Pressure point: Removal of the NHS bursary and its impact on student numbers


In 2016, the Department of Health (DH) announced that, from 1 August 2017, new nursing, midwifery and some pre-registration allied health students in England would no longer receive NHS bursaries. They must now access the student loan system in the same way as students of other higher education courses. DH claimed that this would reduce the risk that the number of student places available would be constrained by funding, and enable higher education institutions to provide sufficient places to meet expressed demand. It also said that this would, in turn, lead to an improvement in the supply of qualified health care graduates, as well as reduced reliance on agency and overseas staff. In its impact assessment, DH estimated that a total of 10,000 more places might be made available by the end of the current parliament. It also noted increased student motivation and better courses as further benefits of more directly linking study and its costs.

The annual number of places available on pre-registration nurse education courses has varied between around 16,000 and 23,000 over the past 20 years, with lows in the early part of this decade but small year-on-year increases since 2013/14. There is no doubt that expressed demand for these places has outstripped supply by a ratio of at least 2:1 (Figure 16). In 2016/17, for example, there were just over 43,800 applicants – who made a total of 188,000 applications – for the 20,741 funded places available.

Figure 16: Number of funded places and applicants to study nursing at university in England, 2013/14–2016/17

Source: UCAS end of cycle statistics, HEE commissioning and investment plan 2016/17.

Number of nursing student applicants in decline

The DH has recognised that predicting behavioural change is uncertain, but based on evidence from previous student funding reforms, assumed that while applications may dip ‘in the very short term, in the longer term, overall student numbers may increase’ as a result of the end of the bursary system. Whether previous student funding reform was a reasonable proxy for anticipating behaviour among potential nursing students remains to be seen, in part because the age and gender profile of nursing students is unlike that of any other group of students.

The release, in early 2017, of data by UCAS on the number of applicants to study nursing was greeted by predictable media headlines, such as: ‘Students turn backs on nursing degrees in wake of Government decision to axe NHS bursaries, official figures suggest’, ‘Nursing degree applications slump after NHS bursaries abolished’, and ‘Nursing degree applicants fall 23% in wake of bursary loss’.,,

Is it all about the end of the bursary?

Although applicant numbers in England are down, by almost 23% to 40,060 according to the latest UCAS applicant data, a closer examination of the available data suggests that this is not simply due to the change in funding arrangements. The NHS bursary has been retained in Northern Ireland, Scotland and Wales** and yet all three countries have seen a decline – albeit smaller than in England – in the number of nursing applicants. The number of applicants is down by 10% in Wales compared with 2016, with reductions of 6% seen in Northern Ireland and 2% in Scotland. These reductions cannot be explained by the removal of the NHS bursary. It is also apparent that, with the exception of Wales, the decline in applicant numbers has been underway for a number of years (Figure 17). For example, numbers fell by nearly 1% in Scotland between 2014 and 2015 and by nearly 4% between 2015 and 2016. Similarly, in Northern Ireland there were 6% fewer applicants in 2014 and 2% fewer in 2015.

What is driving the changes in applicant numbers is complex and poorly understood. One contributing factor is the fall in the number of 18- and 19-year-olds across the UK since 2010. According to Office for National Statistics estimates, the number of female 18-year-olds in 2017 (92% of applicants to nursing are female) was 4.6% lower than in 2011. In other words, nursing is having to compete in a shrinking pool of qualified school leavers. However, this can only be a small part of the explanation since, unlike other subjects, those aged 18 and 19 make up a comparatively small share of the applicants to nursing (Figure 18). Indeed, figures for England show that applications from those aged under 20 had the smallest decline (13%) between 2016 and 2017.

Figure 17: Change in number of nursing student applicants in the UK by country, and the EU (index 100=2013), 2013–17

Source: Compiled from UCAS Undergraduate end of cycle data resources.

Figure 18: Applicants to nursing and non-nursing subjects in England by age (%), 2017

Source: Compiled from UCAS Undergraduate end of cycle data resources.

Drop in older applicants most substantial

The decline in applicant numbers has been particularly notable among older applicants (Figure 19) – it also started earlier. In England in 2017, applications from those aged 20–24 and 25–29 fell by 23% and 31% respectively. This may reflect the reduction in numbers of potential students in the age groups that nursing education has traditionally recruited from, because a growing proportion of this population has already been through higher education. Equally, it may reflect high rates of employment, pay differentials and the potential impact of future loan repayments on individuals who may already have a higher debt burden. The introduction of the nursing associate role and apprenticeship routes into the professions may also have acted to reduce the number of applicants wanting to pursue the degree route.

Figure 19: Change in number of nursing student applicants in England by age (%), 2013/14–2016/17

Source: Compiled from UCAS Undergraduate end of cycle data resources.

In addition to the change in the number of applicants from the UK, there has been a drop of almost 400 (23%) in the number of applicants from other EU member states. It should be noted that these numbers have seen a downwards trend since 2013 (when they peaked at about 1,910). In contrast, the number of applicants from outside the EU has increased by almost 200 (to 670) over the same period. Historically, very few applicants from outside the UK have been successful in getting a course place.

Consistency in re-appliers and cross-border applications?

Applicant figures include those applying for the first time, as well as ‘re-appliers’ (applicants who had applied through the UCAS scheme in a previous cycle). Just under one in five (19.4%) applicants in England are re-appliers – a proportion that has remained consistent over the last 5 years. In 2017, the number of re-appliers fell from 9,840 to 7,790 (Figure 20). The decline in applicant numbers has impacted both first-time applicants and re-appliers to a similar extent (23% and 21% respectively).

Figure 20: Number of first time and reapplying applicants for nursing courses in England, 2013–17

Source: Compiled from UCAS Undergraduate end of cycle data resources.

Further change can be seen in the level of cross-border applications. The proportion of applicants living in England who applied to institutions in Scotland or Wales has been fairly constant at about 7.5% (roughly 3,700 applicants). In 2017, the absolute number of cross-border applications fell but the share of applications from those living in England rose (to 8.1%), with about 2,440 applicants from England to courses in Wales and 800 to Scotland. Conversely, 17% (360) fewer applicants from Scotland or Wales applied to institutions in England.

Application rates among 18-year-olds for nursing in England in 2017 represent about 1.4% of the available population according to data released by UCAS, having fallen from 1.5% in 2016. This is noticeably lower than in Wales (1.8%), Scotland (2.0%) and Northern Ireland (3.7%), suggesting there might be scope for growth (Figure 21).

Figure 21: Application rates for UK university nursing courses among 18-year-olds by country of residence, 2013–17


Source: Compiled from UCAS Undergraduate end of cycle data resources.

One consequence of the change in funding arrangements is that the number of places available is no longer known in advance. How many applicants have been accepted onto nursing courses will not be known until UCAS release the final 2017 end-of-cycle statistics in December 2017. However, in a circular to vice chancellors and principals setting out the decisions taken at its board meeting in March 2017, the Higher Education Funding Council for England stated that ‘We believe that these various elements of grant, combined with net tuition fee income, increase the funding levels for each professional area within scope for the reforms in 2017/18’.

All things being equal, we would expect that increase to translate into a rise in student intakes. However, it remains to be seen whether the rise will match the increases in Scotland (4.7%) or Wales (13%). As of 14 September 2017 (the most recent clearance statistics released by UCAS) the number of acceptances across the UK was 27,240 – just over 1,000 (3.6%) fewer than in 2016 but higher than in any other year (Figure 22). Some students are still holding offers. If these convert to placed students at a higher rate than in previous years then the size of this gap will be reduced. Reductions in the number of placed students from England (5.5%), Northern Ireland (2.7%) and the EU (19.2%) have been offset slightly by increases from Wales (3.2%), Scotland (8.5%) and non-EU countries (Table 1).

Initially then, it appears that the change in funding arrangements in England has led to a fall in student numbers rather than the anticipated increase, although that decline has not been as steep as some commentators anticipated on the basis of applicant numbers.

Figure 22: Change in numbers of placed applicants on UK university nursing courses by country of residence (index 100=2013), 2013–17

Source: UCAS, Statistical releases – Daily clearing analysis 2017, published 18 September.

Table 1: Number of placed applicants on UK university nursing courses by country of domicile 1 month after A-level results day, 2013–17

Country of domicile of applicant

















Northern Ireland
















































Source: UCAS, Statistical releases – Daily clearing analysis 2017, published 18 September.

In addition to the fall in student numbers, there has been a shift in the age profile of applicants from England. The number and proportion of 18-year-olds has risen from 19.1% in 2016 to 22.2% in 2017, while the figures for those aged 20 and over have declined. This is as a result of a 6% increase in the number of placed applicants who are under 20 and falls in those aged 20 to 24 and 25 and over, of 9% and 11% respectively (Figure 23). Whether this change is planned, or what consequences it might have, is unclear.

Figure 23: Age profile of placed applicants on nursing courses in England, 2013–17

Source: UCAS, Statistical releases – Daily clearing analysis 2017, published 18 September.

Many student nurses do not complete their course

In addition to assessing the trends in numbers of applications and applicants to nurse education, another factor that requires close monitoring in order to have a full picture of the impact of the changes in pre-registration of nurses is the drop-out rate of those who begin an undergraduate nursing course, but fail to complete (‘attrition’). Previous analysis suggests that the rates are affected by selection processes, student access to finances, and the student experience during clinical placements. The mandate between the government and HEE for 2016/17 had stated that HEE would ‘continue to work with partners to improve retention of trainees, including reducing avoidable attrition from training programmes by 50% by 2017’.

Despite repeated calls for a standard analytical definition of attrition across the UK and a transparent approach to publishing attrition rates on each course and each institution, the only recent publicly available national source of comparative attrition data is a survey conducted by Nursing Standard, following a freedom of information request. This survey examined attrition using a simple definition: the percentage of students entering the course who did not complete 3 years later (although it should be noted that this will overestimate the overall attrition rate as some students defer and return at a later date). By this measure, the student nurse attrition rates across universities in England in the 3-year period from 2013 to 2016 varied from a low of 9% to a high of 44.5%. The overall UK average attrition rate was 25.1% – this had not changed significantly from the previous national surveys conducted in 2006, 2008 and 2010.

This analysis suggests that one in four students did not complete their course and therefore could not register to practice nursing at the 3-year mark. It will be important to monitor attrition rates to assess if the shift to a loan-based approach in England has any impact on completion rates, but this process will be hampered by a lack of common definition of attrition and an absence of transparency in the current reporting process.

What can be done to improve student nurse numbers?

The Health Foundation’s 2016 report on the NHS workforce argued that the shift to a student loan-based approach had the potential to increase student intakes, but that other factors were currently inhibiting the realisation of this potential. The report noted that the earnings potential for student nurses was relatively lower than in comparator countries such as Australia and the US, that funding should be made available to support older entrants and those with financial hardship, and that there would be a need to address the existing bottleneck of restricted availability of clinical placements. No policy intervention on these critical issues was taken, until well beyond the point in time that such action could have any significant impact.

This was the very late announcement by the government, on 9 August 2017, that it would fund additional clinical places for nurses, midwives and AHPs on courses starting from 1 August 2017. Subsequent detail and clarification in a letter issued by HEE on 16 August confirmed that funding would be made available for up to 1,500 additional clinical placements in England, for intakes in 2017 and early 2018, and that ‘work was underway’ to determine the funding allocation mechanism for 2018 onwards. This was a last-gasp response to a problem that was well known before the switch to the loan system, and could and should have been addressed much earlier in the application cycle. It was characterised by one commentator as being a ‘shambolic’ approach.

Analysis of the pattern of acceptances for the 2017/18 intake is further complicated by these late-in-the-day events. The drop in applicant numbers is undoubtedly a cause for concern. However, further analysis suggests the removal of the bursary is not the only cause and that the number of applicants was already on a downwards trend right across the UK. A more nuanced understanding is required if these trends are to be reversed. It is clear that the number of applicants is still significantly greater than the number of places that are available. One reason for this is that the limited funding available for the NHS bursary based approach was not the only constraint on the number of nurses that could be trained. As clearly demonstrated by recent events, there is also the question of the capacity of the NHS to provide clinical placements to match university intakes, and the ability of universities to improve student attrition rates.

** In Wales, the bursary has been retained but newly qualified nurses will be required to pay back the funding if they fail to work in the country as a nurse for at least 2 years after graduating.

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