• NHS trusts spend £1.46 billion a year on temporary staffing to plug the nursing gap – the equivalent of salaries for 66,000 newly qualified registered nurses
  • If existing gaps were permanently filled, trusts could save as much as £560 million a year
  • Poor retention is highlighted as a significant factor driving the shortage, with 70 per cent of registered nurses leaving their NHS trust within 12 months of qualification


NHS trusts in England are being forced to turn to expensive temporary staffing arrangements to plug gaps in nursing rotas – at a cost of £1.46 billion last year.

Data secured under the Freedom of Information Act as part of The Open University’s new report Tackling the Nursing Shortage quantifies the financial impact of the national shortage – £1.46 billion. This bill for temporary staff would be enough to pay the salaries of 66,000 newly qualified registered nurses – more than filling the 38,000 existing vacancies.

In 2017, NHS trusts paid for an additional 79 million hours of registered nurses’ time at a premium rate – 61 per cent above the hourly rate of a newly qualified registered nurse in full-time employment. Based on the difference in cost, if current vacancies were filled permanently, the NHS could save as much as £560 million a year.

However, a new UK survey of 500 registered nurses and healthcare support workers commissioned by The Open University reveals that three quarters (76%) of registered nurses expect the shortage to worsen in the next 12 months and three in five (61%) believe even more temporary staff will be needed.


Poor retention is a problem in the NHS. Issues around pay, workload, organisational culture and access to continued professional development is driving nurses on to other trusts and the private sector, or to leave the profession altogether. Brexit has also seen a 28 per cent rise in EU nurses quitting Britain, which could further exacerbate the problem.

The study found one in three (34%) registered nurses are unhappy in their current role – and a similar number (35%) are thinking of leaving their job if things do not improve.

Retention is particularly problematic at the beginning of nurses’ careers, with seven in 10 (70%) newly qualified nurses quitting their NHS trust within a year of qualification, leaving gaps that can be hard to fill. Many nurses have to complete their pre-registration training away from home, particularly in rural areas, but it means significant numbers are moving back when they qualify, with 16 per cent giving this as their main reason for moving between trusts.

Attracting new recruits is the other challenge. The introduction of student loans for nursing degrees has seen the number of applications to study nursing at university fall by around a third, and overseas applications have fallen 87 per cent in the last year as a result of the EU referendum. For this reason, creating new or alternative routes into the nursing profession is essential.

Providing alternative ways to study to become a registered nurse is one suggestion for tackling the shortage. In this survey, nearly two thirds (63%) of registered nurses believe offering flexible distance learning would help to recruit nursing students from more remote areas and keep nurses in these areas after they qualify. 71% believe apprenticeships could help to attract new student nurses to the profession and 60% believe that they offer a good alternative to recently removed bursaries.

Offering trusts the opportunity to develop their existing health care support workers and new recruits via on-the-job training makes the concept of a Registered Nurse Degree Apprenticeship appealing. The NHS is the biggest contributor to the apprenticeship levy, so this approach would ensure they are making the most of their investment. The report concludes that an increased focus on work-based training and apprenticeships could therefore offer a more stable long-term approach.

Jan Draper, Professor of Nursing at The Open University


The full report can be accessed here:

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