History of nursing in the United Kingdom

This article outlines the history of nursing in the United Kingdom from the 1850s, showing the lobbying for, establishment and development of the state regulated profession of nursing.

19th century

Before the advent of training, nursing was often casual and low paid. Pay in London voluntary hospitals was between 6 shillings and 9s 6d a week, with some board and lodging. Outside London, pay was much lower. Few nurses were described as educated. Facilities in hospitals were poor, though some began to provide meals for nurses. The designation sister arose from the ministry of religious sisters, who were recruited separately from nurses and were more respectable, honest and conscientiously devoted to the welfare of patients (which often brought them into conflict with the hospital authorities). Matrons, whose work was largely administrative, were even more so. The Nursing Sisters of St John the Divine (est. 1848) and the All Saints Sisters of the Poor (1851) provided the nursing staff for several of London's largest teaching hospitals, including King's College, Charing Cross and University College Hospitals until close to the end of the century.

Nursing in the Poor Law infirmaries was largely carried out by able-bodied paupers, who were not paid. In 1866 there were a total of 53 nurses employed in the 11 metropolitan workhouses, at an average annual salary of £20 18s^[1] (equivalent to 8 shillings per week).

Florence Nightingale

Florence Nightingale (12 May 1820 – 13 August 1910) was an English social reformer, statistician and is seen by many as the founder of modern nursing. Nightingale came to prominence while serving as a manager and trainer of nurses during the Crimean War, in which she organised care for wounded soldiers at Constantinople. She significantly reduced death rates by improving hygiene and living standards. In 1860, she laid the foundation of professional nursing with the establishment of her nursing school at St Thomas' Hospital in London. It was the first secular nursing school in the world and led to the development of formalised nurse-training in the UK.^[2]

Other women involved in nursing in the Crimea were Betsi Cadwaladr and Mary Seacole.

1858–1900

Developments in nurse education

In 1881 Eva Luckes, Matron of The London Hospital established the first two year training scheme in London.^[3] She instituted a series of lectures by herself, a surgeon and a physician. In 1884 she introduced the precursor to Sister -Tutors, and selected two of her most trusted and skilled hospital sisters to give probationers extra tuition.^[4]^[5] Before this the nurses home Sisters at St Thomas's Hospital used to lecture probationers from the Nightingale School. In 1895 Luckes introduced the first Preliminary Training School for Nurses in England similar to that established by Rebecca Strong at Glasgow Infirmary in 1893.^[3]^[6] This became the blueprint for nurses education following the Nurses Registration Act 1919.^[4]

1850–1870

1858: State registration of the medical professions began, prompting calls for a similar system for nursing.
1859: Notes on Nursing by Florence Nightingale was published.
1860: Nightingale School of Nursing was established at St Thomas' Hospital in London.

1870–1900

1879: Workhouse Infirmary Nursing Association was created.
1881: Queen Alexandra's Royal Army Nursing Corps (QARANC) was formed.
1886: The Hospital (journal; 1886–1924) was launched.
1887: British Hospitals Association established the first UK register of trained nurses for those who could show that they had worked for at least a year in a hospital or an infirmary and had been trained in the duties of a nurse.
1887: Queen's Nursing Institute (QNI) was created.
1887: Royal British Nurses' Association (RBNA) was created by Ethel Gordon Fenwick. It campaigned for the establishment of a register of nurses. It wanted the training to last three years with national standards. They set up a voluntary register in opposition to that of the British Hospitals Association. Princess Helena, one of Queen Victoria's daughters, played a central role in sponsoring and legitimizing the profession. Helena had a firm interest in nursing, and was the first president of the British Nurses' Association.
1888: Nursing Record, a nursing journal, was created.
1889: Queen's Nursing Institute Scotland (QNIS) was formed.
1894: Matrons' Council for Great Britain and Ireland was established.
1897: National Association of Workhouse Masters and Matrons was created.

Military nursing

Nightingale laid the foundations of professional nursing with the principles summarised in the book Notes on Nursing.^[7] Her highly publicised exposure of the abysmal care afforded sick and wounded soldiers energized reformers. In 1860 Queen Victoria ordered a hospital to be built to train Army nurses and surgeons. The Royal Victoria Hospital opened in 1863 at Netley and admitted and cared for military patients. Nurses were formally appointed to Military General Hospitals from 1866.

The Army Nursing Service (ANS) oversaw the work of the nurses starting in 1881. These military nurses were sent overseas beginning with the First Boer War (often called Zulu War) from 1879 to 1881.^[8] They were also dispatched to serve during the Egyptian Campaign in 1882 and the Sudan War of 1883 to 1884. During the Sudan War members of the Army Nursing Service nursed in hospital ships on the Nile as well as the Citadel in Cairo. Almost 2000 nurses served during the second Boer War, the Anglo-Boer War of 1899 to 1902, alongside nurses who were part of the colonial armies of Australia, Canada and New Zealand. They served in tented field hospitals. 23 Army Nursing sisters from Britain lost their lives from disease outbreaks.^[9]

Princess Helena was also President of the Army Nursing Service. Following Queen Victoria's death, Queen Alexandra took over the presidency, but Helena retained presidency of the Army Nursing Reserve.^[10]

20th century

1900–1914

The pressure for state registration grew throughout the 1890s and continued in the pre-War period, but was undermined by disagreements within the profession over the desired form and purpose of the regulatory system. There were six failed attempts between 1904 and 1918, the British parliament passed the bill allowing formal nurse registration.^[11] A government committee reported in 1904 setting out a detailed and persuasive case for registration. However, the government sat on the report and took no action. Over the next decade, a number of Private Member's Bills to establish regulation were introduced but all failed to achieve significant support in Parliament.

In 1901 there were 3,170 paid nurses employed in workhouses, with about 2,000 probationers - about one nurse for 20 patients. In total there were about 63,500 female nurses and 5,700 male nurses in England and Wales, working both in institutions and, the majority, in patients homes. The men were almost entirely mental nurses and were not admitted to nurse training schools. Nurses in workhouses were paid about £17 a year. Hospital nurses in 1902 were paid around £19 a year, but the cost of maintenance, laundry, uniforms and accommodation which were provided was around £30 a year. In domiciliary work two guineas a week with meals provided was normal pay, and the work was easier. In hospitals 12-hour days were normal.^[12]

In March 1902, Queen Alexandra’s Imperial Military Nursing Service (QAIMNS) was established, named after Queen Alexandra, who became its President^[13]
1902 Midwives Act was passed, introducing state regulation of Midwives, prompting calls for a similar system for nurses^[14]
1904 a House of Commons Select committee was established to consider the registration of nurses, but no action was forthcoming.
1905 Nursing Times (journal) was launched
1907 First Aid Nursing Yeomanry (FANY) was created. Confusingly, their main roles were not as nurses but as ambulance drivers and as the organisers and administrators of hospital and casualty clearing stations for the Belgian and French armies^[15]^[16]
1908 the Fever Nurses Association was created
1908 the National Council of Nurses was formed^[17]
1909 Voluntary Aid Detachment Nurses (VADs) was formed.^[18]

1914–1920

First World War

By the beginning of the First World War in 1914, military nursing still had only a small role for women in Britain; 10,500 nurses enrolled in Queen Alexandra's Imperial Military Nursing Service (QAIMNS) and the Princess Mary's Royal Air Force Nursing Service. These services dated to 1902 and 1918, and enjoyed royal sponsorship. There also were 74,000 Voluntary Aid Detachment (VAD) nurses who had been enrolled by the Red Cross.^[19] The ranks that were created for the new nursing services were Matron-in-Chief, Principal Matron, Sister and Staff Nurses. Women joined steadily throughout the War. At the end of 1914, there were 2,223 regular and reserve members of the QAIMNS and when the war ended there were 10,404 trained nurses in the QAIMNS.^[9]

The First World War provided the final impetus to the establishment of nursing regulation, partly because of the specific contribution made by nurses to the war effort and also as a reflection of the increased contribution of women more generally in society. The College of Nursing (later the Royal College of Nursing) was established in 1916 and three years later persuaded a backbench Member of Parliament (MP), Major Richard Barnett, to introduce a private members bill to establish a regulatory system.

The bill was finally passed in December 1919 and separate Nurses Registration Acts were passed for England/Wales, Scotland and Ireland, which was still part of the United Kingdom at the time. These acts established the General Nursing Council for England and Wales and the other bodies which survived intact until the legislative changes in 1979 which were to create the UKCC and the National Boards of Nursing. Ethel Gordon Fenwick was the first nurse on the English register.^[20] The RBNA gradually lost membership following the Nurses Registration Act 1919; meanwhile the Royal College of Nursing (RCN) substantially increased its membership and influence.

1914-1918 The First World War had a significant impact on the professionalisation of nursing (28 July 1914-11 November 1918),
1916 College of Nursing was founded by Arthur Stanley (politician) Sarah Ann Swift Rachael Cox-Davies and Sidney Browne. they established a third voluntary register of nurses in addition to those of the British Hospitals Association and the Royal British Nurses' Association. All three lobbied for the Nurses Registration Act
1915 National Association of Masters and Matrons of Poor Law Institutions was created
1917 Cavell Nurses' Trust was created^[21]
1918 The National Asylum Workers' Union organised strikes at Prestwich Hospital, Whittingham Hospital and Bodmin Hospital. It threatened to organise strikes in all the London asylums in support of a 48-hour week in 1919^[22]^[23]
1919 The Association of Hospital Matrons was created^[24]
1919 The Professional Union of Trained Nurses (PUTN) was created^[22]^[23]
December 1919 The Nurses Registration Act 1919 was passed,^[25] the General Nursing Council (GNC) was created, and the Ministry of Health established.^[26]

1920s

In the 1921 Census, 111,501 women and 11,000 men declared that they were nurses. The registration regimen stopped the very small hospitals from offering training. The first national examination was in 1925. About 40% of the candidates failed.

The Labour Party produced its first draft policy statement on the profession in 1926, advocating a 48-hour week, the separation of training schools from hospitals and advocating that the profession should be organised on Trade Union lines.^[27]

1921 Princess Mary's Royal Air Force Nursing Service (PMRAFNS) was created
1920-1922 The RCN campaigned against the Unemployment Insurance Act 1922.^[28] The National Insurance Act 1911 had exempted nurses from paying, as they were too low paid,^[29] but nurses were included in the 1920 Bill, despite wages remaining too low. The RCN successfully led nurses to lobby their MPs and the Minister of Labour, including a petition of 35,000 nurses. When passed in 1922 the Act exempted nurses^[30]
1922 The State Register of Nurses was first published by the General Nursing Council.
1926 British College of Nurses (BCN) was created.
1928 Florence Nightingale Fellowship (FNF) was created.

1930s

In the 1931 Census, 138,670 women and 15,000 men declared that they were nurses. 88% of the women were single, 5% married and 7% widowed or divorced.

In 1930 nurses in the voluntary hospitals worked 117 hours a fortnight in London and 119 in the provinces. In 1936 the London County Council introduced a standard 54 hour week for nurses and in 1938 moved to a 96-hour fortnight.^[31]

In 1937 the Trades Union Congress adopted a "Nurses' Charter", demanding a 96-hour fortnight, improvement of the amenities of nurses' homes and arguing that nurses should be able to live out.^[32] At that time the average nurse was working 104 hours per fortnight.

1934: Florence Nightingale Foundation was formed.
In 1935, county councils began training courses for assistant nurses to care for the chronic sick.
1937: Society of Registered Male Nurses was created.
1937: National Nurses Association was created.
1938: Association of British Paediatric Nurses was created.
1939: Royal College of Nursing incorporated 'royal' into its name.
1939: The Ministry of Health and Board of Education published the Athlone Report, an Interim Report of the Interdepartmental Committee on Nursing Services – which focused on nursing recruitment, retention and skills.^[33]

1940s

1941–1949 The RCN's Horder Committee (1941–1949) sat in response to the 1939 Athlone Report, published four reports^[34]
October 1941 Nurses Salaries Committee was established with Lord Rushcliffe as chair^[35]
Nurses Act 1943 was passed. It directed the General Nursing Council to regulate state enrolled nurses (until 1961 called 'assistant nurses') with two years' training instead of the three years' required for registered nurses. The act set out the formation, maintenance and publication of the roll and to establish conditions of admission to and removal from the roll. Unlike the Register of Nurses, the Roll included male and female assistant nurses on one list^[36]
1943 Nurses Salaries Committee or Rushcliffe Report published two reports. It was the first official body to fix salary scales and conditions for nursing in England^[37]^[38]^[39]
1946 the RCN and the University of Edinburgh collaborated to create a nurse tutor course.^[40]
1947 The Ministry of Health, Department of Health for Scotland, and Ministry of Labour and National Service (Wood Committee) published its Report of the Working Party on the Recruitment and Training of Nurses.^[41]
1948 the arrival of HMT Empire Windrush marks the post war migration of British Commonwealth subjects to the UK. Many Caribbean, African and Irish migrants went into nurse training helping to fill 54,000 nursing vacancies.^[42]
By 1949 there were about 1300 registered male nurses; numbers of male nurses increased as demobilised service men with medical experience join the profession^[43]
1948 The National Health Service Act 1946 (NHS) came into effect on 5 July 1948^[44]
1948 a Whitley Council (a partnership forum for discussion between employers and employees) was specifically established for nursing and midwifery in the NHS, at a time of significant nursing shortages^[45]
1948 Marie Curie Nurses was formed^[46]
Nurses Act 1949, this reconstituted the General Nursing Council for England and Wales and amended the previous Nursing Acts, to improve nurse training. ^[47] The reconstitution included abolishing the supplementary register so that male general nurses joined the general register alongside their female colleagues.^[48]
1949 The Queen Alexandra’s Imperial Military Nursing Service became a corps in the British Army and was renamed as the Queen Alexandra's Royal Army Nursing Corps.

Second World War 1939–45

The armed forces estimated at the beginning of the war that they needed 5000 trained nurses. Up to 67,000 were thought to be needed to care for the expected air-raid casualties. This was more than the number of trained nurses in employment. A Civil Nursing Reserve was set up - 7000 trained nurses, 3000 assistant nurses and also nursing auxiliaries. The auxiliaries were given fifty hours training in hospital before they started work. After protests it was agreed that they should not do domestic work. 6,200 from the Civil Nursing Reserve were working in hospitals in June 1940.

The Ministry of Health guaranteed a salary of £40 to nursing students in training, about double what voluntary hospitals were paying before the war.^[49]

During the war nurses belonged to Queen Alexandra's Imperial Military Nursing Service (QAIMNS), as they had during World War I. (Nurses belonging to the QAIMNS are informally called "QA"s.) Members of the Army Nursing Service served in every overseas British military campaign during World War II, as well as at military hospitals in Britain. At the beginning of World War II, nurses held officer status with equivalent rank, but were not commissioned officers. In 1941, emergency commissions and a rank structure were created, conforming with the structure used in the rest of the British Army. Nurses were given rank badges and were now able to be promoted to ranks from Lieutenant through to Brigadier.^[50] Nurses were exposed to all dangers during the War, and some were captured and became prisoners of war.Two hundred and thirty-six nurses died as a consequence of the war.^[51] Five nurses who trained at the Royal Victoria Hospital Belfast, N. Ireland died in service. Ruth Hannah Dickson had served in WW1. She re-joined the QA/Rs in Singapore having been a missionary in China. The evacuation ship she was aboard was hit by a Japanese U-boat as it left Singapore. She survived the attack to be taken Prisoner of War and died in a concentration camp in 1944. Ellen Lowry and Ida Nelson were nursing with the Colonial Service in Singapore. Their ship was also attacked leaving Singapore and they drowned. Doreen Pedlow QA was aboard a ship leaving Singapore when it too was hit. Doreen drifted for three days on a raft before she died. Beatrice Dowling was serving with the Naval Nursing Service in Singapore when she too died at sea. Their 5 names are on the Roll of Honour in Westminster Abbey.^[52] At the outbreak of WW2 there were 640 nurses attached to QAIMNS. By the end of the war this number had risen through the recruitment of reservists to 12,000.^[53]

Whitley Council or 'clinical grading'

The Whitley Council negotiated NHS terms and conditions of employment (pay). These placed nurses alongside other hospital staff on "grades" between A and I (with A being the most junior, and I the most senior). Unregistered staff were employed on grades A and B (occasionally grade C). Second level nurses were employed on various grades (usually between C and E), with first level nurses taking up grades D-I.

1950s

1950 Queen Alexandra's Imperial Military Nursing Service trained nurses^[13]
1951 following the 1949 Nurses Act, male general nurses joined the general nursing register ^[48]
1951 The Lady with a Lamp film premiered, raising money for the RCN Educational Appeal Fund^[54]^[55]^[56]
1952 2nd Lt. Nurse Abbie Sweetwine of 494th Medical Group of the United States Air Force ran triage at the Harrow and Wealdstone rail crash based on her military field experience. The success of the team's response is credited with inspiring the development of the use of paramedics in Britain^[57]
1953 the Nuffield Trust published HA Goddard's The work of nurses in hospital wards : report of a job-analysis. The first major study of nursing workload in the UK, it found that trained nurses spent too much time on non-nursing tasks, urging better delegation to ward orderlies and improved staffing^[58]
1956 University of Edinburgh was the first University in Europe to establish a dedicated Nursing Training Unit^[40]
The Mental Health Act 1959 abolished the legal separation of psychiatric hospitals, allowing those patients to be admitted to any hospital
By 1959 most hospital nurses were working an 88-hour fortnight.^[59]

1960s

The availability of sterile supplies brought an end to washing and sterilisation of equipment such as dressings and syringes. Edinburgh initiated the first degree in nursing. Charlotte Bentley of the National Association of State Enrolled Assistant Nurses worked with Irene Ward, who was a member of parliament for Tynemouth. A private member's bill, the "Nurses (Amendment) Act, 1961", passed through parliament to remove the demeaning term "assistant" from the State Enrolled Nurse's job title.^[60]

1960 the University of Edinburgh was the first UK higher education institution to offer a pre-registration bachelor's degree in nursing^[61]
1961 it was considered that the use of the term 'assistant nurse' was hindering recruitment. The Enrolled Nurses Rules Approval Instrument SI 1961/1519 changed the name to State Enrolled Nurse and the Roll of Assistant Nurses became the Roll of Nurses^[36]
1963 Nursing Homes Act 1963 brought registration and greater control by local authorities^[62]
1964 Daphne Steele became the first Black British matron^[63]^[64]
1964 The RCN published its Platt Report 1964 on the Reform of Nursing Education^[65]
Nurses Act 1964 gave the General Nursing Council the authority to regulate state enrolled nurses for mental health nurses and learning disability nurses by creating two additional rolls^[36]
1966 the Salmon Report on Senior Nursing Staff Structure called for reform to nurse grading, initiating the end of matrons^[66]
1967 Nurse Dame Cicely Saunders set up the first hospice.
1967 Termination of pregnancy becomes legal under the Abortion Act 1967^[67]
1969 the University of Manchester offered an integrated degree programme in nursing, health visiting, district nursing and midwifery^[68]
1969 the government published the Mayston Report on Management Structure in Local Authority Nursing Services.^[69]

1970s

The 1972 Briggs Report of the Committee on Nursing in the United Kingdom reviewed the role of nurses and midwives in hospitals and in community care. It made recommendations on education, training, and professional regulation. The report was accepted in 1974,^[70] but recommendations from the Briggs Report were not implemented until 1979 when it formed the basis of the Midwives and Health Visitors Act (1979).^[71]

Degrees in nursing became more widely offered through universities and polytechnics which combined higher level study and practical clinical ward based training. Newcastle Polytechnic, Leeds Polytechnic, Manchester University, London University and Liverpool University were the first. Each course was different. All led to SRN (State Registration), in addition to a degree (either B.Sc or B.A). Some also included additional certifications such as Certificate in Obstetrics (Newcastle), Certificate in Health Visiting (Liverpool). Student nurses on these courses were unpaid, but may have been eligible for mandatory/ concessionary student grants. Unlike traditional hospital training courses which took three years, a Nursing Degree course lasted between 4 and 4.5 years.^[72]

1972: The Briggs Parliamentary Report was published^[73]
1974: The Halsbury Report was published by the government's independent Committee of Inquiry into the Pay and Related Conditions of Service of Nurses and Midwives; the government implemented its recommendations for an average 33% pay rise for nurses^[74]
Manchester University appointed the first professor of nursing
1977: The Royal College of Nursing (RCN) was registered as a trade union
Report of the Committee of Enquiry into Mental Handicap Nursing and Care was published in 1979. The Committee of Enquiry was chaired by Peggy Jay^[75]
The Nursing Process established an ethos based on assessment, planning, implementation and evaluation
Reform of shift patterns began.

1980s

In 1983, the UKCC was set up. Its core functions were to maintain a register of UK nurses, midwives and health visitors, provide guidance to registrants, and handle professional misconduct complaints. At the same time, National Boards were created for each of the UK countries. Their main functions were to monitor the quality of nursing and midwifery education courses, and to maintain the training records of students on these courses.

This structure survived with minor modifications until April 2002, when the UKCC ceased to exist and its functions were taken over by a new Nursing and Midwifery Council (NMC). The English National Board was also abolished and its quality assurance function was taken on board by the NMC. The other national boards were also abolished, but new bodies were created in each country to take over their functions, for example, NES in Scotland.^[76]

Mass meetings were held over pay, the state of the NHS, clinical grading and the abolition of the enrolled nurse.
1982 Primary Health Care magazine was launched, aimed at community health nurses.
September 1982: The Trades Union Congress organised a Day of Action in support of health unions in their pay dispute. There was strike action by nurses who belonged to National Union of Public Employees or Confederation of Health Service Employees ^[77]^[78]
1983 The United Kingdom Central Council for Nursing, Midwifery and Health Visiting (UKCC) became the profession's new regulatory body^[79]^[80]
1985 The RCN published its Judge Report on nursing education^[81]
1986 The government published the Cumberlege Report 1986, 'Neighbourhood nursing: a focus for care', which recommended that community nurses be permitted to prescribe from a restricted list of treatments^[82]
1987 Nursing Standard was launched
1989 Nursing Children and Young People (journal) was launched as Paediatric Nursing.

1990s

Reforms to training under Project 2000 began to be implemented
Post-registration education was introduce.
Nurse-led helpline NHS Direct was founded
1992 Men were allowed to join the Queen Alexandra’s Imperial Military Nursing Service^[13]
1994 Nursing Management (journal) was launched
1996 British Journal of Community Nursing was launched
1997 Journal of Child Health Care was launched
1998 Evidence-Based Nursing (journal) (journal) was launched
1998 Evidence-Based Nursing (journal) was launched
1998: Mental Health Practice (journal) was launched.

21st century

2000s

Health care reforms were set out in the NHS plan.^[83]
Agenda for Change paved the way for a new pay structure for nurses.
Nurse employers were inspected for staff-friendly policies under Improving Working Lives^[84] and Investors in People
By 2001, nearly half of the newly registered nurses were immigrants, especially from the Philippines, India, South Africa, Australia and Nigeria, as compared to 10% in 1990^[85]
2002 Nursing and Midwifery Council replaced the United Kingdom Central Council for Nursing, Midwifery and Health Visiting (UKCC)^[86]
2003 Gastrointestinal Nursing journal was launched
2005 nurse numbers reached 397,500 – an all-time high
2005 the NMC register, with its 15 sub-parts, was revised to just three parts: nurses, midwives and specialist community public health nurses.^[87]
Nursing students were given supernumerary status throughout their three years of training
2006 383,000 qualified nurses and midwives were employed by the NHS, a 24% gain over 1997^[85]
2006 British Journal of Cardiac Nursing was launched
2008 the NMC decided that the minimum academic level for all pre-registration nursing education would in future be a bachelor’s degree. This was endorsed by the UK Government the following year^[88]
2009 healthcare assistants (HCAs) were entitled to commission.

2010s

2010 the Front Line Care report was published, a prime minister's independent commission on the future of nursing and midwifery in England.^[89] A different Government was elected in May 2010 and responded to the report in April 2011.^[90] It was the first overarching governmental review of nursing and midwifery since the Briggs Report was published in 1972.
2010 the RCN Foundation was incorporated as a charity, when the RCN separated its charitable and trade union activities^[91]
2011 in Scotland, all pre-registration nursing programmes moved to degree level^[92]
March 2011 the London anti-cuts protest included nurses and midwives as did the day of action in November 2011. Throughout the year there were local demonstrations, actions, and protests about pay and pensions in the public sector.
2012 Quality with Compassion: the future of nursing education, an independent report commissioned by the Royal College of Nursing, led by Phil Willis^[93] was published^[94]
By September 2013 all UK pre-registration nursing programmes were at degree level^[92]
2014 the government rejected the NHS Pay Review Body (NHSPRB) recommendation for a 1% pay rise.^[95]
2014 midwives and nurses were amongst members from seven unions including the Royal College of Midwives and Unison who went on strike over pay.^[96]
November 2015 spending review,^[97] George Osborne stated that he would remove the NHS Student Bursary from 2017
December 2015 nursing students held a political demonstration King's College London outside the Department of Health over the removal of the NHS student bursary, which was attended by several hundred supporters. Kat Webb initiated a petition on the government's e-petition site, which received more than 150,000 signatures^[98]^[99]^[100]
2015–2016, the minimum starting salary for a registered nurse was £21,692 in England, Wales while in Scotland it was £21,818.^[101] As of 4 June 2015^[update], Northern Ireland was yet to announce their pay rates for 2015–16^[101]
In 2016, the government announced that nurses would receive a 1% pay rise which would take effect from 1 April 2016.^[102] The RCN Chief Executive Janet Davies stated that "The fact remains that pay awards for NHS staff have been severely constrained since 2010".^[103]
January 2016 more than 7,000 NHS students and supporters marched on Downing Street in protest at the withdrawal of the student bursary.^[104]^[105]^[106] The protest was attended by Shadow Health Minister Heidi Alexander MP, Wes Streeting MP, Natalie Bennett, Sian Berry, representatives of UNISON, Unite the Union and Royal College of Midwives.^[107] The hashtag #bursaryorbust was the top trending Twitter.^[108]
February 2016 the nursing student bursary debate was raised in parliament at Prime Minister's Questions, and was the subject of the 'Early Day Motion (EDM) 1081 – The NHS Bursary' sponsored by Wes Streeting MP.^[109]^[110]

In October 2016, Western Circle published research, claiming that the sector of NHS Nurses were heavily dependent on payday loan. According to the research, the number of nurses using payday loans doubled in the 3 years since 2013.^[111]
2016 following the EU referendum nurse applicants from European countries fell by 96%.^[112] In actual numbers in July 2016 1,304 nurses from the EU joined the Nursing and Midwifery Council register, whereas in April 2017 46 joined.
In 2017 the student nurse bursary was abolished in England and Wales, resulting in a 23% fall in the number of nurse degree applicants. Northern Ireland retained the bursary and applications remained steady at an average of 10 applicants per year for every one commissioned place on an undergraduate nursing programme ^[113]