The UK government has unveiled sweeping reforms to NHS recruitment in England, pledging to guarantee job opportunities for every newly qualified nurse and midwife through a package of measures aimed at removing employment bottlenecks and improving patient care. The initiative, known as the Graduate Guarantee, was announced on August 11, 2025, following mounting concerns that thousands of graduates have been left in professional limbo despite record numbers entering the field during the pandemic.
Why it matters:
For many, the announcement marks a pivotal moment in NHS workforce planning. In recent years, a surge in applications to nursing and midwifery courses—spurred by the pandemic and a renewed sense of calling—has led to a situation where, in some regions, there are up to three times as many graduates as job vacancies. According to the Department of Health and Social Care (DHSC), there are currently 4,000 more nursing and midwifery graduates than available roles, out of a total of 24,870 students who have graduated or will do so in the next six months. This mismatch has left many newly trained professionals unable to secure employment, even as the NHS faces ongoing staffing shortages and patient backlogs.
Driving the news:
Health Secretary Wes Streeting framed the reforms as a necessary correction to an “absurd” situation. “It is absurd that we are training thousands of nurses and midwives every year, only to leave them without a job before their career has started,” Streeting said. “No one who dedicates themselves to a nursing or midwifery career should be left in limbo, when their skills are so urgently needed in the effort to rebuild our NHS.”
The Graduate Guarantee enables NHS trusts to recruit staff based on projected needs rather than waiting for vacancies to formally arise. This means newly qualified nurses and midwives can be hired in anticipation of future staffing requirements, smoothing their transition from education to employment. The package also includes an £8 million investment to temporarily convert vacant maternity support worker posts into Band 5 midwifery positions, specifically creating new openings for recent graduates. Additionally, an online hub will provide information and support for job applicants, further streamlining the process.
State of play:
The reforms follow extensive talks between the government, the Royal College of Nursing (RCN), and the Royal College of Midwives (RCM). Both organizations have long advocated for more certainty and support for students as they enter the workforce. The DHSC asserts that by removing recruitment barriers, thousands of new roles will be unlocked across the healthcare sector, helping to address patient waiting times and ensure a well-supported, confident workforce.
Employers, however, have voiced concerns about the financial implications of the plan. Daniel Elkeles, chief executive of NHS Providers, cautioned, “It’s not clear how this will be fully funded, nor what it could mean for other staff groups facing similar challenges. Trust budgets are already under enormous pressure. There is no spare money.”
What they’re saying:
Wes Streeting, Health Secretary: “I am sending a clear message to every newly qualified nurse and midwife: we’re here to support you from day one so you can provide the best care for patients and cut waiting lists.”
Professor Nicola Ranger, General Secretary of the Royal College of Nursing: “Our student members have led the way in calling for ministers and healthcare leaders to provide certainty and clarity on jobs. Today’s announcement is welcome news that should provide hope to students as they come towards the end of their education and training. When the health service urgently needs nursing staff, it was absurd to leave people in limbo. The test of this will be if students can find jobs, vacant posts are filled, and patients receive the care they deserve.”
Gill Walton, Chief Executive of the Royal College of Midwives: “We’re pleased that the Government has listened to the voices of student midwives who are desperate to start their career, only to find those opportunities blocked. I know today’s announcement will come as a relief to so many of the RCM’s student midwife members. These are people, mainly women, who have worked incredibly hard to complete their degree and are trained and ready to support our current midwifery workforce at a time when so many maternity services are under pressure.”
Paul Rees MBE, Chief Executive and Registrar of the Nursing and Midwifery Council: “A guaranteed opportunity for a role after years of hard work in education is excellent news for future nursing and midwifery graduates. It means highly trained professionals can move into roles more quickly, utilising their skills and knowledge for the benefit of patients and communities.”
Duncan Burton, Chief Nursing Officer for England: “Every nurse and midwife deserves the guarantee of a job to apply for when they graduate, so we’re unlocking more opportunities right across health and care and providing refreshed online advice and support with applications to help ensure a smooth transition into employment.”
By the numbers:
- 24,870: Total number of nursing and midwifery graduates who have already finished or will graduate in the next six months.
- 4,000: Number of graduates exceeding available vacancies.
- Up to 3: Ratio of graduates to vacancies in some regions.
- £8 million: Funding to temporarily convert vacant maternity support worker posts into Band 5 midwifery roles.
Zoom in:
The government’s Plan for Change, of which the Graduate Guarantee is a part, is designed to improve workforce planning and patient care across the NHS. The reforms are not limited to hospitals; they also aim to strengthen community care, reflecting the shift in healthcare delivery away from acute settings. Steph Lawrence MBE, Chief Executive at The Queen’s Institute of Community Nursing, noted, “It will be essential to ensure this occurs across all sectors of the NHS and in particular in community, given the shift from hospital to community.”
Vivienne Stern MBE, Chief Executive at Universities UK, added, “Our healthcare graduates power the NHS and this guarantee of additional support into employment is good news for students, the NHS, and the country.”
Despite the optimism, not all healthcare professions are covered by the new measures. The health union Unison pointed out that new graduates in occupational therapy, paramedics, and other professions also face limited job opportunities. The College of Paramedics described the current graduate employment crisis as “shocking,” with up to 40% of new paramedic graduates unable to find work.
Between the lines:
The Graduate Guarantee arrives against the backdrop of ongoing disputes over NHS pay in England. The Royal College of Nursing is calling for talks with ministers after a consultative ballot showed strong opposition to a 3.6% pay award, and possible future strike action has not been ruled out. The GMB union is also scheduled for talks at the Department of Health after its members rejected the wage offer. While the new measures address recruitment bottlenecks, the broader issues of workforce morale and funding remain unresolved.
What to watch:
The true test of the Graduate Guarantee will be whether it translates into real jobs for graduates and improved staffing for the NHS. As Professor Nicola Ranger emphasized, “The test of this will be if students can find jobs, vacant posts are filled, and patients receive the care they deserve.” With NHS trusts under financial strain, the challenge will be to ensure that these reforms are not just promises on paper but deliver tangible results for staff and patients alike.
The bottom line:
The government’s Graduate Guarantee represents a significant shift in NHS recruitment strategy, aiming to match the ambitions of newly qualified nurses and midwives with real job opportunities. Its success will depend on sustained funding, effective implementation, and the ability to address the needs of all healthcare professions facing employment challenges.
