No need to panic over fall in nursing applications

UCAS figures show a 23% decline in the number of people from England making at least one application to study nursing this year. In the context of the NHS’ vacancy rates and reliance on international staff, this seems concerning. A fall on this scale looks like a blow to the government’s ambition to create a sustainable home-grown NHS workforce.

Some have been quick to blame the decline in applications on the funding reforms for healthcare education being introduced this year, and particularly on the removal of the NHS bursary for students studying nursing, midwifery and allied health subjects. For some organisations, the decline in application numbers will be used to vindicate opposition to the reforms.

As the organisation representing the university faculties that teach nursing, midwifery and the allied health professions, the Council of Deans of Health could be expected to have more cause than most for concern. Yet for our members, the story is much more complex than that.

Controversially, we supported funding reform for healthcare courses. This was a difficult decision, but the case for change was compelling:

• The bursary system was tied to a commissioning process which was subject to distorting budgetary pressures and short-termism. Serious expansion of places under this system in the current economic climate was unlikely.
• Workforce planning for our subjects is widely acknowledged to have failed, with cuts in commissions for nursing between 2010 and 2012 contributing to workforce shortages now.
• Fluctuations in annual commissions made it difficult for universities to plan and invest in programme development. Investment in the education of healthcare professionals was also threatened by the fact that government course funding was failing to keep pace with costs. Universities were receiving less per student than courses under the general funding system and in some cases less than the cost of delivery. A funding gap of around 10% threatened nursing, midwifery and allied health course provision in some institutions.
• Meanwhile, the bursary system was not working as well as it could for many of our students, with many relying on university hardship funding to make ends meet. Under the loan system students will have more cash upfront to live on during their studies.

Understanding the dip

Despite the decline in applications, our members are surprisingly sanguine. Most university health faculties expected fewer applications in the first year of changes to the funding system.

Furthermore, a range of additional factors are likely to have influenced this year’s applicant numbers, including a fall in EU applicants, and widespread negative press coverage about the challenges facing the NHS. UCAS points out that about half of the fall in nursing applicants mirrors the wider fall in applicants from older age groups to non-nursing courses.

Prospective nurses also have a wider choice of routes into the profession than before. Two thousand people will begin training as nursing associates this year, many of whom are said to be planning to continue into nursing courses after qualifying. It is impossible to know what impact this option has had on applications to nursing degrees, or the effect of plans for apprenticeships in nursing. Yet we do know that these work-based routes are more likely to appeal to mature applicants, the group that has seen the sharpest declines in applications to university nursing courses this year.

The scale of the fall in application numbers is not the critical factor for universities or the health and social care sector. Courses that were previously heavily oversubscribed can survive a significant dip in application numbers as long as the quality of applicants is good, and our members report that this remains so.

The Council has been working with HEFCE over the past year to identify the health subjects deemed to be most vulnerable to the reforms, such as therapeutic radiography, podiatry, prosthetics, orthotics, and orthoptics. Reports of applicant numbers to ‘nursing’ also disguise differences across the four branches of the profession. Learning disability and mental health nursing are more vulnerable to a large fall in mature student applications than child and adult nursing.

Work to do

Whilst the Council is sanguine, we are not complacent. We are looking to the Department of Health to promote healthcare careers and publicise the employability of our graduates. We have also produced our own website explaining the reforms to students and careers advisors. We will be examining the UCAS figures closely and seeking to understand whether the viability of any subject has been compromised. Targeted demand and supply side interventions may be required in the short term.

Programme sustainability is one thing, but expansion is quite another. The Department of Health has reiterated its belief that the reforms will create up to 10,000 more training places by 2020. But universities and students cannot expand output without support. All of our courses rely on intensive work-based learning provided by a finite number of mentors and practice educators. Arrangements for the funding and organisation of these workplace placements beyond this year have not yet been confirmed. Only when it is will health faculties be ready to increase the available places on their programmes.