We have a new government. Time to revisit an election promise, which has a direct connection to the STaR project. “50, 000 more nurses by 2024/5” was the Conservative manifesto commitment in December last year. This was immediately brokered down to 31, 000 additional “new” nurses, because part of the plan was to encourage about 19,000 existing nurses to stay on[i].
Boris Johnson had barely re-crossed the threshold at number 10 Downing Street before the new government made an announcement about changed funding modalities for student nurses in England. An annual grant of £5,000 to cover living costs is promised to all new and current undergraduate student nurses[ii]. A further £3,000 will be available for people studying hard-to-recruit disciplines, such as mental health and learning disability nursing. This new money will not cover tuition fees. Students will still be required to pay tuition fees of £9,000 a year.
Even with this “new” money, the scale of the nursing shortage in NHS England will take some solving. Recent research by the Health Foundation[iii] highlighted that that nursing remains the key area of shortage and pressure across the NHS, and that recent modest growth in nurse numbers has not kept pace with demand. NHS nursing vacancies increased to almost 44,000 in the first quarter of 2019/20, which is equivalent to 12% of the nursing workforce. To prevent nursing shortages growing further, urgent action is needed to increase the numbers of nurses in training, reduce attrition and improve retention.
In 2019 the number of applicants to nursing courses in England increased for the first time since the NHS bursary was withdrawn in 2017. The number of applicants in England had risen to 40,780, but nevertheless remained below the figure for 2017. In contrast, Scotland, where the NHS bursary has been retained and its value increased, saw a 6.7% increase in student nurses in 2019, taking the number of applicants to its highest ever level.
If the NHS is to reduce vacancies and grow the pool of qualified nurses to recruit from, the forthcoming NHS People Plan will need to set out measures that will rapidly expand the number of people starting undergraduate nursing degrees in England. Analysis by the Health Foundation shows that there are different patterns of applications and acceptances by age, branch of nursing and geography.
For example, the numbers of students starting mental health and learning disabilities nursing fell significantly between 2014 and 2018. All continuously running learning disability courses had fewer students in 2018 than in 2014. This is in contrast to children’s nursing, where around two-thirds of courses (63%) had increased in size. Fewer over-25s started nursing degrees in 2018 compared with 2016, particularly impacting learning disability and mental health courses.
Overall trends can also hide pressure points in different areas of the country. Adjusting for population size London and the South East are in the bottom three regions for the number of acceptances to study nursing and the top three for the number of vacancies per 100,000 people.
As highlighted in the work for STaR, a relatively high proportion of students who start a nursing degree do not graduate within three years – either dropping out completely or putting their studies on hold. The latest data analysed by the Health Foundation showed that attrition remains stubbornly high despite government commitments to reduce it. One in four nurses who were expected to graduate in 2018 did not do so, and the overall attrition rate was highest for learning disability courses.
There is a time lag of four years before new student nurses become productive professionals. Even if the newly promised funds attract more student nurses, there can be no quick win for the government in achieving the 31,000 target by 2024/25 just by increasing the intakes of new student nurses this year and next. It will also have to work effectively with universities and employers to then reduce attrition rates of those who have been attracted to a student nurse place. STaR is well placed to give insights and support to an evidence-based approach to reduce attrition and support successful transition into practice.
[i] Buchan J (2019) How will the Conservative election pledge of 50,000 more nurses by 2024/25 be realised? Nursing Standard, 18 December 2019 https://rcni.com/nursing-standard/opinion/expert-advice/how-will-conservative-election-pledge-of-50000-more-nurses-202425-be-realised-156321
[ii] Jones-Berry S (2019) Nursing students in England to receive £5,000 grant from next September. Nursing Standard, 18 December 2019. https://rcni.com/nursing-standard/newsroom/news/nursing-students-england-to-receive-ps5000-grant-next-september-156506
[iii] Buchan J, Gershlick B, Charlesworth A, Seccombe I (2019) Falling short: the NHS workforce challenge. Workforce profile and trends of the NHS in England. Health Foundation, London