Temporary staff are filling the gaps in the nursing workforce

The Royal College of Nursing warns 30,000 nurses leave the profession yearly, and it faces a fragile future.

Efforts to cut agency costs with the creation of an internal NHS temporary nursing pool have had "disappointing" results, it says.

But England's Chief Nursing Officer Chris Beasley said the temporary pool had made a positive difference.

She added that a new deal offering more pay and flexible hours would help the NHS retain staff.

US exodus

The latest figures are published in the report, A Fragile Future? - an annual overview of the state of the UK-wide nursing labour market commissioned by the RCN.

Figures released on Sunday ahead of the report's publication showed an increasing number of nurses were opting to go to the United States, which is pursuing a major recruitment drive.

My concern is that the foundations of nursing are built on sand, not stone Dr Beverly Malone, Royal College of Nursing Why I quit the NHS

It said 2,000 NHS nurses left Britain for America last year, thought to be the largest number on record.

The report warns that despite growing numbers of people entering the profession, demand continues to put pressure on supply.

While some 35,000 new nurses were taken on in one year alone, 30,000 left, including those retiring.

Many nurses are nearing retirement age and others have signed up with temporary agencies which charge hospitals premium rates but allow nurses to pick and choose the hours they work.

Recruitment 'problem'

One of the most serious trends was increasing reliance of the NHS on bank and agency nurses, the report concluded.

Bank nurses are employed on NHS salaries, while agency nurses are employed by private organisations who charge the NHS for their time.

Temporary staff can be useful for short-term cover of permanent staff, but the RCN said longer-term dependency could be costly and reflected an inability to recruit permanent staff.

We're not complacent and continue to put our efforts into recruiting more nurses Chris Beasley, Chief Nursing Officer

NHS spending on agency nurses stood at �628 million in 2003 - almost triple the amount in 1997.

The growth in bank nurses outstripped the growth of NHS qualified nurses, increasing at twice the rate between 1999 and 2003.

Many others are from overseas. In 2001/2002, more foreign nurses joined the NHS than UK-trained nurses.

About 14,000 now join per year - a five-fold increase on previous years.

Despite publicity campaigns, only 3,000 to 4,000 nurses have been returning to nursing each year, and many working in the NHS are thinking of leaving.

More training

General secretary of the Royal College of Nursing, Dr Beverly Malone, said: "Whilst the RCN acknowledges numbers of nurses has increased, my concern is that the foundations of nursing are built on sand, not stone.

"We have to ask why so many nurses feel unable to commit to the NHS and prefer to work on a temporary basis.

"Nurses tell us that the chance to choose which hours they work is a major factor. All NHS nurses should be able to enjoy flexible working - the sad fact is many nurses cannot."

She warned that the compound effect of an ageing workforce, increasing numbers of nurses leaving the profession, or competition from abroad in recruiting nurses, threatened stability and patient care.

Ms Beasley said the NHS had more nurses than ever before, and more were being trained.

"However, we're not complacent and continue to put our efforts into recruiting more nurses and other staff," she added.

She said although international recruitment still had an important contribution to make in delivering NHS services, the aim continued to be "towards home grown staff and building a more diverse workforce which reflects local communities."

'No crisis'

Health Secretary John Reid insisted there was no crisis in nurse recruitment, and that the NHS now had more nurses than ever before - 80,000 more than in 1997.

Furthermore, 18,500 nurses had returned to the profession in the last four years, more nurses were being trained and the number of applications for vacancies had almost doubled.

However, speaking on the BBC Radio Four Today programme, Dr Reid said some nurses would always want to work for agencies because of the greater flexibility it gave them.

"There are shortages because, even with 100,000 more doctors and nurses, we still need more in the NHS which shows you how badly off we were only seven years ago.

"I am not in the least complacent. What I am saying is that it is not true we have fewer staff or worse trained. We have more staff than ever, they are better trained than ever."

Paul Burstow MP, Liberal Democrat Shadow Health Secretary, said: "Overseas recruitment is the government's sticking plaster solution to the shortages of nurses.

"It is morally indefensible to aggressively recruit nurses from developing countries that have their own health crises.

"Nurses should be allowed to work flexibly as this will attract more people into the profession. But it is essential that money is not wasted through poor organisation of temporary staffing."

Shadow Health Secretary Andrew Lansley said: "The problem of nurse shortages is not one of recruitment, but retention.

"NHS organisations must now be set free from central targets and bureaucracy so that they, with their employees, can determine flexible working practices which best suit the needs of nurses and patients alike.