Education And Debate

Mind the gap: the policy response to the NHS nursing shortage

BMJ 2002; 325 doi: (Published 07 September 2002) Cite this as: BMJ 2002;325:541
  1. Belinda Finlayson, research officer (,
  2. Jennifer Dixon, director,
  3. Sandra Meadows, visiting fellow,
  4. George Blair, adviser on workforce issues
  1. Health Care Policy Programme, King's Fund, London W1G 0AN
  1. Correspondence to: B Finlayson
  • Accepted 1 May 2002

The British government has launched local and national initiatives to tackle the problems of recruiting and retaining nursing staff. But will these be sufficient to resolve the current crisis?

Difficulties in recruiting and retaining key workers are severely hampering the quality of service the NHS can provide and the progress towards “modernisation.” In our other article published in this same issue, we outline the extent of recruitment and retention problems in the nursing and midwifery workforce. Here, we describe the main initiatives for England introduced by the government to tackle the problems and the new administrative machinery to implement them. We discuss whether these initiatives will be adequate.

Summary points

  • Problems in recruiting and retaining nurses are hampering the “modernisation” of the NHS

  • Universities are struggling to fill places on nursing diploma and degree courses so are recruiting students from overseas

  • New NHS workforce development confederations have the potential to resolve recruitment and retention problems but face substantial obstacles

  • The existing range of national initiatives may not resolve the crisis fast enough

  • More widespread or radical solutions may need to be considered

Government policies

The underlying causes of recruitment and retention can be grouped under four broad headings: pay and the cost of living; the changing nature of the job; feeling valued; and the availability of other employment opportunities.1 Recent government policies to tackle these problems relate to the first three. We consider the main initiatives outlined in the NHS Plan and the white paper Improving Working Lives. 2 3

Pay and cost of living

The government has sought to improve nurses' salaries through a series of annual increases and special allowances. From 1 April 2001, nurses received a basic pay increase of 3.7%. Senior nurses (including charge nurses, ward sisters, and nurse specialists), on whom the government was dependent to implement key aspects of the NHS Plan, …

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