombursariestoastudentloansystem.Inrelationtothisdecisiontoreplacebursarieswithloansfornursingstudents,theMACwarnsthatpublicsectorpayrestraintmaylimitthenumberspreparedtotakeuptheextraplacesprovidedbyuniversitiesthroughthenewsystembeingintroducedinEngland.Thisyear’sLMRalsopointstothenarrowinggapbetweengraduateandnon-graduateearningsintheeconomyasawholewhichmayimpact on nursing as a degree choice.

1 www.gov.uk/government/uploads/system/uploads/attachment_data/file/510630/Partial_review_of_the_shortage_occupation_list_-_review_of_nursing.pdf

http://www.gov.uk/government/uploads/system/uploads/attachment_data/file/510630/Partial_review_of_the_shortage_occupation_list_-_review_of_nursing.pdf


The committee also points to the failure to ensure that the number of nurses trained is sufficient to meetdemandfornursesinthecareandindependentsectors,creatingastructuralundersupplyintheseareas.TheMACgoesontoquestiontheirlowlevelsofinvolvementinandcontributiontothetrainingofpre-registrationnursesintheUK,despitetheirrelianceonthiscohortofstaff.

BoththeRCNandtheMAChavehighlightedthehistoricpatternofpeaksandtroughsinthesupplyofmigrantnurses,withthecommitteesuggestingthatmigrantnurseshavebeenusedtosavecosts.Itstates that nursing is an occupation in which migrants earn, on average, less than UK workers doing thesamejob.Inmostothergraduateoccupations,migrantsearnonaveragemorethanUKworkersinthe same job.

Payrestraintisalsoasharedissueofmajorconcern,withtheMACindicatingthatpaycouldbeakeydriverofpoorretentionofnursesinpermanentrolesintheNHSandcaresectors,withmanymovingtoagencyworkorleavingtheprofessionaltogether.Italsopointstotheuseofsignificantpayincreasesinthelate1990sand2000stotargetseverenurseshortagesintheNHSandquestionswhythisstrategycouldnotberepeatednowgiventheshortageofnurses.

TheRCNbelievesthatunlesstheUKgovernmentsrapidlygettogripswiththedemandandsupplyfactorscausingthecurrentnursingshortageandtakestrategicactiontoaddressthesupplyissues,includingrecruitmentandretention,theshortageislikelytogetworse.Thepotentiallyseriousanddangerousimplicationsforhealthandsocialcareshouldnotbeunderestimated.Withoutsufficientnursingstaffandexponentiallyrisingdemand,patientcareisbeingputatrisk.


2. The UK nursing workforce

The Labour Market Review aims to estimate the size, shape and composition of the nursing workforce usingOfficeofNationalStatisticsdatasetsinadditiontodatacollectedbythefourUKhealthdepartments.Itshouldbenotedthatdatasetsoftenusedifferentterminology,particularlyaroundthedefinitionofnursesandmidwivesandnursingsupportstaff,anddataissometimescollectedacrossdifferenttimeframesandthatthesedifferenceshavebeenidentifiedwheresignificant.Forexample,somedatasetsrefertoregisteredandotherstoqualifiednurses.Nursingsupportstaffarereferredtoasnursingassistantsandauxiliariesinofficialdatawhileotherdefinitionsareusedbydifferenthealthdepartments.

Section2providesananalysisoffiguresfromtheLabour Force Survey(LFS)whichprovidesofficialmeasuresofemploymentandunemploymentfortheUK.Itgivesanindicationofthenumberofnurses,nursingassistantsandauxiliariesandmidwivesworkingacrosstheUKeconomy(asdefinedbytheOfficeforNationalStatistics).

Figure 1: Nurses, nursing assistants/auxiliaries and midwives in employment (2006-2016)

Source:AnalysisofLabourForceSurveysApril-June2006-2016

TheLFSprovidesanestimationofthesizeofindividualsectorsasdefinedbystandardindustrialclassification(SIC)codesandthenumberofpeopleworkingingivenoccupationsasdefinedbystandardoccupationclassification(SOC)codes–inthiscasenurses2,nursingauxiliariesand

2 SOC2231definesnursesasthoseproviding‘generaland/orspecialisednursingcareforthesick,injuredandothersinneedofsuchcare,assistmedicaldoctorswiththeirtasksandworkwithotherhealthcareprofessionalsandwithinteamsofhealthcareworkers.Theyadviseonandteachnursingpractice.’

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02006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016

Nurses MidwivesNursing auxilaries and assistants


assistants3 and midwives.4ThesegroupsareclassifiedasworkingintheNHS,otherpartsofthepublicsectorandtheindependentandvoluntarysectors.

Figure1showsasteadyincreaseinthenumberofnursesbetween2006and2016,withtheexceptionofaperiodofdeclinebetween2008and2010.Therewereestimatedtobearound665,841peopleemployedintheoccupationalcategoryofnursein2016,havingrisenby23%since2006.

Thereareanestimated302,381peopleemployedinthecategoryofnursingauxiliariesandassistantsintheUKin2016,havingrisenby37%since2006.

Inaddition,thereareestimatedtobearound42,308peopleemployedasmidwivesintheUKin2015,havingrisenby27%since2006.

Overthissameperiod,thetotalnumberofpeopleinemploymentroseby7%fromalmost29milliontojustaround31.7million.

Figure 2: Nurses and midwives in employment and sector of work (2016)

Source:AnalysisofLabour Force Survey January-March 2016

Figure 3: Nursing auxiliaries and assistants in employment and sector of work (2016)

Source:AnalysisofLabour Force Survey January-March 2016

3 SOC6141definesnursingauxiliariesandassistantsaswho‘assistdoctors,nursesandotherhealthprofessionalsincaringforthesickandinjuredwithinhospitals,homes,clinicsandthewidercommunity.’

4 SOC2232definesmidwivesasthosewho‘deliver,orassistinthedeliveryofbabies,provideantenatalandpostnatalcareandadviseparentsonbabycare.Theyworkwithotherhealthcareprofessionals,andadviseonandteachmidwiferypractice.’

Health authority or NHS trust

Charity/voluntary sector

Other public sector

Private sector

1.8%

14.7%

80.8%

2.7%

6.6%

22.7%

64.8%

5.9%

Health authority or NHS trust

Charity/voluntary sector

Other public sector

Private sector


AnalysisofLFSdatashowthatthemajorityofbothnursesandnursingauxiliaries/assistantsworkforhealthauthoritiesorNHStrusts/boards.Aroundoneinsevennursesandoneinfivenursingauxiliaries/assistantsworkintheprivateorindependentsector.

AccordingtoLaingBuisson(independenthealth,communitycareandchildcaresectoranalysts)revenuesgeneratedbyprivateorindependentsectorprovidersinthehealthandcaremarketgrewby5%in2015toreach£45.3bn.

Theyexplainthatgrowthwasledbyprivateacutehealthcare,drivenbyprivatedemandaswellasNHS‘chooseandbook’patientsoptingtoreceiveNHSpaidtreatmentinindependenthospitals,followedbycarehomesforolderpeople(drivenbyprivatelypayingresidents)andmentalhealthhospitals.5Privateandindependentsectorprovidersthereforeplayamajorroleindeliveringcare,yetitisdifficulttoassesscurrentorfutureworkforceneedsbecauseitislargelyexcludedfrombothofficial workforce data and formal workforce planning processes.

Figure 4: Proportion of nurses, nursing auxiliaries/assistants and all UK employees working part time (2006-2016)

Source:AnalysisoftheLabour Force Survey 2006-2016

Figure4showsestimatesofpart-timeworkingamongthenursingworkforceascomparedtothewhole UK working population.6

In2006,almosttwofifths(37%)ofnursesreportedthattheyworkedparttime,droppingto28%in2013andthenmovingupto33%in2015.Asimilartrendisevidentamongnursingauxiliariesandassistants,with41%reportingworkingparttimein2006,decliningto35%in2013andincreasingto37%in2015.

Part-timeworkingisclearlymoreprevalentinthenursingworkforcethantheworkforceasawhole;justoveraquarterreportedtheyworkedparttimedroppingto22%in2014beforereturningto26%in2016.

5 www.laingbuisson.co.uk/MediaCentre/PressReleases/HealthcareReview28.aspx

6 Full-timeandpart-timestatusisself-classifiedbyrespondentstothe Labour Force Survey.

504540353025201510

50

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Nurses All UK employeesNursing auxilaries and assistants

%

http://www.laingbuisson.co.uk/MediaCentre/PressReleases/HealthcareReview28.aspx


Figure 5: Proportion of female nurses, female nursing auxiliaries/assistants and all female UK employees working part time (2004-2014)

Source:AnalysisoftheLabour Force Survey 2004- 2014

Figure5looksatpart-timeworkinginmoredetailthoughanalysisoftheincidenceamongfemaleemployeesonly,duetothehighproportionofwomeninthehealthcareworkforce(around90%ofnursesand80%ofnursingauxiliariesandassistantsarefemale).

AmongallfemaleemployeesintheUK,part-timeworkingishigherthanamongmen.In2016,twofifths(41%)ofallwomenreportedworkingparttimein2016comparedto12%ofmen.

Lookingatnursesinemployment,therewasanoveralldownwardtrendinpart-timeworkingamongthefemaleworkforcebetween2006and2013from37to30%.By2016,theproportionworkingparttimehasreturnedtothelevelseenin2006.Thetrendappearsslightlymoreerraticamongnursingauxiliariesandassistants,withpeaksandtroughsoverthelast10years,finishingat41%in2016.

50

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252006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016

Nurses All UK employeesNursing auxillaries and assistants

%


3. Immigration

Section3considerstheissueofimmigration,thecurrentnumbersofnursingstaffbornortrainedoutside the UK and recent developments impacting on immigration.

ThefirstmajordevelopmentisthedecisiontoplacenursingontheShortageOccupationList,inrecognitionthatthedemandforqualifiednursesacrossallhealthandsocialcareproviderscurrentlyexceedstheavailablesupply.

ThesecondmajordevelopmentistheJune2016referendumdecisionfortheUKtoleavetheEuropeanUnion.

ThissectiondrawsondatafromtheNursingandMidwiferyCouncil(NMC)andtheLabour Force Survey(LFS)toprovideestimatesaboutthenumberofnursingstaffbornortrainedasanurseoutsidetheUK.Therearekeydifferencesinthedatapresented,inparticulartheNMCdatapresentsthenumberofqualifiednursesandmidwiveswhoregisteredabroad.AllnursesandmidwiveswhopractiseintheUKmustbeontheregister,howeverthisdoesnotnecessarilymeantheyareworkingasanurseormidwife.SincetheLabourForceSurveyasksrespondentsabouttheircountryofbirth,therearethereforemethodologicaldifferencesbetweenthedataanalysedandpresented.

3.1 Nursing and Midwifery Council data

LookingfirstatNursingandMidwiferyCouncil(NMC)datatogiveaninindicationofthenumberofnursesandmidwivesontheNMCregister,therewere686,782nursesandmidwivesontheregisterasof31March2015.Thisrepresentsanincreaseof5,924(0.9%)since2014.7Oftheseregistrants,around33,000nurseswhotrainedintheEUorEuropeanEconomicArea(EEA)areregisteredtoworkintheUK.Over9,000EEAnursesjoinedtheNMCregisterin2015/16,whichisa21%increaseon2014/15figures.

3.1.1 Inflow and outflow of registrants

TheNMCalsorecordsverificationsissuedtoothercountrieswhichgivesanindicationoftheoutflowofregisterednursescomparedtoinflowfromnewregistrants.Figure6showsthattheinflowhasbeenhigherthanoutflowsince2013/14.

Ofthe4,866verificationsissuedin2015/16,twofifths(46%)wereissuedtoAustralia,20%totheUSA,10%toIrelandand6%toNewZealand.

7 NursingandMidwiferyCouncil.Annual Reports and Accounts 2014-15 and 2013-14 www.nmc.org.uk/about-us/reports-and-accounts/annual-reports-and-accounts/

http://www.nmc.org.uk/about-us/reports-and-accounts/annual-reports-and-accounts/


Figure 6: Inflow and outflow of nurses and midwives from the UK (1995/6 – 2015/6)

Source:NursingandMidwiferyCouncil

3.1.2 New entrants 2015-16

Figure7showsthetrendinnumbersofnewnursesenteringthelabourmarketfromUKtrainingbetween2006/7and2015/16.Itshowsthattherewere17,257newregistrationsin2015-16,afallof25%since2013-14,reflecting,atleastinpart,reductionsinthenumberofnursingstudents.

Figure 7: Number of new entrants to the UK nursing register from UK sources (2006/7 to 2015/16)


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Figure8showsthepatternofannualregistrationofnursesandmidwivesfromnon-EEAcountriesandEEAcountriessince2006-07.TheNMCdatarecordswhenanurseregisters,butthisdoesnecessarilymeanthattheyareworkingintheUKasanurse.

Overallnumbershavebeenrisingrapidlysince2010/11,triplingoverthisperiodfrom3,858to11,261in2015/16,withmostgrowthseeninregistrationsfromnursesinitiallyregisteredintheEU.Thedropinmid-to-late2000sislinkedtostricterimmigrationrulesaswellasmorecostlyapplicationrequirementsimplementedbytheNMCforinternationalnurses.Meanwhile,thenumberofEUregistrantshasincreasedashealthandsocialcareorganisationsseektofillworkforcegapsandnursingstaffseektoleaveEuropeancountrieshitbyeconomicdownturn.

In2015/16,60%ofnewentrantstotheNMCregisterwerefromtheUK,32%fromtheEEAand8%fromoutsidetheEEA.

Figure 8: Number of new entrants to the UK nursing register from non-EEA and EEA sources (2006/7 to 2015/16)


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3.2 Labour Force Survey data

This section looks at data from the Labour Force Survey(LFS),lookingatresponsesfromrespondentswhoreportworkingasnurses,midwivesornursingauxiliariesandassistantsandtheircountryofbirth.ThisanalysisincludespeoplewhobecameUKnationalsaftermovingtotheUKandpeoplewhowerebornabroadtoUKnationalparentsandthereforemaybeslightlyhigherthanotherestimates.However,thisgivesanindicationoftherelianceonEUandnon-EUnationalsamonghealthandsocialcare providers.

Acrossallproviders,thereareanestimated21%ofthenursingandmidwiferyworkforceand25%ofthenursingauxiliaryandassistantworkforcewhowerebornoutsidetheUK.Therelianceonforeignbornnursingstaffisparticularlyhighintheprivatesector,makinguptwofifthsofthenursingandmidwiferyworkforceandalmostathirdofthenursingauxiliaryandassistantworkforce.

Table1: Country of birth as percentage of occupational groupings

All sectors NHS Private firms

EU % Non-EU % EU % Non-EU % EU % Non-EU %

Qualifiednursesand midwives

6.8 14.6 6.4 15.0 11.7 29.7

Nursingauxiliariesand assistants

5.1 20.2 5.7 19.7 5.2 24.7

Source:Labour Force Survey,January-March2016

3.3 European nationals in the nursing workforce

DependingonthesettlementthattheUKnegotiateswiththeEUpost-Brexit,theUKmayrestricttheflowofimmigrantsfromEurope.ThefuturesituationofEEAnationalsalreadyworkinginthehealthand care sector is also unresolved. Both these factors could cause a major problem for staffing in the NHSandotherhealthandsocialcareorganisations,eitherdirectlythroughnewrestrictionspreventingEU-bornNHSstafffromworkinginBritain,orindirectlybecauseEU-bornstaffmaychoosetoleavetheUKduetotheuncertaintycreatedbeforenewrulesareputinplaceonmigrationrestriction.

Analysisofthedatasuggeststhatthecountryofbirthforalmost7%ofallnursesandmidwivesand5%ofnursingauxiliariesandassistantsintheUKworkforceiswithinanotherEUcountry.Inaddition,almost15%ofallnursesandmidwivesand20%ofnursingauxiliariesandassistantsemployedintheUK were born in other countries.

FornursesandmidwivesworkingforahealthauthorityorNHStrust,theproportionborninanotherEUcountryisestimatedatjustover6%andtheproprtionborninanothercountryis15%.Amongnursingauxiliariesandassistants,almost6%wereborninanotherEUcountryandfurther20%outsidetheEU.

Thefiguresaremuchhigherforprivatefirms,with12%ofnursesandmidwivesborninanotherEUcountryand30%inanon-EUcountry.Lookingatnursingauxiliariesandassistants,5%werebornelsewhereintheEUwhile25%reporttheircountryofbirthasanon-EUcountry.


3.4 Shortage Occupation List

TheShortageOccupationListisdesignedtotemporarilyassistemployersinmeetingdomesticmarketshortages,andisregularlyreviewedbytheMigrantAdvisoryCommittee(MAC).

Themostrecentfullreviewwasheldin2013,anditwasnotrecommendedthatnursesshouldbeplacedonthelistatthattime.However,apartialreviewin2015concludedthattherewasasignificantshortageofnursesandthattheyshouldbeaddedtothelistforalimitedperiod.

ThereportreleasedbyMACinMarch2016criticisedtheDepartmentofHealthforusingimmigrationasa“get-out-of-jail-freecard”whenshortfallsshouldhavebeenanticipatedanddomesticnursesshould have been trained.

Thecommitteerecommendedthatthereshouldbeamaximumannualcapof5,000placesfornursesunderTier2(workvisasforskilledmigrantsfromoutsidetheEuropeanEconomicArea)withthelimitreducinggraduallyoverthenextthreeyears.ThislimitwassetbecausetheannualquotaofTier2visascurrentlystandsat20,700foreveryindustrythatwantstobringinnon-EUworkers,andthecommitteeidentifiedthedangerofnursescrowdingoutskilledmigrantsfromoccupationsnotinshortage,includingengineersandworkersinthefinancialsector.Inaddition,UKemployerswishingtorecruitanon-EEAnursearealsorequiredtocompleteaResidentLabourMarketTest.


4. The nursing workforce in NHS England, Scotland, Wales and in Health and Social Care in Northern Ireland

ThissectionlooksattrendsinthenursingworkforceacrossthefourUKcountriesbetween2009and2015.8WhileservicesareoftenreferredtoastheNHStheyaremostlyindependentfromeachotherandoperateunderdifferentmanagement,rules,andpoliticalauthority.

This timeframe has been used to allow for consistent comparison of data, taking into account methodologicalchangesmadebyNHSDigitalinEngland,whichisresponsiblefortheprovisionofNHSworkforcedata.

Thesemethodologicalchangeshaveinvolvedthere-categorisationoftheworkforce,whichinturnimpactsonthecomparabilitywithpreviouslypublishedworkforcenumberswhichhavebeenusedinpreviouseditionsoftheRCN’sLabour Market Review.

SinceNHSDigitalhaveproducedrevisedhistoricaldatagoingbacktoSeptember2009,thisdatehasbeenusedasthestartingpointforthisyear’sLabour Market Review for workforce data relating to all fourcountries’nationalhealthservices.

Alleffortshavebeenmadetoensureconsistencybetweenmeasuresbuttherearevariationsindefinitionsandmethodsofdatacollectionbetweenthedifferentcountries.Althoughdatamaynotbefullycomparablebetweencountries,wecanseeageneralupwardtrendintheregisterednursing,midwiferyandhealthvisitingworkforceandanupwardtrendinthehealthcareassistant/healthcaresupportworkerworkforceoverthelasttenyearsinEngland,ScotlandandWales.Trendsforeachcountryareexploredfurtherinthereport.

Table 2: Full-time equivalent (FTE) and percentage change in the qualified nursing, midwifery and health visiting workforce, 2009, 2014-2015, England, Scotland, Wales and Northern Ireland910

2009 2014 2015 % change 2009-2015

% change 2014-2015

England 297,430 299,819 302,4089 1.7% 0.9%

Scotland 42,670 42,61610 43,085 1.0% 1.1%

Wales 21,714 21,987 22,146 2.0% 1.7%

NorthernIreland 13,934 14,472 14,725 5.7% 2.0%

8 Dataforallfourcountriesisprovidedaswholetimeequivalent(WTE)figuresandmeasuredatSeptemberannually.

9 NHSHospital&CommunityHealthService(HCHS)monthlyworkforcestatistics–ProvisionalStatistics:(2016)

10 ISDScotland(2015)NHS Scotland Workforce – Data as at 30th September 2014 – Nursing and midwifery staff in post www.isdscotland.org/Health-Topics/Workforce/Publications/data-tables.asp?id=577#577

http://www.isdscotland.org/Health-Topics/Workforce/Publications/data-tables.asp?id=577#577


Table 3: Full-time equivalent (FTE) and percentage change in the health care assistant/health care support worker workforce, 2009, 2014-2015, England, Scotland, Wales and Northern Ireland

2009 2014 2015 % change 2009-2015

% change 2014-2015

England 134,153 137,224 141,976 5.8% 3.5%

Scotland 15691 15,575 15732 0.3% 1.0%

Wales 6,471 6,313 6,537 1.0% 3.6%

NorthernIreland 4,125 3,990 4,044 -2.0% 1.4%

Notes on tables 2 and 3:

• England2009,2014-2015.Table2figuresareWTEqualifiednursing,midwiferyandhealthvisitingstaffinhospitalandcommunityservices.Table3figuresarenursingsupportstaff.

• Scotland2009,2014-2015.Table2figuresarenursingandmidwiferystaff,bands5–9in NHSScotland.Table3figuresare1-4nursingandmidwiferystaff.

• Wales2009,2014-2015.Table2figuresareWTEqualifiednursing,midwiferyandhealth visitingstaffandnursingsupportstaffinhospitalsandthecommunityexcludingnursingassistantpractitioner,nurserynurse,nursingassistant/auxiliary,nurselearner– pre-registration,andnurselearner–post1stlevel.11Table3figuresareWTEnursing assistantpractitioner,nurserynurse,nursingassistant/auxiliary,nurselearner– pre-registration,andnurselearner–post1stlevel.

• NorthernIreland2009,2014-2015Table2figuresareWTEqualifiednursingandmidwifery staff in the health and social care workforce.12Table3figuresareWTEnursesupportstaff.

11 StatsWales(2014)Nursing staff by grade and year, Qualified nursing, midwifery and health visiting staff and nursing support staff https://statswales.wales.gov.uk/Catalogue/Health-and-Social-Care/NHS-Staff/Non-Medical-Staff/Nursing-Midwifery-and-Health-Visitors/NursingStaff-by-Grade-Year

12 DepartmentofHealth,SocialServicesandPublicSafety(2015)Northern Ireland Health and Social Care Workforce Census March 2015 www.health-ni.gov.uk/news/northern-ireland-health-and-social-care-workforce-census-%E2%80%93-march-2015

https://statswales.wales.gov.uk/Catalogue/Health-and-Social-Care/NHS-Staff/Non-Medical-Staff/Nursing-Midwifery-and-Health-Visitors/NursingStaff-by-Grade-Year

http://www.health-ni.gov.uk/news/northern-ireland-health-and-social-care-workforce-census-%E2%80%93-march-2015


4.1 NHS England nursing workforce

4.1.2 Hospital and community

Figure 9: Qualified nursing and midwifery staff (FTE); health care/nursing assistants (2004-2014) Index change: 2004 = 100

Source:NHSDigital

Figure9showsthetrendinqualifiednursingstaffandunregisterednursingstaffintheNHSinEnglandbetween2004and2014.Whiletherehasbeenanoverallincreaseof9%intheFTEnumberofqualifiednursesandmidwives(from286,841in2004to313,514in2014),thechartshowsthatthereweretwoperiodswhennumbersfell;between2006and2007,and2010and2011.

Lookingatnumbersofhealthcareassistantsandnursingassistants/auxiliaries,therehasbeenanoveralldownwardtrendbetween2004and2014,withfull-timeequivalentstafffallingby4%(from110,196to108,556).However,numbershavereturnedtogrowthsince2012whentheystoodat103,549.

115

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802004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014

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Figure 10: NHS England, monthly staffing, qualified nursing, midwifery and health visiting (FTE) September 2009-March 2016

Source:NHSDigital

Figure10showsmonthlystaffingfiguresandtracksthetrendinthequalifiednursingandmidwiferyworkforceinmoredetail.Thisshowsanoveralldownwardtrendbetween2009and2012andreachingaten-yearlowof269,912inAugust2012.Therehassincebeenanoverallrecoveryinnumbers,reaching285,387inMarch2016.

Table4looksindetailatthetrendinqualifiednursing,midwiferyandhealthvisitingstaffbetween2011and2015,andshowsthemixedfortunesacrossdifferentworkareas.

Numbersincreasedoverthisperiodinadultandchildren’snursing,amongmidwivesandhealthvisitors,therehavebeensizeablefallsincommunityandlearningdisability/difficultynursing.

Table 4: England, qualified nursing, midwifery and health visiting staff (FTE) by work area (2011-2015)

2011 2012 2013 2014 2015 % change 2011-2015

All 277,047 271,407 274,627 278,981 281,437 1.6%

Adult 166,977 165,017 168,410 172,511 174,960 4.8%

Children’snursing 17,490 17,839 19,157 19,467 19,650 12.3%

Communityhealth 40,281 39,836 36,705 36,490 36,413 -9.6%

Mental health 39,024 39,178 37,397 37,536 37,659 -3.5%

Healthvisitors 7,802 7,687 7,910 7,963 7,986 2.3%

Learning disabilities/difficulties

4,667 4,613 4,035 3,999 4,000 -14.3%

Midwives 19,878 20,178 20,344 20,357 20,414 2.7%

290,000

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Sep 14Dec 1

4Mar 1

5Jun 15

Sep 15Dec 1

5

Mar 16

FTE


Figures11and12lookatmorerecent,monthlydataandconfirmstherecentopposingtrendsinstaffingnumbersbetweenadultandcommunitynursing.ByFebruary2015,thenumberoffull-timeequivalentqualifiednursingstaffhadreached177,716inadultsettingsand36,260incommunityservices.

Figure 11: NHS England monthly staffing, qualified nursing (FTE) in adult settings (September 2009-March 2016)

Source:NHSDigital

Figure 12: NHS England monthly staffing, qualified nursing staff (FTE) in community health September 2009 -March 2016)

Source:NHSDigital

180,000

175,000

170,000

165,000

160,000

155,000

FTE

Sep 09

Dec 09

Mar 10Jun 10

Sep 10Dec 1

0Mar 1

1Jun 11

Sep 11Dec 1

1

Mar 12Jun 12

Sep 12Dec 1

2Mar 1

3Jun 13

Sep 13Dec 1

3

Mar 14Jun 14

Sep 14Dec 1

4Mar 1

5Jun 15

Sep 15Dec 1

5

Mar 16

44,000

42,000

40,000

38,000

36,000

34,000

32,000

FTE

Sep 09

Dec 09

Mar 10Jun 10

Sep 10Dec 1

0Mar 1

1Jun 11

Sep 11Dec 1

1

Mar 12Jun 12

Sep 12Dec 1

2Mar 1

3Jun 13

Sep 13Dec 1

3

Mar 14Jun 14

Sep 14Dec 1

4Mar 1

5Jun 15

Sep 15Dec 1

5

Mar 16


Figure 13: England, qualified nursing workforce (FTE), health visitors and district nurses (2000-2016)

Source:NHSDigital

Communityhealthnursinghasseenanoverall12%dropinFTEstaffingnumberssinceSeptember2009andlookingingreaterdepthattheworkforcegroupsinthisworkareashowshowtwodifferentoccupationshavefared.Whilethenumberofhealthvisitorshasgrownbyaquartersince2009,thenumberofdistrictnurseshasdroppedby41%.TheHealthVisitorImplementationPlan2011-15assistedadramaticincreaseinthenumberofhealthvistors,yetnumbershavefallensincetheendofthe programme.13Thenumberofdistrictnumbershasbeenfallingsince2009asthenumberbeingtrained has failed to keep up with the number leaving or retiring.

13 www.gov.uk/government/uploads/system/uploads/attachment_data/file/213759/dh_124208.pdf

12,000

10,000

8,000

6,000

4,000

2,000

0

FTE

District nurses Health visitors

Sep 09

Dec 09

Mar 10Jun 10

Sep 10Dec 1

0Mar 1

1Jun 11

Sep 11Dec 1

1

Mar 12Jun 12

Sep 12Dec 1

2Mar 1

3Jun 13

Sep 13Dec 1

3

Mar 14Jun 14

Sep 14Dec 1

4Mar 1

5Jun 15

Sep 15Dec 1

5

Mar 16

http://www.gov.uk/government/uploads/system/uploads/attachment_data/file/213759/dh_124208.pdf


Figure 14: Source of recruitment of joiners to the qualified nursing staff group (as can be best determined from the data available)

Source:NHSDigital,2016

Figure14looksatthesourceofrecruitmenttothequalifiednursingworkforceascanbebestdeterminedfromthedataavailable.Itshouldbenotedthatforasizeableproportionofjoinersthesourceofrecruitmentisunknown,rangingfrom42%for2010-11to17%in2014-15.Whilethismakesanalysisdifficult,therearesomeinterestingtrendsinthedata.

TheproportionofthenursingstaffjoiningtheworkforcefromtheEUrosefrom3.5%in2010-11to12.4%in2013-14,withasmallernumber(1.5%)recruitedfromoutsidetheEU.

Theproportionofjoinersfromeducation/trainingdroppedslightlyfrom15.3%toaround14%whilethelevelofmovementaroundtheNHSappearstohavesloweddownwiththeproportionofjoinerscomingfromotherNHSorganisationsfallingfrom33%in2010-11to26%.

40%

35%

30%

25%

20%

15%

10%

5%

0%2010-2011 2011-2012 2012-2013 2013-2014 2014-2015

NHS organisation

Other private sector

Education/training

Abroad – EU country

Private health/social care

Newly qualified

No employment

Abroad – Non-EU country

Other public sector


4.2 NHS in Scotland

Figure 15: Scotland, registered and non-registered nursing and midwifery staff (FTE) 2009-2015. Index change: 2009=100

Source:InformationServicesDivision,Scotland

Figure15showstherelatedpatternsofgrowthintheregisteredandnon-registerednursingandmidwiferyworkforceinNHSScotlandbetween2009and2015.WhilethenumberofFTEregisterednursingandmidwiferyroseslightlyfrom42,670in2009to43,085in2015(1%),theperiodhasbeenoneofdeclinefollowedbyrecovery,fallingtoalowof41,066in2012.

Asimilartrendcanbeseeninthenon-registerednursingandmidwiferyworkforce,startingat15,691in2009,reachingitslowestpointofat14,671in2012beforerisingto15,732in2015.

CommunitynursingworkforcedatahasbeenunderreviewinScotlandduetoissueswithdataqualityandin2014/15anNHSScotlandwideprojecttoimprovetheaccuracyofrecordingandreportingonthecommunitynursingworkforcewascarriedout.Longertermtrenddataisnotavailableasdatapriortothecompletionofthereview(forDecember2014andearlier)isnotcomparable.

Table 5: NHS Scotland nursing staff by selected community speciality, 2015

Mar 2015 Jun 2015 Sep 2015 Dec 2015

District nursing 3,478.2 3,461.5 3,494.2 3,503.6

Healthvisiting 1,889.8 1,874.0 1,899.4 1,902.7

Specialistnursing 1,227.4 1,250.9 1,235.8 1,247.6

Publichealthnursing 627.6 629.9 630.4 618.6

Schoolnursing 350.3 342.6 356.2 358.1Source:InformationServicesDivision,Scotland

110

105

100

95

90

85

802009 2010 2011 2012 2013 2014 2015

Registered nursing and midwifery staff

Non-registered nursing and midwifery staff


4.3 NHS in Wales

Figure 16: Wales, qualified nursing and midwifery staff and nursing support staff (FTE), 2006-2015. Index change 2006=100

Source:StatsWales,WelshGovernment

Figure16showsthatthatnumberofqualifiednursingandmidwiferystaffhasrisengraduallyby6%from20,980(FTE)in2006to22,146in2015,whilethenursingsupportworkforcedroppedfrom6,920(FTE)in2006to6,313in2014(9%)beforerecoveringslightlyto6,537in2015.

110

105

100

95

90

85

802006 2007 2008 2009 2010 2011 2012 2013 2014 2015

Qualified nursing and midwifery staff

Nursing support staff


Table 6: Nursing and midwifery staff (FTE) by work area (2011-2015)

2011 2012 2013 2014 2015 % change 2011-2015

Acute,elderlyandgeneral

15,839 15,913 15,937 15,891 16,181 2.2

Communityservices

3,478 3,536 3,695 3,808 3,915 12.6

Communitypsychiatry

1,256 1,325 1,339 1,337 1,376 9.6

Otherpsychiatry

3,141 3,075 3,064 3,036 2,951 -6.1

Maternityservices

1,700 1,655 1,658 1,649 1,650 -2.9

Paediatricnursing

1,033 1,040 1,033 1,084 1,128 9.2

Communitylearning disabilities

299 300 281 281 284 -5.0

Otherlearning disabilities

470 465 452 444 448 -4.7

Neonatalnursing

423 419 439 428 418 -0.9

Schoolnursing

211 220 207 222 222 5.3

Source:StatsWales.Nursingstaffbygradeandyear2011-2015

LookinginmoredetailatthenursingandmidwiferyworkforceinWalesbetween2011and2015,Table6showsanoveralldropinmaternityservices,paediatricnursingandlearningdisabilities.Thebiggestgrowthhasbeenseenincommunityservices.A10%increaseincommunitypsychiatrynurseshasbeenpartiallyoffsetbya6%fallinnursingnumbersinotherpsychiatrysettings.


Figure 17: Nursing workforce (FTE) community nursing services, health visitors and district nurses (2006-2015). Index change: 2006 = 100

Source:StatsWales.Nursingstaffbyareaofworkandyear2006-2015

Figure18showsasimilarpicturetoEnglandinrelationtothetrendinqualifiednursesworkingincommunityservices;withanoverallincreaseinnumbersworkingincommunityservices(28%increaseinFTEnursingstaff).HoweverwhilethenumberofFTEhealthvisitorshasgrownby50%from582to896,thenumberofdistrictnurseshasfallenby42%overthesame10-yearperiod,from896in2006to522in2015.

1601501401301201101009080706050

2006 2007 2008 2009 2010 2011 2012 2013 2014 2015

All District nurseHealth visitor


4.4 Health and social care in Northern Ireland

Figure 18: Qualified nursing and midwifery staff (FTE), unqualified nursing staff/nurse support staff (2006-2015). Index change: 2006=100

Source:DepartmentofHealth,SocialServicesandPublicSafety,NorthernIrelandHSCWorkforceCensus

UsingtheMarchWorkforceCensusdata,thequalifiednursingandmidwiferyworkforce(FTE)grewoverallbetween2006and2015,risingby7%,havingrecoveredfromadipinnumbersbetween2010and2011.

Thenursingsupportstaffworkforcepeakedin2008beforereachingalowof3,849in2012andthenrisingbackto4,019in2015.

Table 7: Northern Ireland, qualified nursing and midwifery staff (FTE) by work area (2011-2015)

2011 2012 2013 2014 2015 % change 2011-2015

Acutenurses 7,171 7,197 7,334 7,520 7,778 8.5

Mental health nurses 1,581 1,627 1,617 1,636 1,591 0.6

Midwifery 1,014 1,040 1,086 1,095 1,079 6.4

District nurses* 824 834 860 853 793 -3.8

Paediatricnurses 637 682 713 749 765 20.1

Healthvisitors** 438 427 458 461 491 12.1

Learningdisabilitynurses

437 421 417 428 404 -7.6

Source:DepartmentofHealth,SocialServicesandPublicSafety,NorthernIrelandHSCWorkforceCensus

*includescommunitystaffnursesworkingwithindistrictnursingservices

**includesstudenthealthvisitorsfrom2014onwards

110

108

106

104

102

100

98

96

94

92

Qualified nursing and midwifery staff Nurse support staff

2006 2007 2008 2009 2010 2011 2012 2013 2014 2015


Table7providesthenumbersofqualifiednursingandmidwiferyworkforcebyworkareabetween2011and2015.ThenumberofFTEnursesworkinginacutesettingsroseby8.5%overthisperiodandtherewasalsogrowthinthenumberofpaediatricnurses(20%),healthvisitors(12%)andmidwives(6%).Therewassomegrowthinthenumberofmentalhealthnursesuntil2014,beforefallingbackalmostto2011levels.Therehasalsobeenadipinthenumberoflearningdisabilityanddistrictnursessince2011.

4.5 Nursing and age

ThefollowingfiguresprovideestimatesoftheageprofileofqualifiednursingstaffusingavailabledatafromNHSEngland,ScotlandandHealthandSocialCareNorthernIreland.DataisnotavilableforWales.Analysisofthefiguresshowsaprogressivelyageingworkforce.Comparisonsofdatafrom2006and2015highlighthowolderworkersformasubstantialandgrowingcomponentoftheworkforce in all countries.

Figure 19: NHS England, age profile, qualified nursing staff, September 2006 and September 2015 (headcount)

Source:NHSDigital

Figure19showstheshiftinageprofileamongthequalifiednursingworkforceinEnglandbetween2006and2015.Whileoverathird(38%)oftheworkforcewasaged45oroverin2010,thishasrisento48%in2015.

40

35

30

25

20

15

10

5

0

2006

Under 25 25-34 35-44 45-54 55-64 >65

%

2015Age

3.04.5

24.723.0

34.1

24.0

28.2

9.7

13.6

0.3 0.7

34.2


Figure 20: Scotland, nursing and midwifery staff, September 2006 and 2015 (headcount)

Source: Information Services Division, Scotland

Figure 20 shows a similar age profile in the nursing workforce in Scotland to that in England. Two fifths (43%) of the nursing and midwifery workforce was aged over 45 in 2006, compared to over half (54%) in 2015.

Figure 21: Northern Ireland, qualified nursing, midwifery and health visiting staff by age, 2005 and 2015 (headcount)

Source: Department of Health, Social Services and Public Safety, Northern Ireland HSC Workforce Census

40

35

30

25

20

15

10

5

0

2006

Under 25 25-34 35-44 45-54 55-59 60+

%

2015Age

4.2 4.5

17.9 18.3

35.4

22.8

30.5

37.0

8.9

12.2

3.25.2

40

35

30

25

20

15

10

5

0

2006

Under 25 25-34 35-44 45-54 55-64 >65

%

2015Age

3.9 3.6

21.522.5

27.1

34.0

7.9

12.2

0.1 0.6

37.8

28.8


Figure21showsthesharpchangeintheageprofileofthequalifiednursingworkforceinNorthernIrelandbetween2006and2015.In200663%ofqualifiednursingstaffwerebelowtheageof45,comparedwithjustoverhalf(53%)in2015.

DuetochangesintheNHSpensionschemeandgovernmentpolicy,theaverageretirementageofnurses has risen:

• thenormalNHSpensionagehasincreasedfrom60to65

• theNHSearlyretirementageincreasedfrom50to55

• theUKgovernmentabolishedthedefaultretirementageof65years

• thestatepensionageisduetoincreaseto66by2020,to67by2028andto68by2046.

Althoughthenumberofnursesapproachingretirement(55yearorolder)hasincreasedoverthepast10years,thenumberofactualretirementshasbeenflat,suggestinganincreasingnumberofnursesaredelayingtheirretirement.14

14 IndicativefiguresfromNHSDigitalshowingreasonsforleavingandstaffmovementsamongnursingstaffhasremainedstablebetween2011-15


5. Nursing and earnings

5.1 Nursing staff

Section5looksataverageearningsgrowthfornursingstaffcomparedtootheremployeesintheUK,using official statistics.

Figure 22: Median weekly earnings for full-time employees compared to CPI and RPI inflation. Index: 2010=100

Source:OfficeforNationalStatistics.AnnualSurveyofHoursandEarningsandConsumerPriceInflationtimeseriesdataset

Figure22showsthegrowthinfull-timeweeklyearningsforallUKnursingstaffandallUKemployersbetween2010and2015,using2010figuresasthebase.Since2010,nominalweeklyearningsroseby3.5%fornursesand5.5%fornursingauxiliaries,comparedto5.9%forthewholepopulationworkingfulltime.Meanwhile,theRetailPricesIndex(RPI)hasrisenby19%andtheConsumerPricesindex(CPI)by15%.

Medianweeklyfull-timeearningsfornursingstaffstoodat£615in2015and£373fornursingauxiliariesandassistants.

125

120

115

110

105

100

95

CPIRPI All full-time

Nurses full-time

2010 2011 2012 2013 2014 2015

Nursing auxillaries and assistants part-time


Figure 23: Real terms annual change for median weekly earnings (full-time employees)


Figure 24: Real terms annual change for median weekly earnings (part-time employees)


Figure23looksatyear-on-yearchangesinmedianweeklyearningssince2010,adjustingforRPIinflation.Itshowsthatineveryyearbetween2010and2015,realtermsmedianweeklyearningsgrowthhasbeenbelowzeroforallfull-timeemployeesintheUKeconomy.Amongfull-timenurses,therehasbeenacumulativerealtermsfallinweeklyearningsof13.9%anda9.9%cumulativerealtermsdropfornursingauxiliariesandassistants.

2

1

0

-1

-2

-3

-4

-5

-62010 2011 2012 2013 2014 2015

Nurses full-time All full-timeNursing auxiliaries and assistants full-time

%

4

2

0

-2

-4

-6

-8

-10

-12

%

Nurses part-time All part-timeNursing auxiliaries and assistants part-time

2010 2011 2012 2013 2014 2015


Figure24showsrealtermsmedianweeklyearningsgrowthforpart-timeworkersbetween2010and2015.Part-timenursingauxiliariesandassistantshaveexperiencedacumulativerealtermsfallinearningsof16.2%,whileearningshavedroppedby18.2%forpart-timenurses.

Medianpart-timeearningsfornursingstaffstoodat£324in2015and£195fornursingauxiliariesandassistants.

5.2 NHS earnings

Thedatapresentedbelowshowtrendsinmedianearningsforqualifiednursing,midwiferyandhealthvisitorstaffinEnglandbetween2011and2016.ComparativedatafortheotherUKcountriesarenotavailable.

However,itmustbenotedthatduetodifferentapproachestakentopayawardsacrosstheUK,eachcountrynowhasitsownAgendaforChangepayscale.Forexample,anurseemployedonthefirstpointofAgendaforChangeBand5inNorthernIrelandhasastartingsalaryof£526lessthanacounterpartinScotland.

Thisdatashouldbeinterpretedagainstthebackgroundofpublicsectorpayconstraintsince2012.

• 2012:payfreezeforthoseearningabove£21,000peryear.

• 2013:1%consolidatedupliftforallstaffinUK.

• 2014:1%non-consolidatedupliftonlyforstaffatthetopoftheirpaybandinEnglandandNorthernIreland;aone-offpaymentof£187inWales;1%consolidatedupliftforallstaffinScotland.

• 2015:1%consolidatedupliftforthoseearninguptopoint42oftheAgendaforChangepayscale(£56,504)inEngland;1%consolidatedupliftforallAgendaforChangestaffinWalesandScotlandaswellastheLivingWage.

• 2016:1%consolidatedpayupliftforallstaff.

Figure26showsthatwhileRPIroseby18.9%between2010and2016,nominalearnings(nottakinginto account inflation) changed for the following staff groups:

• allstaffonAgendaforChangepaybands:10.3%

• qualifiednursing,midwiferyandhealthvisitingstaff:9.5%

• supporttodoctorsandnursingstaff:13.2%.


Figure 25: Nominal annual change in median annual earnings: all Agenda for Change staff; qualified nursing, midwifery and health visiting staff; and support to doctors and nursing staff compared to RPI, England (2010-2016)

Source:NHSDigital

Figure26showsmedianannualearningstrendfiguresobtainedfromNHSDigital,withgrowthadjustedforRPIinflation.Itshowsthatqualifiednursing,midwiferyandhealthvisitingstaffsufferedarealterms,cumulative,dropof9.4%,whilesupporttodoctorsandnursingstaffsawadropof5.7%.

Figure 26: Real terms (RPI) annual change in median annual earnings: all Agenda for Change staff; qualified nursing, midwifery and health visiting staff; and support to doctors and nursing staff, England (2010-2016)

Source:NHSDigital

6

5

4

3

2

1

0

-1Mar 2010 Mar 2011 Mar 2012 Mar 2013 Mar 2014 Mar 2015 Mar 2016

%

Qualified nursing, midwifery and health visiting staff

All AfC staff RPISupport to doctors and nursing staff

543210-1-2-3-4-5

Mar 2010 Mar 2011 Mar 2012 Mar 2013 Mar 2014 Mar 2015 Mar 2016

%

Qualified nursing, midwifery and health visiting staff

All AfC staffSupport to doctors and nursing staff


6. Nurse education and graduate earnings

This section looks at data and trends regarding the number of commissioned student places as well asdemandforandentrytonursingcoursesinhighereducationinstitutions(HEI).ThisdataiswidelyusedasanindicationofthefuturesupplyofqualifiednursesintotheUKworkforce.Ithasalsobeenrecentlyusedtoestimatethelikelydemandfornursingcoursespriortothedecisiontoreplacethecurrentsystemofgrantsandbursariesfornursingstudents,withthestandardsystemforothercoursescoveringbothlivingcostsandtuitionfeesinEngland.

The rationale for this change has been the search for cost savings, allied to the removal of what is seenasanartificialcaponstudentplaces,whichiscurrentlydeterminedbythefundingmadeavailablebyHealthEducationEngland.TheGovernmenthasestimatedthat10,000newnursingstudentplaceswillbecreatedby2020andpointtocurrentoversubscriptionasanindicationoffuturedemand for nursing courses.

This section also looks at the graduate wage premium to provide a perspective on the relative attraction of pursuing a nursing degree (along with the associated loans to cover tuition fees and livingcosts)comparedtoacareertakinganon-graduateroute.

6.1 Higher education

Figure27looksatthenumberofapplicationsandacceptancestoallcoursesinUKhighereducationinstitutionsbetween2011and2015andtherelationshipbetweenthetwofigures.In2015theacceptanceratereached74%.

Figure28looksatthenumberofapplicantsandacceptancesfornursingcoursesbetween2010and2014andshowsthatthetotalnumberofapplicantsroseby85%,whilethenumberofacceptancesroseby26%overtheperiod.Theacceptanceratehasremainedstableataround40%throughthisperiod.

WhilefiguresforHEIentryaregivenfortheUK,thenumberofplacescommissioned–whichisthekeydeterminantoffutureintaketoeducation–isundertakenseparatelybyeachUKcountry.


Figure 27: Applicants for entry to all courses at higher education institutions in the UK (2011-15)

Source:UCASAnnualreferencetables

Figure 28: Applicants for entry to nursing courses at higher education institutions in the UK (2010-14)

Source:UCASAnnualreferencetables

Figure29showsthatthenumbersofstudentplacescommissionedinEnglandhavebeguntoriseagain,afterfallingto17,219in2012/13.Thereare20,003plannedplacesfor2015/16comparedto22,815in2003/4.

800,000700,000600,000500,000400,000300,000200,000100,000

0

Num

ber o

f app

lican

ts a

nd

acce

ptan

ces

Acceptance rate %

75

74

73

72

71

70

69

682011

700,160492,03070.3%

2012653,635464,910

71.1%

2013677,375495,59573.2%

2014699,685512,37073.2%

2015718,480532,300

74.1%

ApplicantsAcceptancesAcceptance rate

100,00090,00080,00070,00060,00050,00040,00030,00020,00010,000

0

Num

ber o

f app

lican

ts

and

acce

ptan

ces

Acceptance rate %

50454035302520151050

201061,14526,55543.4%

201162,00023,99038.7%

201260,57523,83039.3%

201362,51524,70039.5%

201466,46026,96540.6%

ApplicantsAcceptancesAcceptance rate


Figure 29: England, number of nursing places commissioned (2005/6 to 2015/16)

Sources:ParliamentaryQuestion29November2013[179089]www.publications.parliament.uk/pa/cm201314/cmhansrd/cm131129/text/131129w0002.htm

HealthEducationEnglandDraft Workforce Plan for Englandhttp://hee.nhs.uk/wp-content/uploads/sites/321/2013/12/Workforce-plan-interactive1.pdf

Figure30showsthatstudentintakeplacesinScotlandfellbyaquarterbetween2005/6and2012/13,droppingfrom3,592to2,713.Numbershavebeguntoriseagainsince2013/14,with3,185placesplannedfor2014/15.

25,000

20,000

15,000

10,000

5,000

0

2005/06

2006/07

2007/08

2008/09

2009/10

2010/11

20011/12

20012/13

20013/14

20014/15

20015/16

Com

mis

sion

ed p

lace

s

Entry year

http://www.publications.parliament.uk/pa/cm201314/cmhansrd/cm131129/text/131129w0002.htm

https://hee.nhs.uk/sites/default/files/documents/Workforce%20Plan%20for%20England%202015-16.pdf


Figure 30: Scotland, nursing and midwifery student intakes (2003/04 to 2014/15)

Source:InformationServicesDivision,Scotland

Figure31showsafallof27%incommissionedplacesbetween2005/6and2012/13inWales,droppingfrom1,260to919.In2016/17,thereare1,418placesplanned,representinga54%increasefrom2012/13.In2015/163038placeswereplanned.

Figure 31: Wales, number of nursing places commissioned, 2004/5 to 2014/5 and places planned for 2016/17

Source:HealthandSocialServices,WelshGovernment

4,000

3,500

3,000

2,500

2,000

1,500

1,000

500

0

2004/05

2005/06

2006/07

2007/08

2008/09

2009/10

20010/11

20011/12

20012/13

20013/14

20014/15

Inta

kes

Entry year

1,600

1,400

1,200

1,000

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2005/06

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Entry year


Figure33showsafallof20%inthenumberofcommissionedplacesinNorthernIrelandbetween2008/9and2015/16,droppingfrom792to645.Anincreaseof100placeswasplannedfor2016/17.

Figure 32: Northern Ireland, number of nursing places commissioned, 2008/9 to 2016/17

Source:A Workforce Plan for Nursing and Midwifery in Northern Ireland(2015-2025)15

6.2 Graduate earnings

AnalysisbytheInstituteforFiscalStudies(IFS)showsthatgraduatesintheUKeconomycurrentlyenjoysignificantlyhigherwagesthanthosewithoutadegree,despitetherapidriseinthenumberofpeople with degrees over the past three decades.16However,IFSresearcherspredictthatfuturegraduatesacrossalloccupationsarelikelytobenefitlessandthathence,webelievefutureincreasesintheproportionofgraduatesintheUKwilltendtoreducegraduates’relativewages.

Theiranalysisshownbelowillustratesthatgraduatesintheirlatethirtiesearnabout1.6timesasmuchperhourasthosewholeftschoolat16andthisratiohasremainedroughlythesameforthepast30years.

Between2008and2013,realtermsmedianhourlyearningsofgraduatesfellbynearly20%. Non-graduatessawsimilarfalls,thusmaintainingthegapbetweenthetwogroups.

Thedatapresentedbelowshowtrendsinmedianearningsforqualifiednursing,midwiferyandhealthvisitorstaffinEnglandbetween2011and2016.ComparativedatafortheotherUKcountriesarenotavailable.

However,itmustbenotedthatduetodifferentapproachestakentopayawardsacrosstheUK,eachcountrynowhasitsownAgendaforChangepayscale.Forexample,anurseemployedonthefirstpointofAgendaforChangeBand5inNorthernIrelandhasastartingsalaryof£526lessthanacounterpartinScotlandand£217lessthaninEnglandorWales.

15 www.health-ni.gov.uk/sites/default/files/publications/health/workforce-plan-nursing-midwifery-2015-2025.pdf

16 www.ifs.org.uk/publications/8409

850

800

750

700

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600

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20010/11

20011/12

20012/13

20013/14

20014/15

20015/16

20016/17

Com

mis

sion

ed p

lace

s

Entry year

http://www.health-ni.gov.uk/sites/default/files/publications/health/workforce-plan-nursing-midwifery-2015-2025.pdf

http://www.ifs.org.uk/publications/8409


Figure 33: Median real hourly wage of 25- to 29-year-olds, by educationSource:InstituteforFiscalStudies:Thepuzzleofgraduatewages

IFSresearchershaveconcludedthatthemainreasontheincreaseingraduatenumbershasnotdrivendownthepremiumis‘becausefirmshaveusedtheincreasedsupplyofhighlyeducatedworkerstoswitchtoadifferent,lesshierarchicalandmoredecentralisedmanagementstructure.’Organisationshavechangedthewaytheyworktomakebetteruseofthemorehighlyskilledemployeesavailable.

Asnursingisagraduateprofession,thekeyquestionisnotwhethernursinggraduatesearnmorethannursingnon-graduates,butwhetherthefuturegainsfromobtainingandself-fundingadegreeare worthwhile in comparison to other career options.

15141312111098765

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TheRCNrepresentsnursesandnursing,promotesexcellenceinpracticeand shapes health policies

October2016

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the uk nursing labour market review 2016

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