The Labour Market for Nurses in the UK: 1997-2006
Thomas, Rob, Teaching Business & Economics
The case study covers a period in which there were major changes in the demand for and supply of nurses in the UK. It provides an example of the complexity of labour market adjustment following a sudden change, in this case a sharp rise in funding. As well as economic analysis, this case study involves issues arising from government policy, technological and social changes, globalisation and ethical considerations.
Education may have been the stated priority of Tony Blair in the 1997 general election campaign - readers may recall the slogan "education, education, education" - but the statistics in Table 1 indicate that, in practice, the Labour government also prioritised funding the NHS.
The surge in spending on the NHS was underpinned by the public's expectations of the health care that should be provided by the government in a relatively rich country such as the UK. People learned about improvements in medical treatments and technology that not only save lives but enhance the quality of life. This was, and is, particularly relevant to a country where the population is ageing. (In 2002, according to Social Trends 37, although life expectancy for females and males in the Great Britain had risen to 80.5 and 76.0 years respectively, healthy life expectancy was 69.9 and 67.2 years respectively.) Yet, spending on health care in the UK was below the European Union average in the late 1990s.
The increased funding was accompanied by government pressure on the NHS. The government set targets for healthcare provision in order to demonstrate improvement. Meeting these targets and pressures required more staff, especially nurses. By 2006 an estimated 383,000 qualified nurses and midwives (measured in whole-time equivalents or WTEs) were working in the NHS, 23.5 per cent more than in 1997. Table 2 shows how the number of nurses and midwives was falling in the mid-1990s before the turn around that came with the increase in funding.
The government in the UK, via budgets, influences the number of qualified nurses employed in the NHS and, via funding of places, also manages the number of nurses being trained. According to a Royal College of Nursing report, "it takes approximately four years between the decision being made to fund a place for a student nurse and that nurse being eligible to register and practise" (Buchan 2007). Forecasting is, therefore, necessary but is complicated not only by sudden changes in government funding policy but also, during the period 1997-2006, by changes in the professional education of nurses, the shift in emphasis from acute/secondary to primary care and the introduction of employment legislation such as implementation of the EU Working Time Directive.
All nurses and midwives working in the UK must register with the Nursing and Midwifery Council (NMC) and renew their registration every three years. In line with the decline in the overall number of qualified nurses and midwives during the mid-1990s, the NMC register showed falls in the number of newly qualified UK-trained nurses and midwives during the same period. After 1997, this trend was reversed (see Table 3), slowly at first and then accelerating in the early part of the new decade before slowing again.
Accompanying the rise in the number of newly qualified nurses were increased numbers registering from outside the UK and outside the European Economic Area. Whereas in the early 1990s, only about 10 per cent of new nurses registering were from outside the UK, in 2001-02 nearly 50 per cent were international qualified nurses. These nurses were recruited from countries such as the Philippines, India, South Africa, Australia and Nigeria, and they enabled skill gaps to be filled without waiting for domestically trained nurses to complete their course and gain experience. …