Nurses are now graduating with more student debt than doctors, new analysis reveals, despite far shorter courses and nurses earning hundreds of thousands of pounds less over their careers.
Ahead of the annual Budget, nursing leader Professor Nicola Ranger is urging the prime minister and chancellor to correct the “deep injustice” by forgiving graduate nurses' student loans, warning unfair debt is also harming the recruitment and retention of vital nursing staff and risks undermining plans for a national care service.
Freedom of Information requests by the Royal College of Nursing (RCN) to the Student Loans Company have revealed every nursing cohort in England since 2021, the first to enter the workforce since the nursing bursary was scrapped, has graduated with more debt on average than those on medical degrees. The most recent graduating cohort of nursing students left university with an average of £50,160 debt, while for medics graduating in the same year, the average debt was £47,774.
Medical graduates earn an estimated £200,000 more in net lifetime earnings than nurses, according to the Institute for Fiscal Studies (IFS), while doctors’ pay quickly reaches the point where they start paying back their loans. Meanwhile, registered nurses are systematically weighted to the bottom of the NHS pay scale, with many spending their careers on the same pay band they graduated onto and left servicing a debt that only ever grows.
More than twice the proportion of nursing students are from the most deprived areas than medical students [NOTES], according to further RCN analysis of UCAS data. The College says nursing students are more likely to come from disadvantaged and diverse socio-economic backgrounds than their medical colleagues and less able to rely on the “bank of mum and dad” to help out with university costs. This means they have to take out bigger loans, including the maximum maintenance loan which is currently set at £10,830 a year for those studying outside of London.
Additionally, tuition fees for the final two years of a typical six-year medical degree are funded by NHS bursaries, while a nurse’s three-year course is entirely reliant on Student Finance England.
Professor Ranger says forgiving nurses’ student debt in return for a commitment to work in health and care is a “golden opportunity to build a generation of new nurses fit for a national care service” and also to bolster numbers in the NHS, where there is a shortage of tens of thousands of registered nurses. It is a crucial measure to wrestle back control and take ownership of the supply of staff, the College says.
To meet the needs of a growing, ageing population, the national care service recently proposed by the prime minister will need to be registered nurse led. However, new social care workforce figures show staff turnover is shockingly high among registered nurses. Almost a third (31.8%) in England left the sector this year according to Skills for Care, equivalent to 9,700 people. There are approximately 15,000 fewer registered nurses in the social care sector in England than there were in 2012.
Estimates by London Economics suggest that implementing loan forgiveness this year would result in an extra 12,015 nurses working in the NHS, with staff staying in their jobs for up to a decade longer. If applied to social care, the RCN says it could have similar benefits.
The RCN is proposing a scheme where a graduate's debt is forgiven in return for working in social care or the NHS. 30% of the loan would be written off after three years of service, 70% after seven years and 100% after ten years of working in either sector. It’s also calling for universal, uplifted maintenance grants which truly reflect the cost of living.
In 2017, Andy Burnham, then-recently elected Mayor of Greater Manchester, told the RCN’s annual Congress he opposed the introduction of tuition fees for nursing courses and backed a local loan forgiveness scheme for healthcare graduates in Greater Manchester.
He said: "So many young people will now think that it's beyond them to aspire to go into nursing and what a terrible state of affairs that would be for the country in the future."
He later said: "It seems that there's not an understanding that student nurses are different from other students. Their courses are more onerous. They get fewer holidays, fewer days’ leave, far longer terms and of course the time that they have to spend in clinical practice, some 2,300 hours, means it's hard for them to get a part-time job so how can it make sense to scrap the nurse bursary? I don't think that it can.
"It's too hard for these young people trying to make their way in your profession and we all of us need to speak up for them, do more for them and that's what I intend to do."
Professor Ranger says the new prime minister must now act on his convictions and ensure the chancellor rights the wrongs of the debt system. Making nursing a more attractive career can help the government achieve its aim of increasing the number of young people in education and training across the country.
RCN General Secretary and Chief Executive, Professor Nicola Ranger, said:
“This analysis shows how unfair things are right now. Our profession is a national asset, fundamental to the delivery of care and the health of the nation, yet nurses face more debt than doctor colleagues despite shorter courses and earning so much less in their careers. This isn’t about pitting doctors against nurses but tackling a deep injustice which makes it harder to attract and keep the nurses we desperately need.
“The reality is social care in England is down tens of thousands of registered nurses compared with a decade ago and losing staff almost as fast as it finds them. A national care service meeting the demand of an ageing population with increasingly complex needs will have to be registered nurse-led. Forgiving nurses’ debt is a golden opportunity to grow a workforce to do just that, making nursing a more attractive career and building a generation of new nurses fit for a national care service and our NHS, too.
“The prime minister knows how unfair things are for nurses, but the challenge now is to act. We cannot leave the vision for a national care service, and the fate of vulnerable people, to the whims of a toxic system of debt which only makes safely staffing our services so much harder. The evidence is clear: loan forgiveness will deliver better staffed services, improve care and pay for itself over and over again."
Ends
Notes to editors
The RCN's full briefing 'The Case for Investment in Nursing Education in England' can be read online.
Freedom of Information request to the Student Loans Company show a considerable increase in student debt for nursing graduates since the removal of the nursing bursary in 2016/17. The average student debt for nurses qualifying between 2013 and 2020 is £3,046.55, whilst for those qualifying after 2020/21, the first cohort entering the workforce following the removal of the bursary, it is £46,692.62. Every nurse cohort from 2021 to 2025 currently owes more on average per person than medic graduates.
The average graduate debt for nursing students qualifying in the 2024/25 cohort is £50,160. For medics graduating in the same cohort, the average debt is £47,774.
In June, the IFS published new estimates of the impact of undergraduate degrees on lifetime earnings. It estimated medical graduates will earn roughly £200,000 more than nursing graduates over their careers: New estimates of the impact of undergraduate degrees on lifetime earnings | Institute for Fiscal Studies
Independent analysis by London Economics of the RCN's proposed loan forgiveness model suggests that the estimated benefit-to-cost ratio stands at 4.0, meaning that for every £1 put in by the government, an estimated £4 are returned. If implemented for ten consecutive cohorts, starting with the 2025-26 cohort, then there would be an additional 12,015 nurses working in the NHS: Analysing Loan Forgiveness for Nurses - April 2023 - London Economics
RCN analysis of UCAS end of cycle data 2025 suggests more than twice (22%) of the proportion of adult nursing students are from the most deprived quintile of areas than medical students (10%): UCAS Undergraduate end of cycle data resources 2025 | UCAS
According to Skills for Care’s newly-published ‘State of the adult social care sector and workforce in England’ report, turnover among registered nurses has reached 31.8%, equivalent to 9,700 leavers: The 'State of' report
RCN analysis of the data shows that around 15,000 registered nurses in adult social care have been lost since 2012.
The latest NHS workforce statistics show there are 23,045 nursing vacancies in the NHS in England: NHS workforce statistics - NHS England Digital
According to RCN analysis, the true nursing shortfall in England could be as high as 55,000, more than double what official vacancies figures suggest: Patients coming to harm ‘on a daily basis’, as new report warns England’s NHS short of tens of thousands more nurses than advertised | Royal College of Nursing
