For a quarter of a century, Maggy devoted herself to her work as a district nurse in Lancashire, forging close bonds with the people she cared for in the northern English county.

But last month she took early retirement, concerned that she and her colleagues were expected to see ever greater numbers of patients each day, an approach she believed was incompatible with good care. “I love the job dearly and miss it but there are so many pressures on us now and we cannot give the care to our patients that we should be giving them,” she said.

The decision by Maggy, who did not want to give her full name, will be no surprise to the profession’s leaders. They warn that issues ranging from anger at the prospect of a sub-inflation pay rise to Brexit, which has dimmed the country’s lustre for European nurses, threaten to deepen staff shortages just as the NHS is attempting to restore services devastated by the pandemic.

“We’re totally undervalued by the government,” Maggy said, pointing to the struggle to secure personal protective equipment to protect her vulnerable clients in the early weeks of the pandemic. A proposal from ministers earlier this year that nurses should receive a pay rise of just 1 per cent had been “the last straw”, she added.

She is not alone in having second thoughts about a career in the UK health service. Last month the Nursing and Midwifery Council, the profession’s regulator, warned that while 15,000 more nurses, midwives and nursing associates were now registered compared with March 2020, “the rate of growth has slowed and the longer term impact of Covid-19 on a workforce under increasing pressure is a clear concern”.

Some help is at hand. Later this month the first of more than 10,000 nurses recruited overseas are expected to arrive in the UK, according to one person familiar with the development.

Yet, if numbers cannot be boosted substantially the ruling Conservative government is likely to pay a political price. Prime Minister Boris Johnson’s 2019 general election manifesto included a pledge of 50,000 more nurses in the English workforce by the end of the parliament, in 2024.

Patricia Marquis, the Royal College of Nursing’s acting director for England, said the country had entered the pandemic with around 40,000 unfilled posts, a vacancy rate approaching 10 per cent.

Bursaries which covered the cost of fees were scrapped in 2016 and although maintenance grants and some funding for education were reintroduced nine months ago, the RCN said a 34 per cent increase in applications for nursing courses in England this year only returned numbers to where they were five years ago.

Andrea Sutcliffe, who heads the NMC, suggested the picture was far from uniformly bleak. Pointing to data showing the number leaving the NMC’s register was at its lowest in five years, even after one of the most difficult years the profession had experienced, she said there was “a positive story to tell . . . which I think is fantastic because the pressure that nurses have been under for the past year has just been absolutely intense”.

Stacked column chart showing numbers of people from the UK who left the permanent register of nurses and midwives from 2016-17 to 2020-21

Additionally, the number on the register who had qualified in the UK had slightly increased over the past 12 months, although the rate of growth had slowed compared with previous years.

However, the story behind those figures provided grounds for caution about the outlook, she suggested. In the five years since the Brexit referendum “recruitment from the European Economic Area has dropped off a cliff”, she said.

Column chart showing the numbers of people from the EEA joining the UK

Last year this effect was compounded by the pandemic, which hugely constrained international hiring. These developments had underlined that nursing recruitment was “very vulnerable to world events,” Sutcliffe noted.

Some hospitals have found a successful formula for maintaining staffing levels. Shelagh Meldrum, chief nurse and deputy chief executive at Yeovil District Hospital in Somerset, said it once sourced many nurses from Europe but had successfully pivoted to the Philippines and the United Arab Emirates.

Stacked column chart showing the total number of people on the UK

A tight local community formed by the early arrivals had helped persuade others to follow, she added, ensuring that all frontline roles were filled.

“People came to us and built their families here and their communities here and that helped us with our retention,” said Meldrum. A measure of its success is that the hospital now recruits on behalf of 16 other trusts in the region.

While the pandemic has tested nurses as never before, it has also brought a new understanding of their pivotal role, spurring interest in joining the profession — a development dubbed the “Chris Whitty effect” after the chief medical officer who has become a popular national figure.

However, conversely, some of the profession’s leaders fear the past year may simply have postponed an even more worrying reckoning on staffing levels. The NMC said it had seen a rise in the number of professionals in the retirement age range on its register, suggesting that people may have stayed on to help tackle the pandemic. Overall, about a fifth of nurses on the NMC register are over 55.

Bar chart showing the older age profile of nurses and midwives on the UK

Sutcliffe said the NMC’s own survey of why people had left the profession suggested pay was less of a concern than a sense that they were inadequately supported and valued.

Retirement accounted for more than half of departures, followed by too much pressure (22 per cent) and the impact of a “negative workplace culture” (18.1 per cent).

Sutcliffe described the target of 50,000 more nurses in England by 2024 as “challenging” but said it could be met — provided there was “dedicated effort” to improve professional and personal support for staff and that international recruitment levels were maintained.

The Department of Health and Social Care said: “We are committed to growing and supporting the NHS workforce to ensure it continues to provide world class care by improving retention, investing in and diversifying our training pipeline, and continuing to ethically recruit from overseas.

“There is a record number of nurses working across the NHS, and we are on track to deliver 50,000 more nurses by the end of this parliament,” it added.