A report suggests that more than three quarters of all hospitals are struggling to keep and recruit nurses and midwives at all levels.

There are nursing shortages in all areas, but more in specialist care

The problem is worse for basic rate nurses and specialists in intensive care and care of the elderly.

And 82% of hospitals are having problems finding experienced occupational therapists and physiotherapists.

The government has already pledged to recruit an extra 15,000 nurses and increase by 6,000 the numbers of training places.

But the Conservatives question where these extra nurses will come from.

Difficult working conditions

The report by the NHS Confederation to the pay review bodies for nurses, midwives and other health workers says the main reasons for the crisis are:

• overall workforce shortage
• lack of career opportunities
• difficult working conditions
• a feeling of continuous change
• increasingly difficult and growing workloads
• a feeling that NHS professions are undervalued.

It says that, although pay is not the most important element, the fact that NHS pay rises have consistently been lower than increases in the private sector is "one of the disincentives" to a career in the NHS.

However, despite the extra �21bn for the NHS announced in the government's comprehensive spending review, the Confederation believes there is not room for more than a modest pay rise for NHS staff.

It says a higher priority must be given to recruiting more staff than pushing up salaries.

But it is against the staging of pay rises and says all professions should get the same percentage increase.

Training

The Confederation also calls for more money to be put into student bursaries and for a review of entrance requirements for trainee nurses via the Project 2000 scheme.

Andrew Foster outlines the measures being taken to avoid a crisis

Chairman of the Confederation's Human Resources Committee Andrew Foster told BBC Radio 4's Today programme that the project's drive to upgrade nursing to a graduate profession had "left gaps".

He added: "You do not need three A-levels to be a caring person.

"One of the possibilities is once again bringing people in who do not have the highest qualifications."

Health unions debate the crisis

Health unions report a 30% decrease in student nurse intakes and say the number of nurses over 55 is likely to double in the next few years, worsening the crisis.

Open and flexible

The Confederation also recommends a shakeup of the entire NHS salary and career structure to make it more flexible.

Mr Foster said the Confederation wanted to encourage people who had left the profession to have families to come back to work.

He said: "There is a place for them and they can do a very good job for us."

Alan Milburn on the recruitment crisis

The government also backs greater flexibility in the NHS.

Prime Minister Tony Blair told a recent Nursing Standard meeting that he was in favour of more flexible working patterns and said the NHS should be open to people from all backgrounds.

He also announced plans for a new consultant nurse grade which would allow senior nurses to take on more responsibility and develop their skills.