The Conservatives’ paper-thin manifesto has come a cropper. They’ve been accused of lying after promising that they will hire “50,000 more nurses”: when in fact they have provided funding to teach just 30,000 more nurses – with the remainder being accounted for by improved retention rates.
The party actually has a point: one of the biggest challenges for the public sector – as indeed for the private sector, but that’s less of a collective problem – is the retention of existing staff, because people decide they want to change jobs, or move to another country, or quit to have children. At present, around 35,700 nurses a year leave the NHS – so if you wanted to hire 50,000 extra nurses you would need to train at least 95,700 – both to increase capacity and to replace missing nurses.
So the Conservatives are playing a clever game with the word “more” because people hear that as “extra”, and because in reality the Tory party are simply rebranding a U-turn as a bold policy choice. After abolishing the student bursary for nurses they are bringing it back.
There two big policy problems here, though, and they aren’t that they are pledging 50,000 nurses and committing money for just 30,000 – it is that they are making frankly Herculean assumptions about their ability to increase retention rates and they haven’t made any money available to actually hire any more nurses.
Let’s look at retention rates, first. Since the introduction of NHS England’s Retention Improvement Plan in June 2017, the rate of nurses leaving the Health Service has fallen from 12.5 per cent to 11.9 per cent, at a cost of around £750m. The government proposes that it will reduce that retention rate to 6.6 per cent by the end of the parliament – at a cost of £759m a year, rising to £879m a year by 2024. These are not reasonable assumptions about the level of retention improvement you can get for so little money.
The reality is you cannot meet the Conservatives’ promises on staffing and running the public services while meeting their promises on Brexit and immigration – the United Kingdom is going to have to choose one of them. Unless the UK achieves unprecedented increases in staff retention, we are going to end up hiring nurses from abroad to meet that 30,000 target.
But even if you can somehow close the retention gap, the money that the Conservatives have earmarked on meeting this pledge isn’t towards hiring 50,000 more nurses – merely towards training them. The problem here is obvious – you can train as a lawyer, but unless someone puts up the cash to hire your services you are not working as one. And that’s the big problem with the Conservatives’ nurses pledge – not whether or not they are hiring 30,000 or 50,000.