Intended for healthcare professionals

Education And Debate

Nursing numbers in Britain: the argument for workforce planning

BMJ 2000; 320 doi: (Published 15 April 2000) Cite this as: BMJ 2000;320:1067
  1. James Buchan, professor (,
  2. Nigel Edwards, director of policyb
  1. a Faculty of Social Sciences and Health Care, Queen Margaret University College, Edinburgh EH12 8TS
  2. b NHS Confederation, 26 Chapter Street, London SW1P 4ND
  1. Correspondence to: J Buchan

    When the Labour government in Britain took office in 1997 it inherited a growing problem of nursing shortages, which finally hit the headlines in 1998. The shortages have been recurring ever since, particularly during the influenza “crisis” last winter. How has the government fared in dealing with nursing shortages, and has it put the worst behind it?

    Summary points

    Britain has a serious shortage of nurses, as well as problems in recruiting and retaining them

    It is not simply that there are too few nurses; some key skills shortages also exist, with increasing demand for more qualified staff in some areas

    Much better planning of the workforce is required, and this needs to be more integrated with the planning for other groups in healthcare

    A change in the pay system may help, but the creation of better work environments may be part of the solution

    The rapid pace of change in the nursing profession has produced a challenge that the NHS needs to address

    Roots of the problem

    The roots of the recent nursing shortages lie in the early 1990s. As part of the NHS reforms and the introduction of the internal market, there was a move towards an employer led system to determine intakes to nurse training. The involvement of NHS trusts was to be welcomed, but the narrow focus, varying capacity of local training and education consortiums, and lack of a national overview meant that most trusts underestimated required staffing numbers. The system also underestimated non-NHS demand for nurses, particularly in the rapidly expanding nursing home sector. The effect of this new “planning” system was to reduce markedly the number of student nurses. In 1984 England had more than 75 000 nursing students and pupil nurses. By 1994 that number had more than halved. The register of the United Kingdom Central Council for Nursing, …

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