Nursing has 23,046 vacancies. Four different funding models could address the pipeline — this page models what each would actually mean, not which is right

Scenario A: Current system

Standard tuition fee loan (up to £9,790/year) and maintenance loan, plus the NHS Learning Support Fund's flat £5,000/year Training Grant (non-repayable) available to every eligible student, with a £1,000/year top-up for a small list of shortage specialisms.

Direct public cost

Training Grant alone, for one UK-wide entry cohort's first year: £131.6m (illustrative, see the module note — this is not a total programme cost).

Who benefits

Every eligible nursing/midwifery/AHP student gets the grant regardless of financial need; students on designated shortage courses get slightly more.

Who bears the cost

Students still borrow for tuition and most maintenance costs, repaid on standard income-contingent terms (see Chapters 11A–11B) — a mix of individual borrowing and direct government grant spending.

Implementation issues

Already running — the main issue is whether the flat, course-based (not geography-based) targeting reaches the areas with the worst shortages, since there is no regional top-up in the current design.

Behavioural uncertainty

Whether the grant materially changes who applies to nursing, versus simply reducing the debt of those who would have applied anyway, was not established by any source found for this page.

Retention implications

No official evaluation linking the Training Grant to NHS retention after qualification was found.

Scenario B: Degree apprenticeship for all entrants

Every new nursing student trains via a degree apprenticeship instead: an NHS employer pays for the course and a wage, and the student never takes out a tuition loan. This already exists at a small scale (£65.4m committed for 2,000 additional places over 3 years, from 17 April 2026) — this scenario asks what scaling it to most or all entrants would imply, not what is currently funded.

Direct public cost

No credible current-cost estimate can be built: no official figure for the cost of training one nurse via the apprenticeship route (as opposed to the traditional degree route) was found, and no current national total of apprenticeship starts could be confirmed to scale a per-place cost up. This page does not invent one.

Who benefits

Apprentices earn a wage while training and avoid tuition debt entirely; NHS employers gain a pipeline more likely to already be embedded locally.

Who bears the cost

The employing NHS trust or equivalent, not the individual student's loan account — a direct payroll and training cost to the health service rather than a loan the graduate later partially repays.

Implementation issues

Historical growth has been real but from a small base (304 starts (2017/18) to over 2,000 (12 months to July 2021); 54 universities offered the route by 2025, up from 4 in 2017.) — NHS England's own ambition is roughly 20% of registered nurses via this route against about 9% today, implying most training would still need to happen the traditional way even if this scenario were pursued at pace.

Behavioural uncertainty

Whether enough NHS employers would offer and fund significantly more places, and whether enough applicants would choose an employer-based route over a university-based one, is not established by any source found.

Retention implications

Apprentices are, by construction, already employed by an NHS organisation during training — plausibly associated with higher local retention, but no comparative retention study against traditionally-trained nurses was found for this page.

Scenario C: Targeted public tuition, conditional on years of NHS service

Government pays the tuition fee loan directly (up to £9,790/year per student) for students who commit to a set number of years working in the NHS after qualifying, with the commitment enforceable in some way if not honoured.

Direct public cost

Full-tuition cost for one UK-wide entry cohort's first year: £257.6m (illustrative — see the module note on why this is not a like-for-like Exchequer comparison with Scenario A).

Who benefits

Students who complete the service commitment pay no tuition at all; the NHS gains a guaranteed minimum service period from each funded student.

Who bears the cost

Government pays the tuition cost directly rather than issuing a loan that is later partly repaid — a larger up-front public cost than Scenario A, offset only if the service commitment reduces the current reliance on international recruitment (see the training pipeline data above) or agency staffing.

Implementation issues

No current UK scheme of this exact design (whole-tuition, service-conditional, enforceable) was found to model from — several other countries and some UK bursary schemes use service-linked funding in different forms, but this page does not have a directly comparable existing scheme to cost against.

Behavioural uncertainty

Whether a service commitment changes who applies (attracting people newly willing to commit) or simply pays for people who would have stayed anyway is exactly the kind of question this kind of scheme needs piloting to answer — not something existing data can settle.

Retention implications

A binding service commitment would mechanically raise short-term retention among funded students by construction; what happens after the commitment period ends is not addressed by any source found.

Scenario D: Enhanced maintenance support for shortage specialisms

Increase the Specialist Subject Payment (currently £1,000/year, for mental health nursing, learning disability nursing, radiography, prosthetics/orthotics, orthoptics, podiatry) substantially, and/or extend it to more shortage specialisms or add a genuinely new regional top-up — which, as stated above, does not currently exist in the Learning Support Fund.

Direct public cost

Cannot be costed without deciding the new payment level and which specialisms/regions would qualify — no assumption is offered here rather than picking an arbitrary figure.

Who benefits

Students already choosing shortage specialisms or shortage regions get more support; this scenario does not obviously attract NEW entrants to nursing overall, only redistributes support among those already training.

Who bears the cost

Direct government grant spending, scaled to whatever level and eligibility is chosen — the smallest structural change of the four scenarios, and correspondingly the easiest to cost precisely once a specific design is chosen.

Implementation issues

Administratively the simplest scenario — it extends a mechanism that already exists, rather than building a new one.

Behavioural uncertainty

Whether extra maintenance support (as opposed to extra course-specific top-ups, which already exist) changes specialism choice at the margin is not established by any source found for this page.

Retention implications

Not addressed by any source found.

Which scenario is correct

Deliberately not stated. Each scenario has real trade-offs this page shows rather than resolves — that judgement belongs to policymakers weighing evidence this page provides, not to this page.

A total programme cost for any scenario

Every cost figure above is sized to one entry cohort's first year as an illustration — not a full multi-year, whole-workforce total, because no official total headcount or total spend figure exists to scale it against.

Whether any of these would actually close the vacancy gap

None of the sources behind this page model vacancy-rate outcomes for any of these four scenarios — that would require its own dedicated workforce-planning exercise this page does not attempt to substitute for.