The NHS doesn’t have enough nurses, nor are enough being trained to meet future demand. And yet the government has confirmed it is scrapping nursing bursaries, which cover the cost of tuition fees. Instead, prospective student nurses, midwives and allied health professionals will now have to apply for a student loan. At first glance this hardly looks likely to solve the recruitment problems in nursing. Yet the government’s plans have some logic.
There are about 370,000 nurses, midwives and health visitors employed by the NHS in England. Even so, hospitals have long complained that the pool of locally-trained staff is too small to meet requirements and currently report a shortfall of around 28,000 nurses.
England has long relied on overseas recruitment to fill such shortfalls. At 13%, the NHS has a higher proportion of foreign-trained nurses than any other European country. But this solution is in jeopardy. In 2006, the Home Office made it more difficult to recruit nurses from outside the EU, though it’s since temporarily eased the policy. Brexit may make it more difficult to recruit from EU-27 countries.
Nor is the NHS good at hanging on to nurses once they’ve been trained. Many take agency work in preference to permanent contracts. And about 25,000 leave the profession each year, so the NHS needs to recruit this number annually just to stand still.
Not enough university places
The nursing workforce shortfall is not due to a shortage of people wishing to do nursing, it is due to university courses being full. The number of people admitted to study nursing has been restricted to the number of bursaries available – just 21,450 in 2015. If the NHS wants to train more nurses, it has to lift this restriction.
There are two ways this can be done. The first is to increase the number of bursaries. But the government is providing less money to the NHS than was promised in the election manifesto so there is no extra money for more bursaries. The second is to make student nurses take out loans to cover their tuition fees. This would bring nursing in line with all other courses for English students since loans were introduced in 2012.
The professional bodies argue that making prospective nurses and midwives pay for their training will make courses less attractive. And they are right. If the price of nursing education goes up, demand for these courses will fall.
Even so, nursing places may remain over-subscribed. In 2015, there were around 2.4 applicants for every place on offer. Increasing the cost of training will reduce applications, but the government still expects to fill existing places, as well as an additional 10,000 places to be made available by 2020. And well-designed loan schemes attract demand; the University of Bolton’s student loan scheme received 650 applications for 25 places.
The NHS needs to reduce nurse turnover
Will the expansion of university places now mean that we’ll be training enough nurses? Not necessarily. Nursing graduates have a choice about whether to work for the NHS, elsewhere or in other career. Their choice partly depends on how much they expect to earn as nurses compared with alternative occupations.
In all likelihood, nurses will earn less. In its recent review of nursing, the Migration Advisory Committee noted that the median pay for nurses, midwives and health visiting staff is £31,500. This is £7,500 below the median in other graduate occupations.
Given this difference and the removal of bursaries, other courses will now be relatively more attractive than a nursing degree. To correct the imbalance, nursing salaries will need to rise. But they are unlikely to do so, with the government planning to restrain annual pay growth to just 1% per year over this parliamentary term. Meanwhile, wages for the economy as a whole are expected to grow by 2.3% over the coming year and by 3.4% by 2020.
These poor wage prospects may discourage some prospective students from taking a nursing degree. But, more worryingly, relatively low wages will mean that nursing turnover will remain high, and the trend to opt out of permanent contracts in favour of agency work will continue.
How much do we value nurses?
Nursing is a difficult, stressful profession and it needs to be valued and rewarded accordingly. But the government’s plan to restrain growth in nursing wages doesn’t send a strong signal to that effect.
Removing bursaries is likely to lead to an increase in the number of locally trained nurses, but not enough to fill current shortages. Without better wages, trained nurses will continue to leave the profession or opt for agency work. Consequently, hospitals will continue to struggle to recruit and retain the permanent staff they need.
The nursing workforce problem will not be solved simply by scrapping bursaries; the solution should include both an increase in training capacity and improved wages and working conditions.