Dr Richard Dune

16-05-2025

State of nursing in the UK: 2025 review

Image by monkeybusiness via Envato Elements

The UK sits at the centre of a global nursing crisis. This review highlights key challenges in education, workforce planning, ethics, and future system design

This week, the World Health Organization (WHO) and the International Council of Nurses released the State of the World’s Nursing 2025, the most comprehensive global analysis of the nursing profession to date. It’s not just a health workforce report; it’s a red flag and a roadmap.

While the report covers global trends, its relevance to the UK is inescapable. The UK sits at the centre of this nursing crisis, reliant on international talent, lacking a sufficient domestic supply, and failing to fully empower its nursing workforce. The headlines may have faded since the pandemic, but the underlying structural issues have not.

The UK must confront three truths:

• We cannot meet our health goals without nurses
• We are over-reliant on other nations’ talent pipelines
• Our current model is reactive, fragmented, and unsustainable.

This is not just about filling vacancies. It’s about system design, leadership, and long-term resilience. In this blog, Dr Richard Dune explores what the WHO’s latest report means for the UK and why bold, strategic action is urgently needed.

A decade of disruption (2015 - 2025)

The past ten years have tested UK nursing like never before; political instability, austerity, Brexit, and the COVID-19 pandemic created a volatile environment for workforce planning. Nurses remain the backbone of the NHS, making up the largest clinical workforce, yet they operate within a chronically underfunded and overstretched system.

Key stats (2024–2025)

• 778,000 nurses, midwives, and nursing associates are on the NMC register
• Over 60,000 NHS nursing vacancies persist in England, representing a 10.7% vacancy rate (NHS Digital, 2024)
• 1 in 4 nurses in the NHS is internationally trained (NMC, 2024).

Despite national reliance on nursing expertise, the profession faces under-recognition, under-resourcing, and underinvestment.

Global nursing - The UK in context

The State of the World’s Nursing 2025 estimates a global nursing stock of 29.8 million, a modest rise from 27.9 million in 2018. However, this increase conceals stark inequities:

• 78% of nurses serve just 49% of the global population, predominantly in high-income countries.
• By 2030, the global shortfall will still be 4.1 million, with 69% of the gap concentrated in Africa and the Eastern Mediterranean.

This imbalance reflects a global structural dependency, one that the UK epitomises. We disproportionately benefit from global health workforce flows without adequate investment in our pipeline or meaningful reciprocity with source countries.

Reaping without sowing - UK workforce pressures

Despite growing demand, the UK has failed to invest adequately in building and sustaining its nursing workforce. The result is a fragile pipeline strained at every stage.

An ageing workforce

• Nearly 1 in 3 UK nurses is aged over 50
• Retirement rates are rising faster than graduate inflows
• Newly qualified nurses are not staying; up to 33% leave within three years.

Education and training bottlenecks

• UCAS data shows a 24% fall in nursing applicants between 2016 and 2023
• The removal of the nursing bursary in 2017 caused a sharp decline in enrolments; partial reinstatement in 2020 has not fully reversed the trend
• Student attrition is high, driven by financial pressures, academic load, and lack of placement support
• Training capacity remains constrained, particularly in clinical placements and simulation-based learning environments.

We are trying to grow a workforce in depleted soil. The roots simply aren’t strong enough to sustain future demand.

International recruitment - Ethical and strategic blind spots

The UK continues to plug domestic workforce gaps by recruiting nurses from abroad, especially from:

• The Philippines, India, Nigeria, Ghana, and Zimbabwe.

As of 2023:

• 23% of nurses in HICs like the UK are foreign-born, compared with just 3% in low-income countries.

The WHO has repeatedly warned against this “reverse subsidy.” Source countries lose highly trained professionals, while the UK benefits without proportionate investment in strengthening the health system abroad. Many of these nations are listed on the WHO’s Health Workforce Support and Safeguards List, meaning active recruitment undermines their ability to meet domestic health needs.

This model is not ethical. It’s not sustainable. And it certainly isn’t future-proof.

COVID-19 and the post-pandemic reckoning

The pandemic brought nurses into public view, but did little to resolve the system’s foundational weaknesses.

COVID’s legacy

• Over 850 health and social care workers, including nurses, lost their lives in the UK to COVID-19
• A 2021 survey showed 70% of nurses suffered from high stress or burnout
• Mental health support remains inconsistent and inadequate.

This is echoed in the WHO’s 2025 report: fewer than half of the countries globally provide structured mental health support for nurses. Despite its resources, the UK is not leading in this space.

Political response - Fragmented and firefighting

The NHS Long Term Workforce Plan (2023) pledges to double nursing training places by 2031. This is ambitious, but not guaranteed.

There has been an increased emphasis on:

• Blended learning and apprenticeships
• Advanced Practice Nursing (APN) pathways
• Widening participation in nursing education.

Yet on the ground:

• Frontline staff remain disconnected from strategic decisions
• Nurses' leadership roles lack real authority, especially at the Integrated Care Systems (ICS) and national policy level
• Innovations often happen despite the system, not because of it.

Industrial action

The RCN-led strikes in 2022–2023 over pay, working conditions, and safety sent a clear signal. However, many nurses felt that government responses were reactive and not restorative.

Systemic gaps - Misaligned with WHO priorities

The WHO’s 2025 roadmap is built on strategic investment, ethical practice, and systems-level planning. The UK is not yet fully aligned on any of these.

The opportunity ahead - From applause to action

Nurses are more than just clinicians. They are:

• Connectors of continuity
• First responders in crisis
• Architects of integrated care
• Natural innovators in service redesign.

The State of the World’s Nursing 2025 is a wake-up call, but more importantly, it’s a blueprint. It gives governments, especially the UK, a chance to course correct.

If we want a resilient NHS, we must treat nursing as strategic infrastructure, not just headcount. Investing in nurses is not just good health policy; it’s smart economic, digital, and innovation policy.

Want to reimagine the future of nursing in the NHS?

At The Mandatory Training Group, we believe nursing must be at the centre of system transformation. Nurses understand community, continuity, complexity, and change better than most professions.

Reflect with us:

• It’s time we stop asking nurses to “do more with less” and start asking them to help design the future of care.
• How can we better recognise nurses as leaders in digital health, education, and integrated care?
• What will it take to move from crisis response to long-term workforce resilience?

Click here to discover how ComplyPlus™ can support your nursing teams through tailored training, workforce planning, and leadership development, or explore our full library of CPD-accredited e-learning courses to get started today.

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