Number of UK nursing students plummets despite NHS shortages

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The UK government’s once-in-a-generation plan to expand the NHS workforce has “stumbled at the first hurdle” following a sharp drop in acceptances to study nursing at university this year, the Royal College of Nursing has claimed.

Finalised data from university application service UCAS showed a 12 per cent drop in acceptances for nursing in the UK compared with 2022, leaving the government far adrift of its targets for boosting nurse recruitment to address shortages in the NHS.

Under the NHS Long Term Workforce Plan for England, nursing training places need to increase 65 to 80 per cent above last year’s levels to meet 2031 targets. 

Nichola Ashby, the RCN’s UK deputy director of nursing, said the government had “stumbled at the first hurdle of their NHS Workforce Plan” when preliminary results emerged last month. 

Ashby said nursing remained a “fantastic” and varied career but said multiple factors contributed to the reluctance to enter the profession, including low wages and financial strains exacerbated by the cost of living crisis. 

Although student nurses worked a 40 hour week, many were forced to take second jobs “purely to be able to feed themselves and quite often their children”, she said, pointing out that many new recruits were mature adults with families and mortgages.

“What we’re seeing is, when they qualify, their wages aren’t really enough to be able to attract them to want to stay [in the profession]”, she added.

James Buchan, senior fellow at the Health Foundation, a research organisation, said that with more than 43,000 nursing vacancies in NHS trusts in England alone, recruiting and retaining nurses remained “critical to addressing the NHS workforce crisis”. 

He added that NHS nurses were quitting the profession at close to record levels, so while training more was essential it would be insufficient if the health service could not also retain its existing staff.

Buchan added: “The long term workforce plan will only have the potential to succeed if the government backs it with clarity on implementation, investment and regular monitoring.”

The profession saw a sharp uptick in popularity during the Covid-19 pandemic — dubbed the “Chris Whitty effect” after England’s chief medical officer who gained a high profile during the crisis — but over the past two years applications have shrunk back to 2019 levels. 

The UK has become increasingly reliant on nurses from abroad, with almost half of the new joiners to the nursing register in 2022-23 educated overseas, mainly outside Europe, according to the Nursing and Midwifery Council, the profession’s regulator.

Miriam Deakin, director of policy and strategy for NHS Providers, which represents frontline health leaders across England, said the drop in applications was “extremely worrying”, coming as the NHS faced escalating strike action.

The vice-chancellors of Sheffield Hallam, Portsmouth and Sunderland universities all confirmed low volumes of nursing applicants and warned of a looming crunch for the profession.

Sir David Bell, vice-chancellor of the University of Sunderland, said the institution had been surprised how quickly the pandemic bubble had burst, with just 80 applications in 2023 against a target of 120. 

He added recruitment had fallen most sharply among over-21s and while the numbers of applications from school-leavers were holding up, it was not sufficient to compensate.

“It’s got something to do with the perception of the NHS at the moment: this sense that it’s overworked, overburdened, underpaid. That must be changing the outlook for the profession and I’m not sure the government is fully seized by the urgency of this crisis,” he said.

Graham Galbraith, the vice-chancellor of the University of Portsmouth, added that nursing students also faced additional pressure because their long hours prevented them from taking casual work to help stretch their grants. 

Changes to the student loans repayment system also worked against nurses. “The student finance burden is becoming a concern as nurses’ salary levels mean that, under the new financial arrangements, they will be paying back more for longer than other students entering professions which are better paid,” he said.

The Department of Health and Social Care said the workforce plan demonstrated the government’s commitment to addressing NHS staffing issues, and was backed by £2.4bn over the next five years to fund additional education and training places.

It added that while demand for places had “rebalanced” since the pandemic, applications for nursing were still 12 per cent higher than in 2019 when midwifery was taken into account, along with “thousands” more applicants to study medicine than there were places available.