Where have all the nurses gone?

This post updates and extends a blogpost I did last year about trends over time in the learning disability nursing workforce in England. There has been a lot of noise made about the importance of learning disability nurses in helping people with learning disabilities get decent access to decent healthcare. On the principle that an organisation’s priorities are often shown in where it puts its money, what are the priorities of those training and employing nurses in the NHS?

So, what’s happening to the workforce of nurses working specifically with people with learning disabilities in England? NHS Digital, as part of their suite of NHS workforce statistics, provide monthly information on the number of Whole-Time Equivalent (WTE) nurses in the categories of Community Learning Disabilities nurses and Other Learning Disabilities nurses. The graph below shows this information for the month of May from 2010 through to 2016.

For community learning disabilities nurses, there were 2,571 WTE nurses in May 2010, dropping steadily to 1,973 WTE nurses in May 2016 (a drop of 23% in 6 years), with numbers stabilising from 2014 to 2016. The decrease for ‘other’ learning disabilities nurses (presumably in large part working in general hospitals, although they may also be in NHS specialist inpatient units or other services) is even bigger and more sustained, dropping from 2,916 WTE nurses in May 2010 to 1,529 WTE nurses in May 2016 (a drop of 48% in 6 years). Overall, this is a drop of 36% in the number of WTE learning disability nurses over 6 years.

Similar figures are also available for specialist learning disability nursing support staff working in the NHS. The graph below shows that the number of WTE community learning disability nursing support staff dropped from 1,805 in May 2010 to 551 in May 2016 (a drop of 56% in 6 years). The number of ‘other’ learning disability nursing support staff also dropped, from 8,962 in May 2010 to 4,255 in May 2016 (a drop of 53% in 6 years). Overall, this is a drop of 55% in 6 years.

The equivalent figures for WTE learning disability psychiatrists working in the NHS are in the last graph below. The numbers here have hardly changed, from 450 in May 2010 to 432 in May 2016 (a drop of 4% in 6 years).

When looking at this, it’s worth bearing in mind that this workforce information is for NHS services only – we don’t know how many nurses and nursing support staff are working with people with learning disabilities in third sector/private services (particularly specialist inpatient services, which have increased their, um, market share, shall we say, over this time period).

In some ways it’s unclear what is going on here. Among other things, it could be a combination of deprofessionalisation of staffing within NHS services, a shift towards generic rather than specialist nursing roles, shifting service patterns (away from NHS inpatient services towards independent sector inpatient services, for example), and of course straightforward cuts to nursing roles.

At the start of this post I said that one way to track an organisation’s priorities is to see where it invests its money. This was too simplistic – whatever the NHS is now, it’s certainly not one organisation. Whatever the Department of Health and NHS England may say about the importance of learning disability nursing, the number of nurses who are trained and employed isn’t under their control. It’s ultimately down to Health Education England, over 200 Clinical Commissioning Groups, approaching 250 NHS Trusts, and almost 8,000 GP practices. Not to mention the almost 900 independent sector organisations providing healthcare (figures from the NHS Confederation). In a reversal of Aneurin Bevan’s dictum Whitehall can drop all the bedpans it wants, but there’s no reverberation in hospital corridors.