An ambitious 10-year plan for the UK’s National Health Service (NHS) unveiled by Prime Minister Theresa May relies upon recruiting thousands of nurses and doctors a year from overseas – a practice widely criticised for draining developing countries’ health services of vital qualified staff. The Independent reports that the prime minister revealed parts of the blueprint detailing how the extra £20bn a year she announced last summer will deliver improvements in patient care across the beleaguered service, which has had to cope with years of real-terms cuts under austerity.
It includes targets to diagnose three-quarters of cancer cases early enough for successful treatment, treat more emergency patients and send them home on the same day, and a right for every patient to have online GP appointments via apps by 2024, among other initiatives.
However, to fulfil these commitments, it makes clear a “significant uplift” in international recruitment is needed right away to fill the more than 100,000 vacancies that currently exist. “This will mean a step change in the recruitment of international nurses to work in the NHS and we expect that over the next five years this will increase nurse supplies by several thousand each year,” the plan states.
The report says the NHS is already recruiting thousands of GPs from overseas, and the plan says it will expand foreign exchange schemes for doctors from developing countries and elsewhere to spend time in the NHS, as well as making it easier for trusts to recruit.
As well as attracting criticism for causing a “brain drain” in the countries from which staff are recruited, the strategy flies in the face of a government pledge to become “self-sufficient” in staff, made just two years ago.
The report says the health service’s vision to transform out-of-hospital care, and specialities like cancer and maternity services, does include some measures to boost homegrown staff over the next decade. A new online nursing degree which will cost “substantially less” than the current £9,250 a year will be launched as early as next year in a bid to attract those put off after the government scrapped NHS bursaries.
However, nursing leaders warned the new recruitment plans could harm health services in developing countries. “Overseas recruitment might be a short-term solution, but it will not be enough to solve the burgeoning workforce crisis that’s jeopardising safe patient care in England,” Dame Donna Kinnair, acting CEO at the Royal College of Nursing (RCN) is quoted in the report as saying.
“We need immediate investment in nurse education to grow the domestic workforce – it is neither sustainable nor ethical long term to rely on other countries to provide our nurses.” She added that the RCN welcomes the ambitions of the plan, but is concerned an online degree is being seen as a “magic bullet” to the crisis while there is no money for current staff to specialise into new roles.
Health chiefs argued that without a fix for the workforce crisis, the vision – and an accompanying pledge to save 500,000 lives with prevention and better care – would be “fatally undermined”. NHS figures show 111,000 full-time vacancies in the NHS in England, 41,000 of them nurses, and at the weekend health and social care secretary Matt Hancock was unable to explain how these would be filled.
The report says Brexit has added to this crisis. Over the summer the prime minister belatedly committed to allowing EU citizens resident before 29 March to stay and NHS staff were given a two-week window to apply for settled status in December, before general applications opened. The announcement came after two years of “botched” negotiations, which have resulted in 3,000 fewer nurses from the EEA working in the NHS in 2018, and a collapse of new applicants. While doctors and nurses are recognised as shortage roles and exempted from visa caps, there is still no clarity over how the proposed “low skilled” visa threshold on those earning less than £30,000 will affect EU applicants after 29 March.
The plan says part-time medical degrees and a shift to train more generalists and GPs will help the NHS attract more staff equipped to manage rising numbers of elderly patients with more than one condition. This is in addition to changes to make a 25% expansion in the numbers of nursing and medical training places that the government has already announced. However, the report says, given the length of time it takes to train new staff – three years for nurses and five for doctors – overseas recruits will undoubtedly be needed if the gaps are to be filled.
In addition to filling existing vacancies, more staff will need to be brought in if the NHS is to care for more patients at home and help them avoid A&E, as well as expanding neglected areas like mental health, experts say. However, the detailed workforce plan which was due to be published alongside the long-term vision has now been delayed until later in 2019.
Reforms of flagship waiting time targets, which could see patients waiting longer at A&E for less urgent issues, have also been removed and social care reforms pledged in 2017 have still not materialised.The Independent report