Have you considered New Zealand?

But given the considerable costs to both the state and the student, we at least tend to try when it comes to health.

And, in Wales at least, fail.

There’s a letter circulating from nursing students who have completed over 2,300 hours of unpaid clinical placement, chose to train in Wales, accepted an NHS bursary with a two-year work-in-Wales obligation attached, and are now approaching graduation to find that the jobs they were implicitly promised don’t exist.

They now face graduating under the threat of uncertainty for their future in Wales they write. And, as usual:

…decisions about our futures are being made without meaningful student involvement.

The covenant

NHS Wales runs a centralised matching process for newly qualified nurses called “streamlining,” administered by Health Education and Improvement Wales (HEIW).

The theory is straightforward – students train, they complete placements across health boards, they graduate, and the streamlining process matches them to Band 5 registered nurse posts across Wales.

The bursary obligation – work in Wales for two years after qualifying – was the deal in exchange for that funded training. It is, or was, a covenant – we fund you, you serve Welsh communities.

What’s happened instead is that students received an email on 7 April – the day before the planned streamlining date – informing them the process had been pushed back from 8 April to 11 May 2026 due to a significantly low number of available Band 5 roles.

This was the second delay. The Welsh Government’s explanation was that the extension was needed to allow health boards additional time “to review workforce positions, confirm and validate vacancies, and maximise the number of roles available,” while acknowledging that NHS Wales is managing “a complex financial and operational position” and that improved staff retention means fewer Band 5 roles suitable for graduates are currently available than in previous years.

When streamlining finally opened on 11 May, HEIW announced that 809 roles would be made available. RCN Wales calculates that this covers 69 per cent of anticipated graduates – leaving 31 per cent in “a state of considerable worry and uncertainty.”

The RCN’s reasonable position is that a one-third shortfall is not a temporary recruitment cycle problem – it’s a workforce planning failure.

They knew

A Senedd Health and Social Care Committee papers pack from November 2025 records correspondence about the lack of Band 5 adult nursing positions within Swansea Bay University Health Board.

RCN Wales’ Nursing in Numbers 2025 noted that no adult nursing vacancies had been made available in Swansea Bay despite Swansea University preparing to graduate around 65 students.

As far back as October 2025, ITV Wales was reporting that 65 nursing students due to qualify from Swansea University were facing the prospect of having no jobs to apply for within the local health board, with SBUHB telling ITV it had been left with “limited or no vacancies” following a successful staff retention drive.

And given the recruitment profile, these aren’t graduates that can just up and move from Swansea to Sennybridge, Southampton or Stirling:

My husband runs a local business, we have a mortgage, three children.

Policymakers at HEIW, Welsh Government and the Senedd’s own Health Committee were aware months ago that Swansea Bay’s post-freeze was creating a structural mismatch. “Early indications suggest that up to half of this year’s graduating cohort could be left without a role when recruitment finally opens,” RCN Wales said when it raised the alarm in April. The 31 per cent shortfall is, in some respects, the good news version of where this was heading.

We funded you. Now good luck

The student open letter flags a perverse situation. The NHS Wales bursary includes a requirement to work in Wales for two years after qualifying. If you don’t, you are – in principle – liable to repay support. The Welsh Government and RCN Wales have both given assurances that students won’t be penalised where posts are unavailable, including being released from the work-in-Wales obligation and not being required to repay tuition fee loans when workforce shortages prevent them from securing employment.

The problem with informal assurances is that they aren’t rules. The letter’s demand for “clear guidance on bursary implications where students are unable to secure roles within Wales” is a request for something that should self-evidently already exist. What counts as “unable to secure a role”? What if the only available post is geographically impossible given childcare, caring responsibilities, or a partner’s employment? Does a Band 5 role 90 miles from home count as a reasonable offer?

£89 million for temps, nothing for the graduates it just trained

The letter cites the RCN Wales Nursing in Numbers 2025 figure – £88.7 million was spent on temporary agency staff in NHS Wales in 2024–25. The RCN’s own 11 May statement makes the same – the agency spend could “easily cover” the outstanding roles for newly qualified nurses, which would deliver more consistent care and a sustainable career start for those wishing to work in Wales.

In other words, NHS Wales is simultaneously short-staffed, with nurses and midwives reporting unmanageable workloads and care being delivered in undignified environments, spending nearly £89 million a year on agency staff to plug those gaps, and declining to absorb into permanent employment a cohort of nurses it has just spent three years and considerable public money training, who are legally obligated to work in Wales, and who want to stay.

Have you considered New Zealand?

The nursing issue comes on top of a paramedic version.

On 2 April 2026, the Welsh Ambulance Service Trust (WAST) confirmed it was not in a position to employ newly qualified paramedics this year. Around 70 students graduating from paramedic science programmes at Swansea and Wrexham universities – a cohort that HEIW had spent millions subsidising through bursaries – were told to consider Band 4 Emergency Medical Technician roles, other UK ambulance services, or emigration to Canada, New Zealand, and Australia.

HEIW told the cohort they were now “free agents,” despite the normal bursary expectation to remain in Wales. In 2025, the situation had already deteriorated – only around 20 of 67 graduates were initially offered newly qualified paramedic posts, with some offered technician roles instead. By 2026, even those offers weren’t available.

Then, on 20 April, HEIW announced that university paramedic science programmes in Wales would not be commissioned at all for 2026–27. Its explanation was that the graduating 2026 cohort was commissioned back in 2022, immediately after the pandemic, when projected demand was higher – but since then WAST had changed its clinical model, staff retention had improved, and financial pressures had reduced the number of posts for newly qualified paramedics.

Swansea University’s paramedic science course is no longer open for applications. Offers for September 2026 entry have been withdrawn. The 2026–27 HEIW Education and Training Plan lists “Paramedicine and EMT Conversion” at 60 places rather than a full undergraduate intake – so the remaining commissioned activity is conversion or workforce development, not a pipeline of new paramedic degree students.

In the normal run of things, once you make the offer consumer protection law would have you run the course – but training for a profession of this sort means students aren’t technically consumers, and Medr don’t seem to have noticed anyway.

HEIW commissioned training places on the basis of projected workforce need. Universities recruited and taught students on the reasonable assumption that graduation would be followed by newly qualified paramedic posts.

WAST – the main employer of paramedics in Wales – then found it could not absorb the cohort that the Welsh workforce planning system had produced. The correction was to shut off new starts, but that correction came after the back-end failure had already landed on the 2026 graduates.

And the suggestion that Band 5-trained paramedics should consider Band 4 EMT roles isn’t a like-for-like solution – it under-employs their qualification and changes the career bargain after completion. HEIW’s framing, that pausing new starts is “intended to improve employment prospects for current students and future graduates,” is administratively defensible but does absolutely nothing for the people holding withdrawn offers.

The College of Paramedics estimates that 20 to 25 per cent of 2025 paramedic graduates across the UK – around 700 people – were unable to secure employment in the profession, and specifically identifies Wales and Scotland as places where ambulance services are under financial pressure, leading to managed vacancies or frozen posts. This is a UK-wide training expansion that outran funded establishment. Wales happens to be the place where the failure is most visibly complete.

The structural accountability question is the same in both professions. HEIW commissions education. Welsh Government sets funding and policy. WAST employs paramedics. Health boards employ the professionals. The failure sits in the gaps between those bodies – commissioned places not translated into funded posts, and when the mismatch became undeniable, it was the graduates and offer-holders – not the commissioning bodies – who carried the consequence.

No single actor owns the whole pipeline, which is why nobody has been held accountable for the disconnect, and why the students’ demand for a coherent national workforce plan with transparent numbers is not a lobbying position so much as a description of the minimum you’d expect from a functioning system.

Meanwhile, in England

In August 2025, NHS England launched a Graduate Guarantee for newly qualified nurses and midwives – a commitment that every newly registered nurse and midwife in England would have the opportunity to apply to join the workforce.

The Health Secretary described it as “absurd that we are training thousands of nurses and midwives every year, only to leave them without a job before their career has started.” NHS England reprioritised £8 million of non-recurrent funding to convert vacant maternity support worker posts into Band 5 midwifery roles, and enabled trusts to recruit based on projected workforce need rather than waiting for formal vacancies to arise.

Wales now has neither the guarantee nor a credible substitute. RCN Wales is calling on the new Welsh Government to introduce a graduate guarantee of its own – a commitment that every nursing student in Wales will have a seamless transition from training to employment.

The political question is whether an incoming Plaid Cymru administration, forming a minority government and facing 96 seats of competing demands, will treat this as an urgent first-weeks priority or let it sit in the in-tray next to the HE or NHS Wales funding review.