It’s the Year of the Nurse, but will 2020 see nursing student numbers recover?

The previous Conservative government hoped that removing the nursing bursary in 2017 would mean universities would offer more training places, eventually leading to 10,000 more nursing students.

Instead the number of nursing applications dropped, while acceptances remained broadly static. The new Conservative government has restored elements of the bursary, but will this be enough to address the decrease in applications of recent years?

According to the latest UCAS figures on 2019 nursing applications for undergraduate courses, the number of applicants increased by 6 per cent from 2018, with almost 3,500 more people applying, the first rise since 2017. There has also been a record number of people accepted on to nursing courses in 2019 – 30,390 applicants were accepted, an increase of 6.1 per cent on 2018 (see Figure 1). This points towards signs of recovery, but doesn’t fully compensate for the reductions in numbers we’ve previously explored.

Acceptances on to nursing courses first fell in 2011 following the decision to reduce the number of nursing places commissioned. This was designed to prevent an oversupply of nurses, but many now argue that this was the beginning of the nursing crisis currently facing the NHS. Then, in 2017, the government lifted the cap on the number of student nurses and replaced nursing bursaries with student loans, in the hope that universities would be able to provide an additional 10,000 student nursing places. However, this precipitated a second, more significant, decline in applications between 2017 and 2018, when the number of applicants fell by 24 per cent. The number of acceptances on to nursing courses remained steady (see Figure 1), as many of these courses were receiving more applications than available places before the changes to the bursary. In 2019, with the increase in applications, acceptances onto courses also rose, with nearly 1,500 more people accepted onto nursing courses.

Some specialties have been affected by the decrease in nursing applications more than others, for example, learning disability, community and mental health nursing as these specialties tend to attract mature students who are re-training. However, in 2019, the number of applicants for nursing courses rose across all age groups for the first time since the bursary was removed (see Figure 2).

Removing the nursing bursary appears to have been less of a deterrent for those aged under 18 than for older students (who may already be burdened with debt or have family commitments). The number of applicants aged 18 and under fell by 8 per cent in 2017 (when bursaries were scrapped), while other age groups saw reductions of at least 20 per cent. Having said that, it is encouraging to see an improvement in 2019 in applications in the 19–24 and 25–34 age groups as they account for majority of applications.

Though latest figures might seem encouraging on the surface, it’s important to note that the number of acceptances on to nursing courses has not kept pace with increasing demand for nurses – a result of increased demand for health care; more patients with more complex conditions; and an increasing number of nurses leaving the NHS. The NHS currently has almost 44,000 nursing vacancies in hospitals and future projections suggest a gap of 100,000 full-time equivalent staff in 2028/29.

The nursing workforce crisis is well recognised and was an important topic in the recent election, with the Conservatives promising to boost numbers through increased recruitment and retention. To begin to address the crisis, the new government announced a £5,000 grant (with additional funding available for areas with a particular shortage or for applicants to some shortage specialties) just days after the election to get ahead of the 15 January UCAS deadline. However, it remains to be seen whether this announcement, less than a month before the applications deadline, will have any effect.

Restoring elements of the grants to encourage more applicants is a step in a right direction, especially as living costs are a major factor for student nurses dropping out, but the government will need to consider other strategies, as recruiting more nursing students will not solve the crisis on its own. More student places will not work unless there are enough nurses to supervise students and provide safe clinical placements.

Tackling the nursing crisis means recovering ground lost in the number of nursing students, but also growing the workforce the NHS needs in the future. Solving the workforce crisis means working to make nursing courses more attractive, retain current nurses, and encourage those who have left the profession to return to practice, and undertaking ethical international recruitment.