The recent Caring in crisis: the impact of the financial crisis on nurses and nursing [European Federation of Nurses Associations (EFN) 2012] reported major concerns for the future of the nursing workforce across the European Union. While there is some variability between countries, the nursing workforce in Bulgaria, Croatia, Denmark, Greece, Ireland, Latvia, Lithuania, Montenegro, and the United Kingdom (UK) all appear to be particularly vulnerable to the impact of a budgetary meltdown associated with the recent global financial crisis. Similar concerns have been reported in America (Gantz et al. 2012, Willard et al. 2012), Australia (Kearney 2009), and across the globe (Adams 2012). Austerity measures imposed by governments are affecting the healthcare workforce and the report (European Federation of Nurses Associations 2012) highlights several phenomena that are – in combination – creating a potential ‘ticking time bomb’ for the National Health Service (NHS) workforce in the UK.
In 2009, there were job losses and pay cuts in the UK health sector, and in 2010 there was a national 2-year pay freeze for all staff working in the public sector earning above £21,000, introduced as a response to the extraordinary economic circumstances (European Federation of Nurses Associations 2012). In the Government's comprehensive spending review of 2010, an estimated half a million public sector jobs may be cut by 2014, plus another half-million private sector posts that depend on the public sector (Royal College of Nursing 2010, Salvage 2011). The Royal College of Nursing's Frontline First campaign (2011) reported that approximately 48,029 posts were at risk in England, with 56,058 posts at risk across the UK (Royal College of Nursing 2011). In Wales, vacant posts were not being filled, and maternity and sickness cover were not being provided. These budgetary restrictions have been contextualized by some as an opportunity to add value to services (Adil 2011); however, it is evident that governments in all four UK countries are facing a difficult period (Buchan & Seccombe 2011) as the healthcare system is under tremendous pressure to deliver efficiency savings in an economically constrained climate while also responding to increasing patient demand, rising costs for drugs, and an ageing population (European Federation of Nurses Associations 2012).
As these efficiency savings are being delivered, the government seeks to increase patient choice, reduce bureaucracy, and give clinicians more freedom in the commissioning of services (Department of Health 2010) as part of ‘a mind-blowingly large redisorganisation’ (Salvage 2011, p5). The Health and Social Care Bill (Department of Health 2011) requires cuts across the NHS of £20 billion at a time when the UK workforce is already under significant pressure (Shields & Watson 2008). As unemployment lags behind recession, so employment conditions may be at their most difficult years, rather than months, after the recession (Royal College of Nursing 2009). The European Federation of Public Service Unions (EPSU) has issued a strong statement on the negative effects that the economic crisis and austerity measures are having on health workers, calling for a sustainable healthcare system in Europe. The economic crisis has increased workloads and stress levels for the nursing workforce (Douglas 2011, Palese et al. 2012). There is also increasing evidence of substituting regulated nursing jobs with unregulated healthcare assistants and assistant practitioners (Royal College of Nursing 2011). A recent report suggests that the NHS reforms are sparking the loss of senior nurses who oversee quality and safety (West 2012) and this is likely to be aggravated by an ageing nursing workforce (Wray et al. 2009, Snow 2012) with 180,000 nurses due to retire within the decade (European Federation of Nurses Associations 2012). Approximately one in three Registered Nurses in the NHS is now aged over 50 (Royal College of Nursing 2012) and the likely impact of retirement patterns on the workforce is not clearly understood (Buchan & Seccombe 2011). Although retirement behaviour may be affected by changes in pension provision and retirement age, at best this will only delay the withdrawal of these individual nurses from the labour market.
In addition, approximately 1,260 fewer nurses will be trained throughout the UK in the 2012/13 academic year compared with 2011/12, and about 4,500 fewer than 4 years ago – a drop of 16·9% (European Federation of Nurses Associations 2012). Almost 75% of student nurses already need a second job so they can afford to study, and many drop out of their studies prematurely because of financial worries and debt (Royal College of Nursing 2008). There will be fewer lecturers and fewer training places, leading to fears of a repeat of ‘boom and bust’ workforce planning (Salvage 2011). An RCN round-table discussion (2009) encouraged nurses to think carefully about their role in reducing pressure arising from the downturn, advising them to be flexible about the way they work and to consider taking on new roles in varied settings, to become proactive in helping secure the future of their workforce (Wells & McElwell 2001). However, as we ‘lose’ nurses to factors such as attrition, redundancy, retirement, ill-health, and early exit, being flexible and proactive may not be enough to sustain safe and effective nursing practice.
The world economy, facing the most critical financial crisis since the 1930s, must deal with recession, severe unemployment, and general fears of worse to come, which, in turn, spawn a range of physical, psychological, and spiritual problems (Chang et al. 2012). The backlash of the global ‘financial tsunami’ (Chang et al. 2012) will also have an impact on the demand for health care (Kingma 2009). Demand for health services is likely to rise in the economic recession and in the ‘aftershock’ period, patient demand will put pressure on services in the UK (Royal College of Nursing 2009) and worldwide (Sargent-Cox et al. 2011, Jooma et al. 2012, Kalafati 2012, Palese et al. 2012). Although budget cuts are nothing new in the NHS in the UK, the multiplicity of global, economic, social, and political factors affecting the working lives of nurses have created a unique context and a potentially critical future for nursing.