Nursing Courses: Reduction in Applications

Lord Markham Excerpts

Tuesday 19th September 2023 Lords Chamber

[Lord Hunt of Kings Heath]

To ask His Majesty’s Government what assessment they have made of the causes of a reduction of 16 per cent in applications to nursing courses in England compared to last year, according to UCAS data for the 2023 application cycle.

[The Parliamentary Under-Secretary of State, Department of Health and Social Care (Lord Markham) (Con)]

The drop in nursing applicants reflects an expected rebalancing following unprecedented demand for healthcare courses during the Covid-19 pandemic. Nursing is still a popular career choice. Applicant numbers remain 15% higher than pre-pandemic levels. We also continue to see growth in the number of people pursuing nursing apprenticeships. This is not final data; figures are accurate as at the end of June application deadline, but the application cycle remains open through clearing until mid-October.

[Lord Hunt of Kings Heath (Lab)]

My Lords, I am very grateful to the Minister, but I think he would accept that any drop-off in applications is something to worry about, alongside the current drop-out rate for student nurses in the UK of around 24%. On that basis, surely the NHS workforce plan in relation to nursing is simply not sustainable. If the Minister does accept that, is there not a case for looking at writing off debt run up by student nurses through tuition fees if they commit to working in the NHS for a length of time?

[Lord Markham (Con)]

We are delivering on a number of routes to recruit nurses. Obviously, the graduate route is one route, which, as mentioned, is above pre-pandemic levels; apprenticeships is another route, which is proving very successful; and associates is another route again. So there are many routes in, and the result is that our applications are 20% up on pre-pandemic levels. We set ourselves a target of recruiting 50,000 more nurses by the end of this Parliament and we are currently on 45,000, so we are going to hit it.

[Baroness Manzoor (Con)]

My Lords, I welcome what my noble friend the Minister said regarding the number of nurses joining; nevertheless, the number of nurses leaving the NHS is higher than we would expect. Would my noble friend say exactly whether we are collating this information and understanding why those people are leaving, because they have a very valued skill?

[Lord Markham (Con)]

Yes, absolutely. Clearly, we want to recruit, but we also want to retain our workforce and again that is what the long-term workforce plan is all about—trying to look at a clear professional development path and other things we can help with, such as childcare support and the culture and leadership, and really make nursing a very successful and rewarding career structure. There is a lot to do on it, but I think there has been a lot of good progress as well.

[Lord Allan of Hallam (LD)]

My Lords, the NHS Long Term Workforce Plan will make funding available for an increased number of nurse training places, which is of course welcome, but the increase in capacity for the NHS will happen only if there are sufficiently qualified candidates applying for those places and completing the training. Would the Minister be willing to share the assumptions his department made about application and attrition rates when setting the targets in the workforce plan, so that we can compare those assumptions with reality as revealed by the numbers in the Question today?

[Lord Markham (Con)]

Yes, my understanding is that all the workings behind the long-term workforce plan are currently being analysed by another body— I am not quite sure whether it is the NAO, the ONS or whoever. The point is that all the modelling and the underlying assumptions are being analysed, and I believe there will then be a report on them so that everyone can see what we are trying to do and how reasonable those assumptions are.

[Lord Bradley (Lab)]

My Lords, the University of Salford, where I am chair of council, has seen applications for adult nursing down by 28%, children’s nursing down by 27% and mental health nursing down by 6%, with an overall drop of 23%. From the feedback the university is receiving, the main barrier is that the financial support needed to undertake a highly intensive course, which leaves little time for part-time working, is insufficient to meet the current cost of living. Does the Minister accept that this is a factor in the drop in applications, and will the Government review the financial package of support available to nursing applicants to ensure, as we have heard, that the NHS workforce plan is deliverable?

[Lord Markham (Con)]

Clearly, as the largest employer in the UK—if not most of the world—the NHS always has to be looking at the whole package that it is offering its staff to make it an attractive place to recruit good talent and retain it. The point that the noble Lord makes is absolutely correct, and those are all things that need to go into the mix. As I say, recent data is encouraging. We have increased the numbers by 45,000 and are on course to hit the 50,000 target, but, as ever, we need to be vigilant because we want to recruit a lot more.

[The Lord Bishop of Chichester]

My Lords, following on from the noble Lord who spoke about his university, the University of Chichester—in the diocese where I serve—is now developing practice-focused nursing courses, including a new nursing associate apprenticeship scheme, even though the cost of living in the south-east is a disincentive to seeking to work in the healthcare sector. However, the university is finding that the current funding and availability of external placements are restricting the growth of these courses, despite the university’s capacity to take more students. What measures are the Government taking to support education and placement expansion at the pace requested by the NHS Long Term Workforce Plan?

[Lord Markham (Con)]

The whole long-term workforce plan is supported by a £2.4 billion investment to make sure that we hit our ambitious targets. It takes into account things like apprenticeships: we want to see the proportion of people coming through the apprenticeship route increase from 9% to 28%. On nursing associates—noble Lords will remember that this is a subject close to my heart, because for my mother, who had children when she was very young, nursing was a route for her to get back into the workforce, so this is something that I am glad to see us now picking up again—we have seen nursing associates increase from 1,000 to 10,000 over the last few years. These are all key routes, which we are backing up with investment behind them.

[Lord Hampton (CB)]

My Lords, it appears that the reduction in student nurses was most prominent among mature students. Applications from those aged 30 to 34 dropped by 25%. Out of nearly 49,000 qualified entrants to teaching last year, fewer than 12,000 were over the age of 39. As someone who retrained as a teacher at the age of 50, can I ask what the Government are doing to attract more mature students to both professions—a group of people who might be under less financial pressure and are able to see these professions as the incredibly important and rewarding careers that they are?

[Lord Markham (Con)]

As I just mentioned, the whole point around nursing associates is to try to attract those more mature recruits as well. As I was trying to show with the example of my mother, there are lots of people who have a lot of value that they can give later on in their life. That is definitely the sense of direction that we are trying to achieve. I repeat that, while people are talking as if numbers are going down, across the field of graduates, apprenticeships and associates we are looking at a 20% increase since pre-pandemic levels.

[Lord Lucas (Con)]

My Lords, would my noble friend consider making it much easier for young people to get work experience in the NHS, so that they can see what a wonderful career it is, rather than having to rely on the chance of someone they know working in that industry?

[Lord Markham (Con)]

Absolutely. We are trying to adopt a modular approach so that you can have units that can build towards getting in there. For people who go into social care, for instance, there is a modular unit that can add towards going into nursing later on. That is a means of attracting people to nursing by having more routes in and making a career such as social care attractive in terms of career progression.

[Baroness Walmsley (LD)]

My Lords, the noble Lord, Lord Hunt, mentioned the attrition rate among student nurses, but I understand that the attrition rate among student mental health nurses is even greater. That is a particularly challenging specialist course, and one of the problems is that very often the clinical placements are a long way from where the student nurse lives. Is there any programme of support available to make sure that we do not lose the student nurses who undertake this very challenging route to nursing?

[Lord Markham (Con)]

The noble Baroness is quite correct that mental health is a particular case in point. When we introduced the £5,000 grant for all nurses each year, we gave additional add-ons, and mental health nurses get an add-on in addition to that £5,000 a year. We also increased the travel and accommodation costs allowance by 50% to cater for those who have to travel far and wide.

[Baroness Wheeler (Lab)]

My Lords, the figures on overall declining numbers are concerning, particularly since this is the second successive steep fall, with, as the Minister said, the Department of Health relying on the UCAS clearing system and future nurse apprenticeships to try to make up the numbers. What changes does the Minister consider need to be made to the NHS workforce plan in the light of escalating problems with both the recruitment and retention of key staff?

[Lord Markham (Con)]

I am sorry to keep coming back to the data, but it suggests a 45,000 increase, which shows that we are doing pretty well. A 20% increase across all the different fields since the pandemic also shows that we are doing a good job on recruitment. Clearly, we cannot rest on our laurels, so we need to look at all those routes in, but I do not understand why people characterise the numbers as dropping when in fact the data shows the overall increase is far greater.