Overseas recruiting “remains critical” to reaching the 50,000-nurse objective
Policy commitments have been made in England to expand the NHS workforce by 50,000 nurses through improved recruitment and retention by 2025 and reduce the nurse vacancy rate to 5% by 2028.
However, as of mid-2021, the vacancy rate for nurses remained at 10%, equivalent to 39,000 full-time posts.
In a series of reports published today, researchers said: “Overseas recruitment, while not the only lever, will have to play a major role if these shortfalls are to be addressed and the ambitions of an additional 50,000 nurses by 2025 be met.”
However, they warned that the international nurse recruitment market was becoming more competitive and that the comparatively poor pay offer in England may make other countries look more attractive to nurses.
The health think tank Nuffield Trust was asked by NHS England and NHS Improvement to analyse the “business case” for overseas nurse recruitment including costs and “return on investment”.
The reseachers recognised that recruiting from overseas was attached with “considerable upfront costs”, which were estimated to be around £10,000 to £12,000 per nurse.
But they said these “need to be considered in the context of national funding to support such activities, and the longer-term or broader costs of alternative routes to increase nurse numbers”.
Relying on homegrown nurses alone was “not a feasible solution in the short term” because of the costs and the fact it takes three years to train a nurse, claimed the researchers.
“While the upfront costs of employing a nurse trained domestically may be low for a trust, seeking to meet the bold ambitions to increase numbers and reduce vacancy rates would take longer and be significantly more expensive to the public purse,” they stated.
“The government typically spends at least £26,000, and sometimes far more, on a single nurse training post and not all trainees will necessarily graduate or join the NHS.
“It is also not a feasible solution in the short term as an undergraduate pre-registration nurse degree course is typically three years.”
Apprenticeship nurse degrees were also “potentially not a plausible solution to addressing the nursing shortfall”.
The researchers noted how the cost to a trust of a nurse apprenticeship was around £140,000 “over and above the levy” which is provided to employers to cover the training costs of apprentices.
Meanwhile, they said it was also “expensive” to use temporary staff to fill vacancies.
They suggested that the upfront cost of recruiting an international nurse would be cancelled out within six months to two-and-a-half years from the savings made from not using agency or bank staff to cover that vacancy.
The researchers found that overseas nurses from countries outside of the European Union (EU) stayed working in the NHS for longer than UK nationals before leaving – 12 years compared with nine years.
In addition, international nurses from outside the EU were less likely to move between NHS organisations, while all overseas nurses were contracted to work more hours than their UK counterparts.
The researchers stressed that there were important “ethical, moral and diversity obligations” that employers must consider when recruiting overseas, including not raiding countries that were in desperate need of nurses themselves.
As part of the research, Nuffield Trust explored the “push and pull” factors that influenced a nurse’s decision to move to England.
Key factors highlighted in the report included quality of life, working conditions, career opportunities and, importantly, pay.
The researchers noted how average pay in the UK for nurses was becoming “less competitive than some countries”.
The pay for nurses in the UK is equivalent to US$47,100 – which is considerably lower than that in Australia (US$77,900) and the United States (US$77,700).
Meanwhile, the researchers cited “perceived levels of discrimination and of visa restrictions to reunite with family” as potential disincentives for nurses choosing England as a place to migrate.
They warned that the market for nursing talent was becoming “increasingly competitive”, with the numbers of foreign-born nurses more than doubling across the high-income countries in the 15 years to 2015-16.
In the UK, nearly one in five (18.5%) nurses in NHS hospital and community services are overseas nationals who collectively hail from more than 140 different countries.
The researchers concluded: “There is an ambition for a sustainable, homegrown NHS workforce, and we welcome the intention to reduce our dependence on international recruitment over time.
“Nevertheless, overseas recruitment will have to be a major contributor if the goals on increasing nurse numbers are to be met in the short and medium term.”
Nuffield Trust senior research fellow Dr Billy Palmer, who worked on the reports, described ethical overseas recruitment as a “key lever for achieving better, safer staffing levels”.
Fellow author Claudia Leone added: “Overseas nurses come from 141 different countries and contribute to a vibrant, diverse workforce.
“However, other countries are also keen to attract migrant nurses, and the NHS needs to support overseas nurses effectively, tackle discrimination and offer good opportunities to build a rewarding career.”
Danny Mortimer, chief executive of NHS Employers, welcomed the reports.
He said: “This is a thorough review which highlights the long-standing value of international recruitment and the incredibly important contribution colleagues from around the globe make to the delivery of health and care for our communities.
“We need to ensure our international colleagues are retained to develop and achieve their potential in the sector.”
He also called on the government to provide the “long-term investment” required for domestic nurse training and education including to enable existing NHS staff to undertake nurse apprenticeships and to sustain the recent increase in undergraduates.
Nursing Times approached NHS England for comment.