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The £1.5 billion nursing shortage bill

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  • NHS trusts spend £1.46 billion a year on temporary staffing to plug the nursing gap - the equivalent of salaries for 66,000 newly qualified registered nurses
  • If existing gaps were permanently filled, trusts could save as much as £560 million a year
  • Poor retention is highlighted as a significant factor driving the shortage, with 70 per cent of registered nurses leaving their NHS trust within 12 months of qualification

NHS trusts in England are being forced to turn to expensive temporary staffing arrangements to plug gaps in nursing rotas – at a cost of £1.46 billion last year[1].

Data secured under the Freedom of Information Act as part of The Open University’s new report Tackling the Nursing Shortage, quantifies the financial impact of the national shortage - £1.46 billion. This bill for temporary staff would be enough to pay the salaries of 66,000 newly qualified registered nurses – more than filling the 38,000 existing vacancies.

In 2017, NHS trusts paid for an additional 79 million hours of registered nurses’ time at a premium rate – 61 per cent above the hourly rate of a newly qualified registered nurse in full-time employment. Based on the difference in cost, if current vacancies were filled permanently, the NHS could save as much as £560 million a year.

However, a new UK survey of 500 registered nurses and healthcare support workers commissioned by The Open University[2] reveals that three quarters (76%) of registered nurses expect the shortage to worsen in the next 12 months and three in five (61%) believe even more temporary staff will be needed.

Poor retention is a problem in the NHS with issues around pay, workload, organisational culture and access to continued professional development driving nurses on to other trusts and the private sector, or to leave the profession altogether, while Brexit has seen a 28 per cent rise in EU nurses quitting Britain[3], further exacerbating the problem. The study found one in three (34%) registered nurses are unhappy in their current role - and a similar number (35%) are thinking of leaving their job if things do not improve.

Retention is particularly problematic at the beginning of nurses’ careers, with seven in 10 (70%) newly qualified nurses quitting their NHS trust within a year of qualification, leaving gaps that can be hard to fill in certain areas. Many nurses have to complete their pre-registration training away from home, particularly in rural areas, but it means significant numbers are moving back when they qualify, with 16 per cent giving this as their main reason for moving between trusts.

Attracting new recruits is the other challenge. The introduction of student loans for nursing degrees has seen the number of applications to study nursing at university fall by around a third[4], and overseas applications have fallen 87 per cent in the last year as a result of the EU referendum[5]. Creating new or alternative routes into the nursing profession is essential.

Providing alternative ways to train as a nurse is one suggestion for tackling the shortage. In this survey, nearly two thirds of (63%) registered nurses believe offering flexible distance learning would help to recruit nursing students from more remote areas and keep nurses in these areas after they qualify. Many also believe apprenticeships could also help to attract new student nurses to the profession (71%) and offer a good alternative to recently removed bursaries (60%).

Offering trusts the opportunity to develop their existing health care support workers and new recruits via on-the-job training makes the concept of a Registered Nurse Degree Apprenticeship appealing. The NHS is the biggest contributor to the apprenticeship levy, so this approach would ensure they are making the most of their investment. The report concludes that an increased focus on work-based training and apprenticeships could therefore offer a more stable long-term approach.

Jan Draper, Professor of Nursing at The Open University, said: “The sector is facing challenging times. Relying on temporary nurses to plug gaps is just sticking a plaster over the problem, and costs considerably more than if vacancies were filled permanently. We know that poor retention and low recruitment results in inefficiencies and ultimately puts patient care at risk, so it’s vital that we look to a more strategic and sustainable approach.

“Taking advantage of recently introduced degree apprenticeships that offer flexible work-based learning is one solution, making use of funding already ring-fenced to pay for training while opening up new routes into the profession. Not only can this approach inspire and motivate the workforce, it can also increase future nursing supply and reduce retention issues in local communities, helping to reduce the strain on the sector.”

The Open University’s Registered Nurse Degree Apprenticeship is now open for applications. For further information, please visit

For interviews, details on the research methodology or any other information please contact:
Penny Mitchell / Tabby Haysom
Third City
020 3657 9773 / 07718 475 282

About The Open University

The Open University (OU) is the largest academic institution in the UK and a world leader in flexible distance learning. Since it began in 1969, the OU has taught more than 2 million students and has almost 175,000 current students, including more than 7,000 overseas.

Over 75% of students are in full-time or part-time employment, and four out of five FTSE 100 companies have sponsored staff to take OU courses. The OU has been delivering work-based learning to organisations since the mid-90s and launched its higher and degree apprenticeships offering in 2016 to provide employers with flexible, technology-enabled apprenticeship training for new and existing staff in leadership and management, digital and healthcare. Later this year, the OU will be launching degree apprenticeships for social work and policing.

In the latest assessment exercise for university research (Research Excellence Framework, 2014), nearly three quarters (72%) of The Open University’s research was assessed as 4 or 3 star – the highest ratings available – and awarded to research that is world-leading or internationally excellent.  The Open University is unique among UK universities having both an access mission and demonstrating research excellence.

Regarded as the UK’s major e-learning institution, the OU is a world leader in developing technology to increase access to education on a global scale. Its vast ‘open content portfolio’ includes free study units, as well as games, videos and academic articles and has reached audiences of up to 9.8 million across a variety of online formats including OpenLearn, YouTube and iTunes U.

For further information please visit:

-- The Open University is incorporated by Royal Charter (RC 000391), an exempt charity in England & Wales and a charity registered in Scotland (SC 038302). The Open University is authorised and regulated by the Financial Conduct Authority.

[1] The Open University issued requests to 241 NHS trusts across the UK in January 2018 under the Freedom of Information Act 2000. 61 per cent (146) of these organisations responded to The Open University's request for information. A full methodology for calculations based on the data is available on request.
[2] The Open University commissioned PCP Market Research to carry out a survey of 500 registered nurses and health care support workers in England between 9 and 20 March 2018. 250 of those surveyed were registered nurses.
[3] Nursing and Midwifery Council (2018) New NMC figures continue to highlight major concern as more EU nurses leave the UK.
[4] UCAS (January 2017 and February 2018) Applicants for UK Higher Education [press releases].
[5] Nursing and Midwifery Council (2018) New NMC figures continue to highlight major concern as more EU nurses leave the UK.