Universities warned the government for years that they needed to train more nurses to avert a staffing crisis – but ministers repeatedly refused, saying nurses would end up unemployed, letters seen by the Guardian show.
Now there are 44,000 nursing vacancies in the NHS, and leaked government documents suggest this could reach 70,000 in five years. Universities say they have been unable to attract enough nursing trainees since the bursary for nursing degrees was abolished in 2017. The Conservatives’ manifesto proposals to attract 50,000 new nurses (although 19,000 of those are already working but at risk of leaving) will be unachievable, they say, without a more radical plan.
Prof David Green, vice-chancellor of Worcester University, a leading provider of nursing degrees, says the current staffing crisis was “entirely avoidable”.
“If we had recruited more nurses in 2015, as we were telling the government we needed to do, they would be fully trained and starting jobs on the wards now. Instead, hospital after hospital is struggling to maintain safe staffing, spending a fortune on agency staff and desperately recruiting from abroad.”
Green says the crisis began in 2011 when strategic health authorities slashed the number of nursing degree places they would fund. In the West Midlands there was a 17.5% cut, which meant 457 fewer nursing students. These cuts were maintained for six years, a reduction of nearly 2,750 places in the West Midlands alone.
Green wrote to David Cameron, then the prime minister, and the health secretary in 2011 on behalf of the universities in his region, citing extensive evidence that there would be more demand for nurses in the future, and that the cuts would cause a “major nursing shortage in a few years’ time”.
Anne Milton, then the health minister responsible for the NHS workforce, wrote back saying fewer nurse trainees were needed and that taking on any more would lead to unemployed nurses. She wrote: “A reduction in commissions is necessary to avoid a significant oversupply in the nursing workforce.”
Green says this was “palpable nonsense” and cuts were simply about saving money. He reflects that the student nurses lost in 2011 would now have been working in the NHS for five years. “It is precisely such experienced nurses who are the backbone of the system.”
In 2015 Green stood by the head of the university’s institute of health and society, Jan Quallington, after Health Education England, the government’s health training body, demanded she apologise for criticising training cuts. Quallington wrote in the Health Service Journal that the NHS faced a “ticking timebomb” unless more nurses were trained. HEE said training too many nurses would “not be good value for money for the taxpayer and risks unemployment for the individuals concerned”.
Green says Worcester has turned away many “terrific applicants”. “In 2015 we had 10 applicants per nursing place, and 37 per place for midwifery. We knew that at least four in 10 of the nursing applicants would have made excellent nurses. In midwifery, places were like gold dust.”
Universities say Tory plans to recruit 14,000 new nurses from undergraduate courses may also prove problematic. Until 2017 the government paid nursing students’ fees in England, and students received a means-tested maintenance grant. Since the funding was cut, the Royal College of Nursing says, there has been a 29% drop in the number of applications to study nursing in England. Universities say they are finding it especially hard to recruit mature learners – once a mainstay of nursing degrees and greatly valued by hospitals because of their life experience and loyalty.
Green says this was a “bad and mad policy” and bursaries should be reinstated immediately.
Unlike Labour and the Liberal Democrats, the Conservatives are not promising to ditch nurses’ £9,250-a-year tuition fees but have instead pledged an annual maintenance grant of between £5,000 and £8,000 (£416 to £666 a month). Prof Kevin Crimmons, head of adult nursing at Birmingham City University, says: “That’s a promising start, but you can’t actually live on that.”
Like many universities, Birmingham City will struggle to meet its recruitment targets for nursing degrees starting this January, because debt-averse mature learners are staying away.
Crimmons points out that trainee nurses aren’t typical students because they spend half of their course doing unpaid training in the NHS, working a 37-hour week, often with night shifts.
“They might be carrying out personal care and supporting patients, helping with medication, doing clinical observations. They are working hard and adding value and it would be entirely reasonable to expect the government to pay their tuition,” he says.
Crimmons’ students, many of whom have children, often have to do paid shifts as healthcare support workers on top of their course to make ends meet. As a result they sometimes turn up to lectures unprepared. “If you want a quality workforce you have to support people to have space to learn, and that costs,” he says.
Michael Carter, a 29-year-old nursing student at Southampton University, was one of the last cohort of students to get a bursary. Without it, he says, he wouldn’t have contemplated taking a “£30,000 gamble” and changing career from science to nursing.
“Even with a bursary it can be difficult,” he says. “I get £422 a month to live on and my wife is a PhD student, so it isn’t easy. A lot of my colleagues get less than that and they are doing a lot of extra bank shifts to earn enough to live. They are doing this while working full-time on placement, with uni assignments on top and are working themselves into the ground.”
Carter decided to change career after a spell of being ill in hospital, where he realised how much difference nurses made to patients. “Nurses aren’t only caring for your complex medical needs; they’re also the ones holding your hand when you’re scared,” he says.
Steve Tee, executive dean of the faculty of health and social sciences at Bournemouth University, says it is seeing far fewer mature applicants for nursing and finds it a challenge to meet recruitment targets.
“The removal of the bursary has made it more difficult to recruit into areas like mental health nursing, which have always tended to attract more mature students,” he says.
He adds that there are no quick fixes. “When the workforce supply tap is turned off it takes a long time to recover. Even if we suddenly had a mammoth recruitment next year it wouldn’t resolve the workforce problems for several years.”
• This article was amended on 6 December 2019 to more accurately reflect comments made by Health Education England in 2015 in relation to training nurses.