The NHS risks a future shortage of nurses if it "ducks difficult decisions" the Health Secretary has said ahead of a student protest over the Government decision to scrap nursing bursaries.
Jeremy Hunt said the decision to replace bursaries with loans had to be taken for financial reasons and if done "right" could see up to 20,000 more nursing posts in place by 2020.
Hundreds of student nurses and midwives are expected to gather outside the Department of Health today to march against the move, announced by Chancellor George Osborne last week.
The plan was unveiled in the Comprehensive Spending Review and is expected to free up around £800 million a year in Government spending.
The measure has been heavily criticised by unions including Unison and the Royal College of Nursing (RCN), which described it as "a crushing blow".
Mr Hunt, addressing senior nurses from across healthcare today, said: "The big mistake would be to duck difficult decisions and have a shortage of nurses in five years."
Speaking at the Chief Nursing Officers for England's (CNO) annual conference in Birmingham, he told delegates the cut was needed as part of measures to relieve "enormous pressure on hospital finances" and pay for other measures in the health service.
He said: "In order to do those things and, very bluntly in order to fund those things, we've had to take difficult decisions on tuition fees on bursaries."
Mr Hunt added: "I think we do have to recognise the system we have at the moment is not working."
He said the NHS was grappling with "huge vacancy rates" in nursing, while a third of roles were filled by nurses recruited from overseas.
"Other posts are filled by expensive agency nurses, putting enormous press on hospital finances," he went on.
"We have a problem and being blunt I don't want to make the mistake of five years ago where nurse training places were cut, when we know we'll need more nurses - there isn't a part of NHS that doesn't want to employ more nurses."
Mr Hunt said he would listen to student nurses and work with the RCN and unions over the changes.
"If we get this right we can see a possibility of 10% increase in nurse training places this Parliament compared to the last, and 15% increase in nurse degree places and according to Health Education England they have projected 20,000 more nurses in post this Parliament."
He said the move could lead to better nursing care for patients and described as "the right thing to do".
Mr Hunt also added that the changes could lead to an increase in more nurses from poorer backgrounds, although unions have said the measures would have the opposite effect.
Janet Davies, chief executive of the RCN, said: "The Chancellor's move to axe our bursaries is a crushing blow.
"Students are not the same as other undergraduates. As nursing students, they spend 50% of their time in clinical practice caring for real patients and working tirelessly for the NHS.
"They have no time to earn extra money and, with longer terms and varying shifts, student nursing requires incredible levels of dedication.
"Bursaries aren't a luxury, they're a lifeline. Our students don't apply to study nursing, they apply to train to be a nurse."
Ms Davies added: "Bursaries are crucial and all this will do is deter prospective nurses from applying. Given the serious nursing shortage this will further damage what is already a very fragile NHS."
On a Facebook page dedicated to the event, organisers said student nurses, midwives, occupational therapists, speech and language therapists, podiatrists and radiographers would all face graduation with thousands of pounds of debt.
Trainee nurses aim to hand in a letter for Jeremy Hunt, urging the Government to think again about replacing the bursaries with loans in 2017.
Unison said its calculations showed that a student graduating in 2020 could leave with debts of more than £50,000, but will start on a salary of less than £23,000.