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Report exposes high cost of hiring overseas and agency nurses

Reliance on overseas recruits and agency staff to plug staffing gap branded 'false economy' as RCN-commissioned analysis exposes extent of costs

Reliance on overseas recruits and agency staff to plug staffing gap branded 'false economy' as RCN-commissioned analysis exposes extent of costs

The cost of hiring overseas nurses and agency staff is up to three times more expensive than delivering an above inflation pay rise for nursing staff, a new analysis suggests.

Plugging staffing gaps with international recruits is ‘false economy’

The London Economics analysis, which was commissioned by the RCN, claims the cost of recruiting a single overseas nurse is 2.4 times the cost of giving a 17.3% pay rise to a ‘typical nurse’ – £16,900 compared with £7,100.

Meanwhile the cost of hiring agency nurses is three times more than the cost of matching a pay rise of

Reliance on overseas recruits and agency staff to plug staffing gap branded 'false economy' as RCN-commissioned analysis exposes extent of costs

Picture: iStock

The cost of hiring overseas nurses and agency staff is up to three times more expensive than delivering an above inflation pay rise for nursing staff, a new analysis suggests.

Plugging staffing gaps with international recruits is ‘false economy’

The London Economics analysis, which was commissioned by the RCN, claims the cost of recruiting a single overseas nurse is 2.4 times the cost of giving a 17.3% pay rise to a ‘typical nurse’ – £16,900 compared with £7,100.

Meanwhile the cost of hiring agency nurses is three times more than the cost of matching a pay rise of 5% above inflation, costing around £21,300 compared with £7,100.

Costs incurred in recruiting nursing staff from abroad include recruitment agency fees, visa applications, travel, accommodation and examination fees. With agency staff, a premium is charged because they come via a recruitment agency.

RCN general secretary Pat Cullen labelled England’s reliance on overseas recruits a ‘false economy’.

‘At a time of grave financial uncertainty and record nursing vacancies affecting patient care, ministers must do what is fiscally responsible. It is a false economy to let experienced staff walk away over poor pay and conditions only to spend more recruiting internationally,’ she said.

‘Our NHS is built on the shoulders of our international colleagues and agency nurses play a vital role in patient care, but the UK government must strengthen the domestic workforce and ensure we have long-term, sustainable solutions for the health and care crisis.’

Pay is the ‘only lever’ to improve nurse retention

The report found nurse pay is now the ‘only lever’ available to the government that would have an immediate impact on retention.

Nurses working in the NHS have seen salary levels cut by up to 20% in real terms between 2010 and 2022. In effect this means working one in five days unpaid compared with 12 years ago, it added.

The RCN is currently balloting around 300,000 members on strike action over poor pay and working conditions.

Nursing vacancies in England hit a record high of 47,000 in June. Meanwhile almost half of last year’s new Nursing and Midwifery (NMC) registrants (23,444) trained outside the UK – a rise of 135% from the previous year’s 9,962 international joiners.

Analysis published by the NMC shows that four of the top 20 countries for overseas recruits – Nigeria, Ghana, Nepal and Pakistan – were on the World Health Organization’s (WHO) red list in 2021-22, meaning active recruitment was not permitted from these countries.

RCN urges government to address unethical recruitment and student attrition

Today’s report also calls for urgent measures to address unethical recruitment of overseas nurses, including a clear guide on how to recruit ethically.

Alongside pay and overseas recruitment, the RCN also raised concerns about nursing student attrition and future workforce numbers. Alongside record vacancies it also found there will be 2,000 fewer nursing students graduating in 2025 than there will be in 2024.

The college labelled the declining numbers of nurses and future nurses as the ‘greatest risk to publicly funded health and care services since their creation’.

A recent Nursing Standard analysis found a third of nursing students left their course in 2021.

A Department of Health and Social Care spokesperson said it was inaccurate to suggest a large pay rise could be given to nurses without additional cost to the NHS. They added that the RCN analysis ignores the substantial cost of giving a 17% pay rise to the entire nursing workforce.

‘International recruitment is only one part of our plans to grow the NHS workforce, and the supply of homegrown staff is increasing. The NHS has also reduced spending on agency staff, which has dropped by a third since 2015-16,’ they added.

‘There are more than 29,000 more nurses working in the NHS now compared to September 2019 and we are on track with our commitment for 50,000 more nurses by 2024.’


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