Student nursing numbers: good news at last?

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There have been a number of changes to how student nursing courses are funded over the past 10 years, which have impacted on the NHS in different ways. The two main changes were a reduction in the number of places funded by the government in 2011 (this was intended to prevent an oversupply of nurses, but ironically contributed to the shortages we now see), followed by the removal of the nursing bursary in 2017 (a move intended to remove the cap on the total number of nursing placements).

These changes initially led to a reduction in the overall number of nursing students in training. But here’s one piece of good news from 2020: the number of student nurses rose 25 per cent compared from 2019, an increase of just over 6,000 in one year.  

Student nursing numbers blog chart 1

So why this sudden jump? It’s not because more people are applying than ever before – the number of applications for nursing courses in England is still below pre-2017 levels (there were 145,925 applications to English courses in 2020 and 150,970 in 2017). The most likely reason is that more funding is now available for clinical nursing placements, starting this financial year. As part of the NHS long-term plan, NHS England and NHS Improvement announced that it would provide funding to Health Education England to match the number of places filled on university courses with clinical placements from 2020/21. Without this additional capacity to supervise trainees, the number of nurses trained could not increase in a given year.  

That doesn’t fully explain the increase, however. Late last year, just as applications for courses starting in 2020 were closing the government, recognising the impact of the removal of the bursary on more mature and disadvantaged students in particular, reinstated the maintenance grant (the part of funding that covered living costs) with additional funding for people studying within regions or specialties with particular shortages – though students will still have to cover their course fees. Breaking down this trend by age, we can see that age groups over 30 have seen the biggest increases in student numbers this year, increasing by an average of 40 per cent year-on-year (more than 2,800 people). 

Figure 2 showing the percentage change in acceptances onto undergraduate nursing courses in England, 2019 to 2020

Restoring the maintenance grant may have made the prospective cost of taking up a nursing course seem more affordable for students of all ages, especially among mature students who are more likely to have additional living and caring costs compared to younger applicants. There may also have been built-up demand for places on nursing courses over the last couple of years, especially among people already working in health and care looking to retrain.  

The announcement that the maintenance grant would be reinstated was made with only a month to go before the deadline for applications, so we may not have seen the full impact of this change yet. With a full year for prospective applicants to see how this change affects their circumstances, we may see another rise next year. 

Such a rapid expansion in the number of training places for 2020 suggests that NHS organisations feel more confident about offering additional placements and that the additional funding from central bodies is having a positive effect on the number of people in training. However, we have not seen an increase in nursing staff at the same scale as student placements this year. The total number of ‘education nursing staff’ in the adult care sector increased by 11.9 per cent this year – a welcome expansion, but this only represents an additional 200 staff. With more than 6,000 additional students requiring supervision, each staff member is potentially left with more supervisory duties to balance as part of their workload (though other nurses will also cover supervision). 

This is already a very tough time to work in the NHS – following years of staff shortages, the Covid-19 pandemic has only increased the workload for staff, while also creating a backlog of need for care that the system here in England will have to work though over a period of years to come. The NHS needs more staff, and such a rapid rise in student nurses is a big step forward in achieving sustainable and safe staffing levels in the future, but paradoxically will increase the need for more staff in the short term to ensure the quality of that training.  

The solution to the staff shortages that existed before and have now been exacerbated by the pandemic is a long-term increase in the number of staff trained within the NHS, supported by an increase in the retention of staff and a short-term increase in sustainable international recruitment. Brexit and the Covid-19 pandemic have both made international recruitment more difficult, but increasing concerns about the welfare of nursing staff and the numbers experiencing burnout have made the need for recruitment more pressing.  

Achieving a balance between all the calls on the time of frontline staff would help to relieve some pressure, but will be difficult even after the pandemic ends. Hopefully this year marks the start of a more sustainable supply of nursing staff for the future. 

This blog was updated on 4 February 2021 to clarify how funding for extra places flows through central bodies. 

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