Nearly half of the doctors employed by NHS England are non-British, while a quarter of the declining nurse numbers come from other countries, with experts saying it is “not sustainable” for the UK to continue looking abroad for staff.
South Africa is one of the countries that has haemorrhaged valuable staff, particularly nurses, to the NHS, but Labour MP for Erdington Paulette Hamilton said that “we can no longer take nurses from abroad in the same number … because a lot of countries can’t spare them”.
Yet while there’s a worry about the “over-reliance” on out-of-country staff, at the same time, the United Kingdom is battling to fill posts with local people as the number of students nationally applying to study nursing drops to record lows, the BBC reports.
Recruitment drives
Almost one in five NHS workers in just the Midlands region alone have been recruited from abroad, according to workforce data from NHS England, but a Department of Health and Social Care spokesperson said it was now committed to developing “home-grown talent” by training thousands of healthcare professionals.
The rate of imported staff has almost doubled nationally since 2009, with around 42% of doctors being non-British, as are 25% of nurses and healthcare visitors, 3% of managers and 2% of senior managers.
The growth of recruitment programmes over the past decade has come amid a series of vacancies at NHS trusts, particularly in nursing, which continues to be on the list of national occupations facing ongoing shortages.
Between 2021 and 2023, the Royal Wolverhampton NHS Trust led the biggest overseas recruitment programme seen in the Midlands in recent years, recruiting about 1 500 nurses to work in the Black Country and west Birmingham.
That has now ended as posts have been filled, but it saw nurses arrive from numerous countries, including South Africa, the Philippines, Brazil, Ghana, Nigeria, Nepal and India.
“With a major national shortage of nurses, our international recruitment was pivotal in helping us fill vacancies – but also provided us with an opportunity to diversify the workforce,” said Leanne Walford, a senior matron at the trust.
‘Hammer blow’
The trust has also maintained links with universities in the West Midlands to recruit graduate nurses, but figures suggest the number of students nationally applying to study nursing has hit the doldrums.
The Royal College of Nursing (RCN) said a collapse in numbers of 35% in England and 34% across the UK was a “hammer blow for the government’s planned NHS reforms”.
Last September, England’s former chief nurse Dame Ruth May criticised a “catastrophic decision” in 2015 to replace the grant or bursary paid to student midwives and nurses with loans.
It led to a drop of about 5 700 trainees in England by 2020, Dame Ruth said, which “would have made a difference” in the pandemic.
Financial support
The RCN has called on the government to provide better financial backing for student nurses.
Hamilton, who worked as a district nurse in Birmingham, and in Parliament is a member of the Health and Social Care Committee, said: “The way things have been done over the past few years, we’ve had this austerity crisis where people have not been growing their own – training our own nurses.
“We’ve been to other parts of the world looking for people to do the job for us,” she added, “but that is not sustainable.
“I went into my nursing life without being in debt… we have to offer that to the new generation of nurses.”
Health Secretary Wes Streeting has said he wants to train 5 000 more health visitors and 8 500 mental health nurses.
“He wants to get general nurses into training,” Hamilton added. “It’s not that we haven’t got a willingness, but for that to become a reality, we have to look at how training is offered in this country.”
A Department of Health and Social Care spokesperson said although it recognised that the NHS had always drawn on global talent and the service was stronger for it, “we’re committed to developing our own local talent by training thousands more doctors and nurses”.
Neglect
The British Medical Association (BMA) blames successive governments for neglecting workforce planning, saying NHS England statistics show a total of 311 000 employees have a nationality other than British out of a total workforce of 1.5m.
International recruits have been important to the NHS since its introduction in 1948, but the NHS Long-term Workforce Plan has warned that the growing reliance on overseas staff “leaves the NHS exposed to future global shocks and fluctuations in international workforce supply”.
Patricia Marquis, the executive director of the RCN, said investment in recruiting and retaining the UK workforce was “absolutely critical”.
“People from overseas have been the bedrock of the NHS since its inception,” she said.
“The downside is that we are probably at the point of having an over-reliance on people from overseas and not actually investing in our current workforce and systems to encourage Britons to become nurses themselves.”
‘Richness and experience’
Despite the concerns regarding long-term sustainability, Tracy Pilcher, chief nurse at Nottingham University Trust, said overseas recruits can bring skills, knowledge and passion to their roles.
Patel agreed, saying that “having that sort of international knowledge come into the UK is incredibly important”.
Inconsistent picture
Although 17% of NHS staff had non-British nationalities across the Midlands region, the picture is not consistent across England, both geographically and by speciality.
As of September last year, almost one in three NHS staff in London had a non-British nationality.
About 58% of speciality doctors were non-British compared with only 8% of ambulance staff.
BBC article – Overseas NHS recruitment 'not sustainable' – MP (Open access)
BBC article – NHS over-reliant on overseas staff, health chiefs warn (Open access)
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