Analysis

Why the odds feel stacked against nurse recruiters outside the NHS

A change in immigration rules that will force thousands of overseas nurses to leave the UK could be particularly devastating for employers in the private sector.

Picture credit: Daniel Mitchell

The RCN is lobbying the government to drop its plan to force nurses who come from countries outside the European Union to leave the UK if they have been here for more than five years and earn less than £35,000.

Members at last month’s RCN congress in Bournemouth called on the government to withdraw the plans as private sector employers, meeting at the college’s London headquarters, discussed the likely effect of the rule change, along with other recruitment problems.

The immigration rule change is a blow to a part of the healthcare sector that already faces significant staffing difficulties. A report published last month by workforce development organisation Skills for Care found that more than one quarter of nurses working in England’s care homes are from outside the EU, largely from India and the Philippines.

Workforce challenges

Liquid Personnel director Alison Humphries tells Nursing Standard the reduction in nurse training places over the past five years, and the immigration rule change coincide with increasing demand for care.

The prospect of losing nurses from outside the EU comes at a time when the nursing workforce is ageing, and there has been a legal change for agency workers that makes temporary employment more attractive.

‘The Agency Workers’ Regulations now mean temporary staff have many of the rights of permanent staff after 12 weeks in assignment – things like the same hourly rates of pay,’ explains Ms Humphries. ‘Add in the cost of auto-enrolment in pension schemes and the burden on providers is huge.’

Ms Humphries says increasing numbers of UK workers want to work on temporary or part-time contracts. She adds there are fewer non-UK nurses on the NMC register than ten years ago. In 2003/04 there were 15,000 non-UK nurses registered compared to just over 6,000 in 2013/14.

Despite this trend, the UK is now a net importer of foreign nurses. Following Sir Robert Francis’s 2013 report into care at Stafford Hospital, which linked failings to chronic understaffing, NHS trusts began recruitment drives to boost nurse numbers.

Unable to attract adequate numbers from the UK, many looked overseas. An RCN report in 2014, revealed the UK had become a net importer of nurses for the first time in eight years. In 2013/14 there were 6,228 nursing registrations from abroad – an increase of nearly 45% on the previous year. In the same year 4,379 nurses left the UK to work overseas.

Many independent sector recruiters have difficulty competing with the NHS for staff. Pensions are so good in the NHS that some staff are reluctant to move to private employers.

Large sums spent recruiting staff from other countries do not always pay off. Overseas recruits can be lost to the NHS within months, says a senior manager for a private provider, who did not wish to be named. ‘We are effectively a cheap recruiting service for the NHS. We go and get the nurses from other countries, train them and find them a house, and then they come across an NHS job and leave.’

Shadowing system

Contracts are often broken, but pursuing legal redress is not worth the time or money, the manager adds.

PrimeLife, an independent provider of supported living, palliative care and older people’s care, has introduced a ‘shadowing’ system for job candidates in an attempt to ensure the people they recruit are the right ones. They spend a day or more shadowing a member of nursing staff to see exactly what to expect if they accepted a job. This filters out unsuitable candidates early on, saving PrimeLife time and money.

Human resources director Sarah Camwell says: ‘We know some possible candidates cannot deal with older people dying so we ask them to come in and shadow a member of staff. The candidate might be a 16 or 17 year old or someone older who wants a career change. It is incredible how many people walk out of the door and say it isn’t for them.’

Private providers ‘are a cheap recruiting service for the NHS. we get the nurses and then they leave for an NHS job’

Care homes provider Four Seasons Health Care has introduced preceptorship to improve training and encourage nurses to stay longer, plus career pathways so that nurses can move into management.

Four Seasons people director Louise Cherry adds: ‘We are pioneering the use of technology to listen to the views of our staff. Purpose-designed software systems are accessed via iPads that are being put into all of our 350 homes. Care home staff can use the system to raise concerns, make suggestions or let us have their views about their day-to-day experience.’

Some providers need to up their game if they want the best people, says Ms Humphries. Online interviews can be helpful, but this is alien to some older nurses, she argues.

There is also a fashion for role-play in interviews, but these test candidates’ acting skills and not necessarily their ability to react in a crisis.

She highlights the importance of using behavioural questionnaires during recruitment, rather than relying on CVs. ‘Recruiters tend to hire people based on qualifications, but when they fire them it is usually about their behaviour, so it follows you need to know about their behaviour before they are taken on.’

If some beleaguered providers in the private sector – as well as the NHS – can take on these ideas and those of innovators such as Haven House and PrimeLife, then the tough task of finding and keeping the right staff may become more manageable.

‘A give-and-take approach helps us retain staff’

Independent providers are coming up with ideas to attract nurses and keep them. Christine Twomey (pictured), director of nursing for Haven House children’s hospice in Woodford Green, Essex, believes flexible working is key to recruitment and retention.

The hospice operates a system that many organisations would consider unworkable, with some staff able to choose which days they work each week. ‘There are nurses who work three days a week, but they might do Tuesday, Wednesday, Thursday one week and Monday, Wednesday, Thursday the week after,’ says Ms Twomey.

‘If nurses have children we allow them to go out at any time if there is an event at their child’s school, like a concert, or if their child is ill. When that happens other staff members will cover.

‘There is a lot of give and take on both sides, and we find it works because staff are prepared to come in at short notice and cover for a colleague.

‘But it can be difficult to juggle the shift patterns sometimes. We do have a lot of part-time workers.’

Thorough preparation is central to Haven House’s recruitment operation, adds Ms Twomey. She says the hospice can submit and receive verification within a speedy two days for disclosure and barring requests, which are compulsory for checking candidates’ criminal records.

‘As soon as candidates arrive for interview we get the paperwork prepared and do the photocopying ready to get the application in.’

It can be difficult to recruit enough specialist children’s nurses, in part because too few are being trained, adds Ms Twomey.

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