Latest NMC figures reveal that nursing levels are at an all-time high – what impact will this have on health and social care providers?

On 17 December 2019, the Nursing and Midwifery Council (NMC) published its ‘Mid-year update: 1 April – 30 September 2019’ Register Data Report (“Report”). The latest figures from the Report reveal that between 1 April 2019 to 20 September 2019, the number of nurses, midwives and nursing associates on the NMC register was at an all-time high.

Some of the key findings from the Report are as follows:

  • The number of people on the register grew by 8,015 reaching an all-time high total of 706,252.
  • Nurses on the register grew by 6,669 to 660,213.
  • Nursing associates on the register grew by 999 to 1,488.
  • The number of professionals on the register from the EU/EEA fell.
  • The number of professionals from outside the EU/EEA grew.
  • The number of learning disabilities nurses grew overall but the figure is still lower than what it was 5 years ago.
  • The number of professionals on the register approaching retirement age is growing quicker than the number of under-30s.

A copy of the Report can be accessed at the following link:

https://www.nmc.org.uk/globalassets/sitedocuments/other-publications/nmc-register-data-september-2019.pdf

What do these figures mean for providers?

Whilst there has been growth in the overall number of nurses registered on the NMC register, it is concerning that the number of learning disability nurses is lower than what is was five years ago and that the number of individuals approaching retirement age is growing at a faster rate than the number of nurses registered who are under the age of 30 years old.

At Ridouts, we have seen that many providers struggle to recruit and retain permanent nurses in their services. CQC’s annual ‘State of Care Report’ (“CQC Report”) which was published in October 2019 also reflects this.  The CQC Report discussed the funding and workforce issues that affect the adult social care sector and showed that staff turnover has risen for the sixth year running. The CQC Report also stated that there were clear regional variations in the ability of services to recruit and retain staff.

Agency nurses and CQC inspections

Due to the issues with recruitment and retention of nurses, many providers are reliant on the use of agency nurses in their service to ensure that staffing levels are appropriate. The use of agency nurses is a common theme in CQC inspection reports and is often criticised by CQC, which understandably can be concerning for providers.

CQC is often of the view that if agency staff are used in a service, it can have a direct impact on service user safety. A common criticism in inspection reports is that agency nurses are not familiar with service users and therefore, there is a risk that they are unable to provide appropriate care to service users.

During inspections, one of CQC’s mandatory key lines of inquiry for the question is the service safe, relates to staffing and asking the question: ‘How does the service make sure that there are sufficient numbers of suitable staff to keep people safe and meet their needs?’

For the service to be rated as ‘Good’ there must always be, ‘enough competent staff on duty who have the right mix of skills to make sure that practice is safe and they can respond to unforeseen events. The service regularly reviews staffing levels and adapts them to people’s changing needs.’

If your service is reliant on agency nurses, it is important to demonstrate the following to CQC:

  • Agency staff receive a comprehensive induction prior to starting a shift.
  • The service tries to use the same agency staff as much as possible so that there is consistency and so that agency staff are more familiar with service users.
  • Agency staff are closely monitored by the rest of the permanent staff team and that there is appropriate supervision.
  • Nurses have their own individual registrations with the NMC and their own professional standards to adhere to. They have a duty to practise safely, effectively and put the interests of service users first.

The CQC Report highlighted that Nursing Homes receive lower CQC ratings than Residential Homes overall and although there are various factors that may cause this, it is possible that high staff turnover and reliance on agency staff is also a cause.

Conclusion

It is positive to see that the latest NMC registration figures show that the number of registered nurses in the profession have increased. However, as stated by Andrea Sutcliffe (CBE, Chief Executive and Registrar at the NMC) when commenting on the Report: “…the reality is, even with this considerable mid-year growth, there are still serious shortages across the health and care sector – not least in specialist areas such as mental health and learning disabilities. With so many on our register nearing retirement age, it’s more important than ever that partners across the system work together to tackle the important issue of recruitment and retention of the essential nursing and midwifery workforce.”

If providers are struggling with the recruitment and retention of nurses and as a result are reliant on agency nurses, they should ensure that staffing levels are appropriate and that there are enough competent staff on duty with the right skill mix.