Nursing numbers plummet and waiting lists soar while government delays workforce plan, says RCN

With still no sign of the long-promised workforce plan, a review of NHS England/Digital data by the Royal College of Nursing (RCN) has revealed the depth of the nursing workforce crisis – with the Government’s failure to invest in nursing putting patient care on red alert.

The numbers reviewed by the RCN paint a picture of targets being missed and patients being failed, with record numbers of patients on waiting lists, people waiting hours in A&E, and tens of thousands of vacant nursing posts. Together these are leaving patient care at critical risk.

The long-awaited workforce plan must tackle the nursing workforce crisis head on but, despite it being promised for months, Health Secretary Steve Barclay has been unable to confirm when it will be published.

In acute settings in England, the review by the RCN revealed that:

• Over 1.5 million more people waited over 4 hours in A&E in 2022 compared to 2011 – that’s a sixteen-fold increase from 2011 (98,595 people in 2011 to over 1,622,185 people in 2022).
• In the same period, the NHS elective care waiting list has grown by 169% – in 2011 an average of 2.53 million patients were on waiting lists compared to 6.79 million in 2022. The data also shows waiting lists were continually growing even before the COVID-19 pandemic.
• At the same time, nursing vacancy rates since 2017 have remained stubbornly high. According to latest data, there are over 40,000 nurse vacancies in the NHS in England.

This new assessment comes as new figures recently revealed around 7.33 million people in England were waiting to start routine hospital treatment at the end of March 2023 – the highest number since records began in 2007.

Despite the NHS Long Term Plan’s broad ambitions to shift care out from acute settings, figures from community health services in England show a wider problem – the whole health and care system is buckling under pressure. The workforce elements needed to deliver the NHS Long Term Plan have never been set out by government.

Away from hospital settings, the RCN assessment reveals that between September 2009 and December 2022:

• The number of community and district nurses has fallen by nearly 50% (46.9%). This – alongside the crisis in social care – is leaving thousands of people who are fit enough to go home delayed in hospital beds.  
• Learning disability nurse numbers have fallen significantly, by 45.2% – leaving people with a learning disability and their families without the vital support they need.
• The number of health visitors has fallen by 30.2% meaning young babies and new parents are less likely to receive the support they vitally need in the first few weeks and months.

The College says if there aren’t appropriate social care packages in place, then people fit to go home can’t be discharged from hospitals. This in turn means there’s no spare beds so A&E patients can’t be admitted onto wards. A&E departments themselves fill up so new people arriving have to receive urgent care in inappropriate and often unsafe areas, such as corridors. Despite the critical pressure on social care, its nursing workforce has decreased by nearly 40%.

RCN General Secretary and Chief Executive, Pat Cullen, said: “These figures paint a disturbing picture for patients in hospitals and nursing homes, in the community and in their own homes. The crisis in the nursing workforce is leaving patient care at risk and the immense pressure could risk the collapse of health and care services.

“Ministers are playing a dangerous game by delaying the long-awaited NHS workforce plan – we simply cannot wait any longer.

“But the workforce plan won’t be the end of the story. Our assessment confirms the fact we need investment right across health and care services – without that patients will continue to lose out.

“Some of the most vulnerable are stuck in hospital, partly because of under-investment in social care and more than a decade of declining community nursing numbers. The knock-on effect in hospitals is disturbing, with four-hour plus waiting times increasing 16-fold between 2011 and 2022.

“This catalogue of issues must be addressed urgently, or many people will continue to go without the care they need.

“No more delays, the government needs to deliver.”