Universities UK is not the first sector body to analyse the sector impact of the NHS Workforce plan.
It’s long been clear that the doubling of places for student doctors (with 500 new places by 2025) and nurses – albeit with steady growth rather than a single allocation, and some tinkering around the edges on other modes of delivery – will have a huge impact on the universities that deliver them.
From plan to reality
Equally clear has been the need for this expansion to be thoughtful and strategic, and to come with a parallel increase in the number of available NHS placements. Delivery of such expansion might mean new partnerships, and new approaches to teaching – these need to be carefully considered and scaled given the numbers and costs involved.
And simply pumping students and newly qualified professionals into a system that may not be set up to manage this would cause problems – the longer term increase in NHS salary costs, for instance, needs to be considered. The Institute for Fiscal Studies put the cost of salaries at around £50bn in today’s terms by 2026-27, on top of the £2.4bn already factored in for training new staff.
However, the public is in favour of expansion. Recent Public First polling found that 30 per cent of UK adults saw the expansion of spending on courses like medicine as a key priority for any future allocation to higher education – rising to 41 per cent of the over 65s, and 37 per cent of Conservative voters. There’s clearly a political consensus in favour of expansion too.
For providers themselves, the complexity of regulatory regimes around healthcare provision are nearly as daunting as the capital costs of building capacity, and the recurrent costs of staffing to run it. The whole thing is a huge ask of the sector – but there is one issue that needs urgently addressing first.
Who wants to work in healthcare?
The inconvenient truth is that applications (not even student numbers – applications) for medicine and nursing are falling. Data from the October 2024 UCAS deadline shows applications to medical schools falling for the third year in a row.
And similarly, in nursing, clearing day 15 data shows a two year decline has returned applicant numbers to a pre-pandemic level. Incredibly, the proportion of applicants placed at their firm choice provider has fallen for five straight years (though there has been a corresponding small growth in clearing).
We also need to think about the student experience and student attrition. A recent report (Clinician of the Future 2023: Education Edition, based on a survey of 2212 medical and nursing students globally) from Elsevier found that 21 per cent of UK medical students are considering quitting their course – with 76 per cent worried about the costs of their studies. Both these are substantially above the global average.
But the perception of a career riven with staff shortages and unrelenting workload is strong – 75 per cent of medical students are worried about clinician shortage, and 65 per cent of nursing students are worried about burnout. The consensus seems to be that the prospect of a future involving low pay and poor working conditions is starting to cut through among potential applicants and current students.
Unfortunately, not all of these students will make it through the course. Research from the Nuffield Trust suggests that one in eight nursing students did not complete their intended degree between 2014 and 2020, and one in nine midwifery students do not join the profession on graduation. Data is harder to come by on the totality of the medical training pipeline, but it seems that for every one fully-qualified general practitioner we need to offer two training posts.
The plan put forward by Nuffield focuses on student loan forgiveness in return for years of NHS service, covering nurses, midwives, and allied health professionals. This may increase application numbers, student retention, and graduate progression to the NHS – but it is another expensive ask on top of what has already been promised and requested (though there are suggestions that the cost and savings would cancel out).
State of the nation
There have been many recent expansions in the availability of funded places, and indeed in the number of UK medical schools. Here’s how things look currently.
In terms of the numbers of medical and related students in each provider, the available HESA data is not quite the last word (the vagaries of subject coding apply even at the fairly detailed CAH level three). But this is the state of play in a sample of likely looking codes.
The Office for Students publishes data for medical recruitment across the UK. This chart shows the number of home fee paying and non-home fee paying (usually overseas) medical students initially accepted at each provider in 2022-23 – the thinner yellow lines show confirmed home intakes (minus those who leave the course) in 2021-22. If you’ve spotted that the institution names don’t quite match the map at the top, be aware that three of the four joint medical schools (Brighton/Sussex, Hull/York, Kent/Canterbury) submit joint returns, whereas the University of Nottingham returns numbers for it’s own medical school separate from the joint Nottingham/Lincoln operation.
Asks in context
The UUK request for a government-funded campaign to promote the variety of careers (and new and existing routes into these careers) feels like a bare minimum given what appears to be happening to applications. It does feel like we are looking at a demand-side problem. There’s little indication that the current dash for short, modular, courses would achieve much in healthcare given the need to address (rightly) rigorous professional standards. And although an apprenticeship route is welcome, the amount of apprenticeship attrition and the likely low numbers involved don’t look likely to move the dial.
We will clearly need more educators within universities, but this in itself would pull experienced staff away from the front line and thus from placement provision. On the latter there are clearly huge capacity issues that also have an impact on patient care. Likewise, there is potential in using new technologies to support training capacity – but there will always be a need to get patients and students interacting, and for this to be properly supervised and supported.
Fundamentally, healthcare education is a balancing act between a number of different pressures. We’re dealing with the impact of more than a decade of underinvestment, and there are no easy or quick fixes. Universities are standing up to provide the training and support the healthcare sector needs, but in return need to be properly supported themselves – with long term, consensus-driven, plans and steady, dependable, resource increases.