In 2019, the UK¡¯s previous Conservative government pledged an , and NHS England¡¯s 2023 signalled a new era of ambitious recruitment into healthcare professions.

The rationale was clear, we were facing serious workforce shortages, and the solution seemed to lie in the mass training of new healthcare professionals (HCPs). And higher education institutions responded accordingly, rapidly scaling up undergraduate intakes.

Yet today, less than two years on from the workforce plan¡¯s publication, the context has fundamentally shifted. Vacancies in the NHS have contracted and NHS trusts across England are now grappling not with workforce shortages, but with budgetary restrictions that may require reductions in the very clinical staff we so recently fought to recruit.

Building an?¡°NHS fit for the future¡± is one of the Labour government¡¯s . But while the health service did relatively well in the recent spending review, the clear message from government is that we have to improve productivity; there will be no more posts aligned to waiting list reductions.

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One signal of the recalibration is the anticipated announcement by the chief nursing officer for England of a 30 per cent reduction in corporate nursing roles (roles typically focused on clinical governance, policymaking, education and specialist roles). In the Midlands, where I work, reductions in workforce plans vary widely but show an overall reduction of 3.6 per cent (approximately 10,000 full-time equivalents) in 2025-26.

Despite this, student recruitment into HCP programmes has not slowed. The Royal College of Nursing claims nursing applications for 2025 have , but our experience suggests many universities are still aiming to increase student intakes year-on-year, often with minimal consultation or collaboration with their NHS partners. This disconnect between educational ambition and service reality is creating a silent crisis.

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From the NHS perspective, we appreciate and support the long-term value of investing in our future workforce. Undergraduate courses are three- or four-year commitments, and the needs of the NHS will shift again; who knows what the job market may be like a decade from now. But the current volume of recruitment is unsustainable in the short to medium term and is increasingly misaligned with NHS capacity for clinical placements, never mind graduate recruitment.

Each NHS ward/area/unit undergoes an ¡°educational audit¡±, which identifies how many practice assessors they have and allocates student numbers accordingly. When universities enrol significantly above their placement audit capacity, the quality of supervision and clinical exposure inevitably suffers. And poor student experience, flagged via the National Education and Training Survey (NETS), triggers a review from NHS England, which can impact a trust¡¯s reputation and workforce relationships. As a result, trusts are becoming more reluctant to support student numbers above their capacity. But universities are not reducing their enrolments accordingly.

We¡¯ve been here before. In the early 1990s, the cost of all healthcare training was still met by the public purse, so officials managed student recruitment into nursing programmes. Yet, even so, it took more than five years for a similar oversupply of nurses to be corrected. We are now seeing history repeat itself, with a boom-and-bust model of training and recruitment that risks transforming HCP education from a public good into a transactional commodity. And while the introduction of tuition fees has given students a greater voice, there¡¯s a worrying lack of public discussion about the consequences.

Once students begin their courses, word gets around about the state of the employment market. A , for instance, found that eight out of 10 student midwives are not confident they will secure a job on graduation. But most school-leavers enrolling this autumn will begin several years of demanding, emotionally taxing and expensive study under the impression that they are stepping into a stable, needed profession with clear career prospects.

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Of course, there are plenty of university courses that train students for jobs that may or may not exist when they graduate. But if students choose a course that comes with professional registration, they rightly anticipate getting a job on graduation ¨C particularly as they ¡°work for free¡±, as they see it, for nursing, 2,300 hours on NHS wards as part of their training.

We recognise that beyond the training of doctors ¨C which is still tightly controlled?because of the large amount of public funding that goes into it ¨C universities are autonomous in their admissions processes for healthcare degrees. However, autonomy should not equate to a disconnect from employer demand.

The time has come for a more honest and strategically aligned relationship between universities and the NHS. The goal would be not to dictate recruitment caps but to ensure that universities are enrolling students based not only on national policy aspirations but also on the practical realities of placement capacity and employment opportunity.

In a system as interdependent as England¡¯s, working in silos is a disservice to everyone: students, educators, employers and, ultimately, patients. If we want to safeguard the future of our healthcare workforce and avoid another cycle of boom-and-bust, we must start by facing today¡¯s realities together.

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is senior responsible officer (SRO) for education for Birmingham and Solihull ICS and head of the School of Nursing, AHPs (allied health professionals) and Midwifery at University Hospitals Birmingham NHS Trust.