Outcomes for UK-based applicants for nursing courses

4 March, 2021

1. Analysis of figures released by UCAS show that a majority (54%) of UK-domiciled applicants to nursing courses have been rejected since 2010 (348,000 out of just under 650,000 applicants).

2. More than 23,000 UK-based applicants failed to gain training places last year even as the country faced the initial onslaught of Covid. 36,200 people were rejected even as Ministers put nurses on the shortage occupation list in 2016. And in 2018, nearly 21,000 UK applicants failed to gain a place even as 5,100 work permits were issued to nurses from abroad and nurses were exempted from a (now-scrapped) limit on work.^[1] See summary of figures in Figure 1 below.

Figure 1: Outcomes for UK-domiciled applicants for nursing courses: UCAS.^[2]

3. Applicants and acceptances have notably risen since 2018, while rejections also increased from 20,800 to 23,300. Total applicants - all domiciles included - have averaged about 60,000 since 2010, while acceptances have run at between 23,000 and 37,000 since 2010. The 2016-19 decline in applicants appears to be linked to the removal of bursaries for student nurses in 2017. In 2019 it was announced that the bursary would be restored, and, since last year, annual payments of £5,000 have been available to student nurses - as well as some allied health professionals - with £3,000 more for specialist disciplines. Figure 2 below shows that the annual number of nursing graduates averaged 18,500 since 2002. These figures are not broken down by domicile of the student.

Figure 2: Estimated annual number of nursing graduates. Source: Statista.

4. The failure of a majority of UK applicants to gain a place on nursing courses since 2010 took place despite the fact that work permits for overseas nurses abroad make up a significant (and possibly increasing) share of skilled work visas issued per year. For example in 2018, they accounted for more than a fifth of Tier 2 (General) work permits issued.^[3] The share of nurses joining the Nursing and Midwifery Council register for the first time from overseas rose from a fifth in 2016 to just under a third in 2020.^[4]

5. Since 2010 governments have made it even easier for the NHS to hire from abroad, thus saving on costs while overlooking UK talent. The share of nurses joining the NHS who report a non-UK nationality increased significantly, from 16% in 2012/13 to 29% in 2019^[5]:

• In 2016, Ministers put nurses on the shortage occupation list in 2016, despite criticism from a panel of official experts. Former Migration Advisory Committee Chair Sir David Metcalfe said at the time: “There seems to be an automatic presumption that non-EEA skilled migration provides the health and care sector with a ‘Get out of Jail Free’ card.”^[6]
• In 2018, the Home Secretary decided to exempt work permits for nurses from the (now-scrapped) annual cap on visas. A clue as to why the NHS is so keen on this might be found in a desire to save costs. Migrant nurses on work permits earn around a fifth less than other nurses, controlling for characteristics.^[7]
• In August 2020, the government introduced a new fast-track Health and Care Worker visa which can be issued with a maximum stay of just over five years and involves a reduced visa application fee compared to that paid by other skilled workers with no requirement to pay the immigration health surcharge. There were 1,191 grants of this ‘Skilled worker – Health and Care workers’ visa in 2020 (see Home Office visa statistics).^[8]
• Last month, the government announced the addition of over 100 countries to a list of countries from which agencies can now ‘actively recruit’ overseas healthcare staff^[9]. Included are several developing countries 0 including Zimbabwe and South Africa, which have severe shortages of healthcare staff. The move is immoral because it risks taking much-needed health staff from countries that have much greater needs than the UK even as this country fails to train up enough of its own domestic nurses. As Sir David Metcalfe has noted: “There is no good reason why the supply of nurses cannot be sourced domestically.” ^[10] It can also only add insult to injury to young British applicants - especially at a time of rising unemployment.
• To reinforce this point, a letter written recently by two doctors and published in the South African Medical Journal blamed the UK’s visa and immigration policy for the poaching of health workers from the world’s poorest countries. The two doctors - Professor Johannes Fagan from the University of Cape Town and Professor Mahmood Bhutta from the Royal Sussex County Hospital - described the poaching of medical professionals from the world’s poorest regions as ‘insensitive’ and ‘morally questionable’.^[11]
• The NHS recruits significantly more doctors and nurses from abroad than Germany, France, Spain, Canada, the US, Sweden and the Netherlands.^[12]
• Medical industry groups have said the focus needs to be on reducing reliance on migrant workers and developing the homegrown healthcare workforce. Dr Peter Carter, head of the Royal College of Nursing, said: “You have virtually every NHS trust... recruiting overseas. It is ludicrous, hugely expensive, and labour intensive. The root cause is not training and retaining enough UK nurses.”

6. The question that has to be answered by Ministers is this - Why are the government tripling down allowing and even encouraging NHS bureaucrats to save money on cheaper overseas recruits, while tens of thousands of UK-domiciled applicants are failing to gain places on nursing courses?^[13]