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The Only Way to Be Sure That the NHS Can Safely Care for Its Patients Is By Training Enough Nurses

28/07/2015 16:55 BST | Updated 28/07/2016 10:59 BST

Around 7,500 nurses from the EU registered to work in the UK last year. This is an increase on the previous year, which was an increase on the year before that. Overseas nurses have played a vital role in the NHS since its inception, and will continue to do so, but clearly when trusts are relying more and more on this form of recruitment something is going wrong.

Of all the numbers and statistics in this story - and because it's a story about the health service, statistics are not in short supply - one number above all frustrates me the most: 31,325. That is the number of potential nursing students from across England who were turned away from nursing courses in 2014. While trusts are desperately flying across the globe to fill the gaps in their workforce, there are literally tens of thousands of people in this country who want to fill those gaps.

Of course, no one is suggesting that all of those potential nursing students would have been suitable, nor that everyone who applies to train as a nurse should be accepted. But the number 31,325 puts the lie to a common misconception about the nursing shortage in this country - that it's because no one wants to nurse anymore.

This is a dangerous misconception because it implies that there's not much we can do to ensure the NHS has the right number of staff; that we're just going to have to get used to relying on other countries to supply us with nurses. This isn't true. With over 50,000 applicants for around 20,000 places, nursing is one of the most oversubscribed courses there is. Fixing this problem is a matter of political will - a matter of funding more training places.

This comes down to supply and demand. The Francis Inquiry into the Mid Staffs scandal made crystal clear the link between staffing levels and patient safety. NHS trusts have realised that they must provide safe staffing levels, and that is a really positive thing for patients. Unfortunately, after 2009 the number of training places was cut. It reached a low point in 2011, and only returned to 2010 levels last year. Because it takes three years to train a nurse, we are paying the price of those cuts now.

In other words, trusts want to provide safe staffing but the nurses just aren't there, which means they have to pay over the odds to recruit internationally, and take on agency staff.

That's not all. As the RCN revealed last month, immigration rules which will start taking effect in 2017 mean that nursing staff from outside Europe who arrived since 2011 and aren't earning over £35,000 after six years - which most will not be - will have to leave the country. If these rules aren't changed we won't even be able to rely on overseas recruitment to fill the gaps in our workforce. Patients will suffer as a result.

There are other reasons to be worried. Nurses from countries such as Spain and Portugal will probably start going home as their economies improve, and on top of that, we're facing an overall shortage of nursing in the EU by 2020.

And we know countries like Australia, Canada and the United States are all looking overseas to help fill the shortfalls in their workforces.

All of this means competition for international nurses is increasing. And this is happening while pay terms and conditions in the UK are being eroded, making it even harder for UK hospitals to attract and retain staff. After five years of pay restraint and working on under staffed wards, the prospect of working in Australia or Canada must seem very tempting to many nurses in the UK.

The only way to be sure that the NHS can safely care for its patients is by training enough nurses. That sounds simple, and it is, but it's not happening. Recent increases in training places are promising, but we are still not where we need to be to cope with increasing demand. Hoping that we can continue to fill the gaps with nurses from overseas is not only naïve, it is bad for patients.

Dr Peter Carter is the chief executive and general secretary of the Royal College of Nursing