Nurses are in such short supply in the UK that the NHS is relying on less qualified staff to plug the gaps, according to a new report.

According to the Health Foundation charity, healthcare assistants and nursing assistants have been used to help with tasks that fully qualified nurses would normally carry out if there were enough of them.

Numbers have been shored up for years by overseas recruitment – but Brexit has caused a drop in the number of those coming from the EU, the report says, so the health service is now taking more nurses from countries further afield, including India and the Philippines.

This, in turn, means an ongoing shift in the mix of clinical staff and the type of skills they have, the report says.

And the charity said a government target to recruit 5,000 more GPs by 2020 is “impossible” to meet.

As the main political parties put the NHS at the centre of their general election campaigning, including promising more staff, the Health Foundation says:

• number of nursing vacancies across the NHS is 44,000 (12% of the nursing workforce)
• number of vacancies could reach 100,000 in a decade
• doctor numbers grew by 2.5% over 2018/2019
• full time nurse numbers grew by 1.5% over 2018/2019
• biggest increase in staff in past year was among managers (6.2%) and senior managers (5.7%)
• number of full-time GPs fell 1.6% between March 2018 and March 2019
• temporary staff and trainee GPs make up greater proportion of GP workforce then ever before
• number of pharmacists delivering primary care increased by more than 40%

The Tories have promised:

• 50,000 more nurses
• 18,500 of these are retained from existing nurses
• 12,500 to come from overseas
• 5,000 will come from apprenticeships
• 14,000 will come through training

Labour has promised:

• 24,000 more nurses
• more spending overall than the Tories on NHS

The Liberal Democrats have promised:

• To raise £7bn extra per year for the NHS and social care by putting 1p on income tax
• To target extra help for nursing students, starting with bursaries for those specialist roles where shortages are most acute

The Health Foundation report said: “In 2009/10 there were equal numbers of nurses and support staff, with one clinical support staff member for every full-time equivalent nurse in the NHS.

“By 2018/19, the number of support staff per full-time equivalent nurse had risen 10% to 1.1 full-time equivalent per nurse.”

And it said that between March 2018 and March 2019, the NHS saw the biggest annual increase this decade in its overall workforce.

But it also added that while the changes have so far been implemented well, it is “important that quality and safety are at the forefront of any skill mix change”.

Anita Charlesworth, director of research and economics at the Health Foundation, said: “Nursing shortages continue to deepen and are inevitably impacting on the frontline.

“Services are being forced to make do with shortfalls of increasingly pressurised nurses and rely on less-skilled support staff to pick up the slack.

“Clinical support staff play an incredibly valuable role in the NHS if they are supported in a well-planned way, but these trends appear to be largely unplanned, reflecting the failure to recruit enough nurses.”

Dame Donna Kinnair, chief executive of the Royal College of Nursing, said: “The danger to patients is not from the increase in support workers, but the absence of nurses.

“It is unfair on healthcare assistants to ask them to take on work they aren’t trained or paid for in a desperate bid to plug gaps.

“The evidence demonstrates that where more registered nurses are on shift, patient outcomes improve – it is essential that employers use vital support staff to supplement the work of nurses, not replace them.

“All the election pledges we’ve heard on boosting nursing staff must be about registered nurses, educated to degree-level – this report shows why that is vital.”

A 2016 study from the University of Southampton warned that, for every 25 patients, substituting just one qualified nurse for a lower-qualified member of staff was associated with a 21% increase in the odds of dying.

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