On the eve of the Darzi review launch, the RCN is urging the government to rescue areas of nursing crucial to plans to reform NHS services and focus more on prevention. It comes as new analysis shows specialist nurse numbers are set to be half what they were two decades ago, the last time Labour was in power.
The College is calling on the Prime Minister to back up his ‘mission’ to repair the NHS with new investment to boost recruitment into nursing.
Lord Darzi’s review is expected to focus on NHS reform to deliver better preventative services. Over the summer, the RCN was asked to submit evidence as part of an expert reference group. The government is now planning to set out “strategic shifts” for the NHS, with a focus on moving care into community settings, and from sickness to prevention.
The new analysis by the RCN shows that district nurse, health visitor and school nurse numbers have collapsed between 2009 and 2024, falling by 45%, 32% and 31% respectively across the NHS in England. Apart from learning disability nursing, the NHS nursing workforce in these specialties is falling faster than any other.
In its evidence to the Darzi review, the College highlighted worrying workforce trends in these three areas of nursing, warning that staff shortages are leading to delays in care. The shortages not only prevent nursing staff delivering early interventions which prevent hospitalisation, but also leave hospitals unable to discharge patients, due to there being too few specialist nurses to care for people in the community.
Projections by the College show that specialist nursing numbers are set to fall even further. Without a funded intervention by the government, the number of district nurses will be down 61% by the end of this parliament (2029) compared with 2009. Health visitors are projected to fall by 44% and school nurses by 42%. In total, the workforce across the three specialties is set to halve in size (49.78%), from 18,070 in 2009, to 8,995 in 2029, just as demand for services continues to increase.
Critical public health programmes are led by school nurses and health visitors, including the Healthy Child Programme, a universal health improvement scheme for children aged 0-19. School nurses and health visitors “utilise their clinical judgement and public health expertise to identify health needs early, determining potential risk, and providing early intervention to prevent issues escalating”, according to government guidance.
The NHS Long Term Workforce Plan, which is just over a year old, says children are the most likely age group to attend A&E unnecessarily and that school nurses are key to managing conditions more effectively in communities.
District nurses provide care for people with long-term needs in care homes and residential settings, supporting discharge, preventing unnecessary hospital admissions and enabling more independent living. Earlier this year, Health and Social Care Secretary Wes Streeting said district nursing “ought to be the future of the NHS”, adding “district nursing is at the heart of Labour’s plan to breathe new life into our NHS.”
Lord Darzi is expected to say that the elderly are being let down by the NHS, with people suffering from multiple long term conditions by the age of 75. District nurses are crucial to supporting this demographic, linking care and NHS services and helping to keep people well in their communities.
The RCN says the government must take the opportunity to invest in the nursing profession by introducing a loan forgiveness scheme for nurses working in public services, alongside state-funded degrees to boost recruitment, including in these essential specialties. Ministers must also take steps to improve nursing pay on a long-term basis to support retention of staff.
The RCN says the government’s intention to shift further towards prevention will also require further integration of NHS and Local Authority commissioning, to support key public health services, such as health visiting and public health nursing, who operate across entire Integrated Care Systems.
RCN General Secretary and Chief Executive Professor Nicola Ranger said:
“A shift to delivering preventative care is vital for patients and our NHS. Prevention helps keep people healthy in their communities, eases the pressure on hospital services and is much more cost effective. But the nurse numbers we need to deliver this shift have collapsed and we’re set to have thousands fewer than we did 20 years ago. That is shocking.
“We made clear in our evidence to Lord Darzi that district nurses, health visitors and school nurses are crucial to supporting people of all ages to stay healthy and independent, providing advice and interventions to prevent conditions worsening. They couldn’t be more important to the government’s correct plan to move care into the community.
“The Prime Minister’s mission to repair a broken NHS is the right one, but that will not happen with ambitions for reform alone. Urgent investment in the nursing workforce, all of whom play a key role in prevention and reducing health inequalities, couldn’t be more necessary.”
Ends
Notes to Editors
The RCN has used workforce trends for health visitors, district nurses and school nurses since September 2009 to project the likely workforce size in July 2029 if trends continue at the same rate, without intervention. These calculations have been made based on an average figure across 177 months between September 2009 and May 2024 (latest available workforce data), and 62 months between May 2024 and July 2029 (the end of this parliamentary term).
The combined total number of school nurses, health visitors and district nurses in 2009 was 18,070, half of which is 9,035. Our projected combined workforce size in 2029 is 8,995.
NHS England workforce data Sep-09 May-24 Difference Sep 09 - May 24 % change Sep 09 - May 24 Average change per month Sep 09-May 24 Projected change by next election at current rate Projected WF size by next election at current rate Projected workforce change Sept 2009 - July 2029 Projected % workforce change Sept 2009 - July 2029 Total Nurses (inc. HVs) 278,470 356,581 78,111 28.0% 441.3032173 27360.79947 383,942 105,471 37.9% School Nurses 2,915 1,999 -916 -31.4% -5.175304689 -320.8688907 1,678 -1,237 -42.4% Health Visitors 8,100 5,484 -2,616 -32.3% -14.77967418 -916.3397992 4,568 -3,532 -43.6% District Nurses 7,055 3,866 -3,189 -45.2% -18.01746237 -1117.082667 2,749 -4,306 -61.0%
