Boris Johnson’s pledge to recruit 50,000 more NHS nurses is in doubt after the number coming from the EU fell again and coronavirus prevented thousands of arrivals from the rest of the world. The prime minister made the promise a cornerstone of his general election campaign last year and has since reiterated many times his determination to deliver the increase. But annual data from the Nursing and Midwifery Council shows that the number of nurses and midwives from the European Economic Area (EEA) on its register, and thus able to work in the UK, has fallen for the last three years in a row. The total now stands at 31,385. That is 1,650 (5%) fewer than the 33,035 such health professionals who were in Britain in 2018-19 and 6,639 fewer than the 38,024 who were here in 2016-17, the year in which the UK voted to leave the EU. Last year just 913 people from the EEA joined the NMC’s permanent register for the first time. That is less than 10% of the 9,389 EEA nurses and midwives who did so in 2015-16. Numbers arriving from Spain, Italy, Romania, Portugal and the Republic of Ireland have slowed to a trickle. The NHS in England already has more than 40,000 vacancies for nurses. However, overall there is a new record number of people on the register – 716,607. Last year brought the single biggest ever annual increase in the total – of 18,370. There are 9,012 more nurses, midwives and, in England only, nursing associates on the NMC register than last year and 11,008 more from outside the EEA. Two countries – India and the Philippines – between them accounted for 8,944 of the new joiners from the rest of the world. But the NMC said that in future only a fraction of the number of overseas nurses and midwives would come to the UK because of international travel restrictions to curb the spread of Covid-19. That, plus the temporary closure during the pandemic of test centres where new arrivals have their skills assessed, means that about 1,000 fewer nurses and midwives have come in each of the last three months. Andrea Sutcliffe, the NMC’s chief executive, said: “While the increased figures from the UK and overseas are very welcome for everyone working in and using health and care services, there are potential stormy waters ahead. “As a result of the pandemic and subsequent travel restrictions, we may no longer be able to rely on the flow of professionals joining our register from overseas in the same way. Going forwards, the significant growth we’ve seen recently may not be sustained.” Danny Mortimer, chief executive of NHS Employers, said that while the increase in the overall number of nurses and midwives was welcome, “these numbers are a drop in the ocean compared to what the NHS needs in the longer term, as the government recognised when it committed to recruit 50,000 more nurses by the next election”. Details of the new “NHS visa” scheme, which Johnson announced last year to make it easier for overseas health professionals to work in the UK, were still lacking, Mortimer said. Johnson was forced to admit that 19,000 of the 50,000 increase in nurse numbers he pledged would come from better retention of those already in the NHS. The government has reintroduced financial support for student nurses and midwives, of between £5,000 and £8,000 a year, in a bid to boost the number of homegrown NHS personnel. A survey by the NMC of 6,000 nurses and midwives who have recently left the register found that overwork, job stress and the impact of those on mental health remain the main reasons for people deciding to quit. Dame Donna Kinnair, chief executive of the Royal College of Nursing, said: “It’s tough going to work every day when there aren’t enough of you and there is seemingly little light at the end of the tunnel. Breaking this cycle through investment in domestic supply and action is about both patient safety and the health of our workers.”