Gotta get yer gotchas right

The gotchas around the Conservative pledge to recruit 50,000 more nurses are wrong – but the truth is actually worse.

The Conservative announcement that they will “deliver 50,000 more nurses” has not gone down as they would have hoped. Labour has picked up on the fact that some of this increase will be delivered by better retention of existing staff. Nicky Morgan had a particularly uncomfortable experience trying to explain her way out of this on Good Morning Britain, as presenters (and probably viewers) became increasingly incredulous.

The problem is that this criticism is wrong-headed. Increasing the size of the nursing workforce isn’t just a case of saying so – it’s a stocks and flows problem. If we want a larger nursing workforce, we need to increase the flows in (through more attractive, better-funded training, or recruitment of nurses from overseas) and decrease the flows out (through better retention). The Conservative manifesto refers to policies that are designed to do this, such as reinstating the bursary for student nurses. We might think that the 50,000 figure is overegging the effects of these policies – the Health Foundation has said that in reality half will need to come from overseas – but you wouldn’t want to attempt this without looking at retention.

That said, there’s a bigger problem with this commitment – or at least how it is being sold and understood. The manifesto costings earmark £759m for this policy in the first year. You may have noticed that this is much less than the cost of employing 50,000 nurses (which Full Fact has estimated as at least £2.8bn). That’s because this money isn’t for paying nurses salaries at all. It is just for the policies, like the student bursary, that the government hopes will improve recruitment and retention. It means that NHS England may have a better supply of skilled nurses to employ, but it doesn’t pay their wages.

So what does this mean for the number of nurses that will actually be working in the NHS? Well, what it certainly does not mean is that there will be 50,000 more nurses working in our hospitals and communities than there would be in the absence of this announcement. That’s not to say nurse staffing levels won’t rise: the government has already announced increased NHS funding for the coming years and some of that might be spent on providing more nursing. But this new policy is about developing the nursing workforce, not about funding more nursing care.

Almost everything I have read about the policy has misunderstood this point – and I doubt that would have been lost on the authors of the manifesto. Much cheaper to announce some measures that you hope will lead to better recruitment and retention and let everyone think there will be 50,000 more nurses working in the NHS than to find the £2.8bn that would actually cost. There has to be a strong suspicion that this was a deliberate attempt to mislead.

The correct gotcha is therefore this: will there be 50,000 more nurses working in the NHS as a result of this policy? If so, the numbers don’t add up, since £750m can only pay for around a quarter of that number of nurse salaries. If not, can we be clear that this is just about training, recruiting and retaining people to fill existing jobs, or jobs that the NHS is already planning to create with previously announced funding?

Although, to be fair, that would not have been nearly as effective on Good Morning Britain.

1 thought on “Gotta get yer gotchas right

  1. Nomadic Pensioner

    And of course, if you significantly increase supply of nurses, but there isn’t the money to employ very many of them, you can keep wages low and still get all the nurses you need to fill the poorly-funded posts.

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