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Nursing student numbers: should we panic yet?


Last year, the government scrapped the bursary available to new nursing students, arguing that this would create more training places by allowing universities to set their own fees and generate more income from nursing courses. However, more training places do not necessarily mean more trainees and critics suggested that scrapping the bursary would exacerbate the current shortage of nurses by deterring prospective applicants. Recently released UCAS data can help us assess the effect of withdrawing the bursary on student numbers.

As of August 2017, nursing students pay their university fees and are subject to the same fees and loan-based system as other students. Back in July, although we could see that applications to nursing courses in England for the academic year starting in September 2017 were down 23 per cent compared to 2016, I said we should reserve judgement. I thought waiting until December, when the final figures for acceptances on to these courses would be released by UCAS, would give us a more informed view. Those December numbers have now been published and showed a slight fall in the number of acceptances on to nursing courses in England compared to the previous year.

Source: UCAS End of cycle report 2017: Patterns by subject

Acceptances on to courses were down by slightly more than 700 places compared to last year, from 23,280 in 2016 to 22,575 in 2017, although this was the second-highest number of acceptances since 2009.

Looking behind the overall acceptances figure, this isn’t a consistent trend across age groups: acceptances among people aged 21 and over are down, while acceptances for 18, 19 and 20 year-olds are up year on year.

Source: UCAS End of cycle report 2017: Patterns by subject

The age of the applicant usually correlates to the type of nursing course applied for: people who have previously had a nursing or care role are more likely to apply for mental health or community nursing courses, whereas younger applicants are more likely to apply for acute nursing courses. The rise in the number of applications in 2016 was predictable: the number of applicants aged 26 or older rose sharply as people tried to take advantage of the final year of bursary availability.

Furthermore, more places were offered and accepted through the clearing process than ever before, up by 40 per cent in 2017, suggesting that universities were having a harder time filling the placements they had than in previous years (though the total number of places accepted through clearing was up across all subjects last year).

While the UCAS data helps us to understand what has happened to the number of applications for nursing courses, what has happened to the plan to increase the number of nursing training places? The most likely barrier to achieving the intended increase in training places is finding the time in busy clinical schedules to provide safe and educational supervision for students. The government is clearly aware that the change to the bursary hadn’t proved enough to generate more placements: it announced plans in October to fund 5,000 more nursing placements in addition to the 10,000 already announced to allow hospitals to resource additional student placements. If you look at Figure 1 again though, you’ll see that the number of acceptances in 2016 and 2017 were at a similar level to the number in 2009. Between 2009 and 2011, the number of places taken up by students fell from 22,925 to 19,510, and the growth in numbers seen between 2011 and 2016 has just made up lost ground.

The data seems to suggest that many potential students have been deterred from applying while those who have been accepted on to courses now face the prospect of beginning their professional career burdened by debt. The pay off – an increase in the supply of training places – has not materialised. Furthermore, as the Health Select Committee recently pointed out, the reduction in older applicants will disproportionately affect community and mental health services where shortages are at their worst.

However, this isn’t the first time changes in tuition fees have resulted in an initial fall in the number of students. The number of acceptances on to courses also dropped in 1998/99, in 2006/07 and in 2012/13 when tuition fees were first introduced and then the maximum fee rate rose. In each of these cases, the number of acceptances recovered from the initial fall.

Nevertheless, the Health Select Committee has called on the government to say what it will do if this year’s disappointing outcome is repeated in future years. Given the context of the nursing shortage already in existence and the retention issues the NHS has, it would be wise to get a Plan B ready just in case…