Expert advice

How will the Conservative election pledge of 50,000 more nurses by 2024/25 be realised?

The pledge may well be broken without increased reliance on international recruitment

The pledge may well be broken without increased reliance on international recruitment

Picture: Neil O'Connor

Now we know who is in government, we can revisit one of their controversial election promises.

The Conservative manifesto commitment was 50,000 more nurses by 2024/25. This was immediately brokered down to 31,000 additional ‘new’ nurses because part of the plan was to encourage about 19,000 existing nurses to stay on.

Assuming the money can be found – which is a big assumption – where will the 30,000 plus new nurses come from? And how will this be achieved within five years?

The latest analysis from the Organisation for Economic Co-operation and Development (OECD), which publishes regular international comparative data on health sector staffing, gives us some clues. It also raises two red flags.

The UK's nurse graduation rate is below average

First, the UK is not training enough new nurses. The annual nurse graduation rate estimate for the UK is low by OECD standards, at about 29 graduates per 100,000 population. This compares with an OECD country average of 44 and is only about a third of the rate of Australia, which is 85.

So the UK faces a relatively low new supply from home, a time lag of three to four years before new nursing students graduate and, in England, a loan-based system that replaced the bursary which is turning away viable applicants. 

No quick win for the government here then, unless it can somehow magic a very rapid increase in training places in 2020/21.

Fast-track immigration status may be needed to keep pace

Second, a faster and cheaper option is international recruitment. About 15% of UK-based nurses are foreign trained, almost three times the OECD average. But recent growth in recruitment from India and the Philippines has done little more than compensate for the drop in EU nurses since the Brexit vote in 2016.

Not only will the long-term reliance on international nurses have to continue, it will have to increase if the 30,000 target is to be met. The new government will have to consider giving fast-track immigration status to international nurse applicants and support a scale up of NHS international recruitment.

James Buchan is professor in the faculty of health and social sciences at Queen Margaret University, Edinburgh

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