Analysis

Collapse in overseas nurse recruits exposes UK’s staffing shortfall

A ‘collapse’ in the number of overseas nurses coming to work in the NHS is contributing to high vacancy levels, according to a new report on clinical staff shortages.

In the past, international recruitment has helped fill gaps between predicted and actual demand for nurses, but the NHS can no longer rely on such assistance.

About 15,000 nurses from outside the European Economic Area (EEA) joined the nursing register each year in the early 2000s.

This plunged to 775 by 2008-09 and has not recovered since. In 2014-15, a mere 665 non-EEA nurses were registered in the UK.

The stark message of the report, published last month by NHS Improvement, is that we do not have enough nurses in the NHS, and supply is unable to keep up with rising demand. Its report says that NHS hospitals are 15,000 nurses short of what they need, yet short-term solutions are scarce.

So, what happened to the UK’s once bountiful supply of nurses from countries including the Philippines, India and South Africa?

There has been a rapid rise in demand for hospital nurses since the 2013 publication of Sir Robert Francis’ report into failings in care at the Mid Staffordshire NHS Foundation Trust.

The push for higher staffing levels led to rising demand by trusts to recruit more nurses, but employers’ forecasts have been too conservative and the shortfall has been bigger than anticipated, according to the NHS Improvement report. In 2014, hospitals in England predicted a need for 189,000 adult nurses, 7,000 more than 2013.

Workforce expert Jim Buchan says the mid-2000s saw the NHS in financial difficulties which meant less money for international recruitment.

Professor Buchan, who is based in the school of health sciences at Queen Margaret University in Edinburgh, adds it was also seen as ‘a lot easier and more straightforward’ to recruit from Europe.

‘There has been a ready supply of EEA nurses because of the effect of the recession on countries such as Portugal, Spain and Greece. They don’t need a work permit, they just need to be registered.’

Professor Buchan says another factor affecting international nursing recruitment has been the Nursing and Midwifery Council’s increased core language requirements for nurses from outside the EEA from 2007 which requires overseas nurses to achieve high scores in rigorous English tests before they are able to join the register.

RCN senior international adviser Susan Williams says the language test and changes to the NMC’s overseas nurses programme made the recruitment process much tougher.

But, she points out, it is not the sign of a good system to be recruiting 15,000 nurses from abroad.

‘It is an indicator of shortage and a product of us not educating, training and retaining enough of our own nurses,’ she explains.

Ms Williams says the introduction of a blanket cap on the number of overseas workers coming into the UK has also had a negative effect.

In 2011, a yearly limit of 20,700 non-EEA workers was set, followed a year later by an announcement that skilled workers, such as nurses, would have to meet new visa requirements.

This set out that from 2016, non-EEA nurses who have worked here for more than five years will need to earn over £35,000 a year to retain their right to remain in the UK.

After bowing to pressure from NHS organisations and unions last October, the Home Office temporarily placed nursing on the shortage occupation list, making it easier to get a visa and providing exemption from the £35,000 salary threshold.

However, the change is subject to a review by the Migration Advisory Committee, which is due to present evidence to the Home Office on whether nursing should remain on the list.

King’s Fund head of research Rachael Addicott points out there is also a question of sustainability for a workforce that is reliant on an international supply of nurses.

In a report on workforce planning, she acknowledges overseas nurses can help fill gaps, but warns this is ‘not a panacea for NHS staff shortages’.

Speaking about the issue, she says: ‘We would see international recruitment as one solution to address the nursing workforce challenge.’

Ms Addicott says recruiting overseas is expensive and it is not always certain an employer will get a return on that investment. ‘There is quite a high attrition rate with overseas nurses either returning to their own countries quickly or leaving the employing organisation.’

She suggests a more co-ordinated approach to international recruitment with regional providers collaborating to recruit and support new staff.

One nurse’s story

Betsi Cadwaladr University Health Board surgical nurse Gabriela Boncea came to Wales from Romania in 2004, which at that time was not part of the European Union.

‘My main reason was career development,’ she explains.

‘At that time, there wasn’t any kind of career development in Romania. Nurses are not seen as professionals, they are seen as doctors’ aides and they haven’t found their voice yet.’

Ms Boncea was unable to join the UK nursing register until 2007, when Romania joined the EU.

For the first three years, she worked as a healthcare assistant in a nursing home, and 11 years later became the deputy manager there.

Last year, she took up a position as a surgical nurse in Glan Clwyd Hospital.

Ms Boncea says she wants to believe nurses come from outside the UK to develop their careers, but also thinks economic reasons are a driving factor.

She feels the NMC English language requirements might put people off.

Royal Surrey County Hospital NHS Foundation Trust director of nursing Louise Stead says it has recruited about 220 nurses from the Philippines since October 2014, although 25 withdrew their application after difficulties securing sponsorship certificates.

‘In the absence of enough UK trained nurses, we rely on the migration of nurses from overseas to compensate for this shortfall.

‘In the short term we are left with only two realistic options to ensure our wards are safely staffed – to increase the use of bank and agency nurses or recruit internationally.

To read the NHS Improvement report go to tinyurl.com/NHS-Improvement-staff-shortage

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