The Royal College of Nursing says NHS England will have to rely on international recruitment to fill 39,000 existing vacancies, writes MedicalBrief. As part of this process, 20,000 Kenyan nurses will start working in the NHS this month, supplemented by a “steady flow” of nurses from South Africa and Zimbabwe.
Other countries being targeted include Ghana, India and Philippines. Recruitment consultants say that there is already a steady flow of nurses from South Africa and Zimbabwe seeking work in Britain. Earlier this year, more than 150 nurses and doctors resigned from Bulawayo hospitals to take up jobs in the NHS.
Former South African nurse Melinda Moolman, managing director: nursing, of MMA Recruitment based at the University of Reading told MedicalBrief that they have 2,576 South African nurses on their books, looking for employment in the UK. Over the past year, 147 have taken up work opportunities there, with the remainder still having to go through the expensive registration process.
Moolman, who describes herself as “a good example of the benefits and opportunities nursing in the UK can offer”, said getting registered as a nurse in the UK was an expensive process, with the English exam costing around R4500.00. “But we are currently working with the NHS and some private employers to offer financial support to attract more nurses from South Africa (especially mental health nurses), which hopefully means that the numbers will most likely increase to maybe around 250 to 500 a year.”
Sweetening the pot for nurses from outside the country, the UK Health and Care Worker Visa opened for applications in August 2020 for medical workers from outside Britain’s borders to work within the country. The visa has a number of advantages, said Jacinda Breytenbach, director of Breytenbachs Immigration Consultants in London.
“After spending five years on the visa, it is possible to qualify for Indefinite Leave to Remain (dependants can join the main applicant), and the Immigration Health Surcharge normally payable with other UK visa types is waived, which is a huge advantage for applicants.” The applicant must have a job offer from the National Health Service (NHS); or an organisation providing medical services to the NHS, or one providing adult social care.
Registrar and CEO of the SA Nursing Council Sizo Mchunu said a total of 543 South African nurses had asked for their qualifications to be verified for overseas work during 2020. These requests were global, she added, “not just for one country”.
“It must be noted that these figures indicate only those nurses who have requested that verifications of qualifications and/or transcripts of training be sent to the countries they have indicated. Nurses are not required to notify the Council if they do eventually leave the country. The fact that a nurse has requested a verification be sent does not necessarily mean that she or he has actually taken up the offer of a position in another country.”
The 20,000 Kenyan nurses who are now beginning to leave for the UK are on a three-year contract, under terms of an intergovernmental agreement. The contracts may be renewed after the lapse of the three-year period, depending on their performances.
The UK-Kenya arrangement is based on allowing nurses and health workers who are currently unemployed, a “special route” to work in the UK for a fixed period. Ministers said both countries would benefit from the arrangement through the sharing of experience and knowledge across health services.
NHS leaders have stressed the need for “ethical recruitment” schemes that avoid stripping low and middle income countries of much-needed nursing skills. These include “train-and-return” schemes that would see overseas nurses coming to work in the NHS for a set period of time before going back to work their home nation.
Although “ethical recruiting” requirements theoretically discourage the recruitment of nurses, doctors and other health care personnel from underdeveloped countries, the reality is somewhat different. In many developing countries nurses are poorly paid and, despite massive need, often cannot find full-time employment.
There is also a continuing flow to the UK from countries like South Africa. This is not only from people emigrating formally to the United Kingdom and/or taking up ancestral visas, but from nurses fed up with poor working conditions. Also, SA existing nursing shortages will be exacerbated by an ageing workforce and lack of adequate training facilities. Spotlight reports that with almost half of SA’s nurses due to retire in the next 15 years and with only universities accredited to offer the professional nurse programme, there will be an almost 80% drop in new nurses in three years’ time.
The Democratic Nursing Organisation of South Africa (Denosa) has repeatedly, and to little avail, called on the SA government to improve working conditions here, to discourage nurses who are seizing the opportunity to leave, tempted by higher wages and better working conditions in the NHS.
Chief executive of the International Council of Nurses, Howard Catton, told Nursing Times that there was a need to uncover why African nurses were unemployed in the first place and to work to ensure there were enough funded nursing positions in the country to meet demand. He described a “paradox” whereby Africa had some of the worse nurse shortages in the world, but many nurses were also unemployed.
“We want to see more nursing jobs created and funded within African health systems to strengthen them, to increase access to health care and to improve the ratio of the numbers of nurses in the population,” said Catton.
Many Zimbabweans will be looking at the UK option following last month's statement from the national Department of Health that it would reject work visa applications from health care workers in that country. However, Southern African Development Community (SADC) area health-care professionals can request the release letter from their respective country’s health ministry, certified by the embassy in Pretoria.
The public health director of workplace management, Sindile Sodladla, stated that Zimbabwe was listed in the category of countries that the Department of Health should not recruit from on the grounds that their country was facing a staff crisis due to migration. The SA government was obliged to adhere to “all the relevant protocols” between members states of the SADC, the AU and the WHO, “as it pertains to recruitment of health professionals from developing countries”.
“These agreements, protocols and recruitment codes were designed to prevent the uncontrolled recruitment of health professionals from countries where the public health system is faced with huge staff shortages, particularly with regard to health professional occupations,” reads a letter sent to applicants.
IoL reports that Democratic Nursing Organisation of South Africa (Denosa) spokesperson Sibongiseni Delihlazo said the sub-Saharan region was the hardest hit when it came to a shortage of health-care workers. “The government must look into the area of satisfying health-care workers. It is sad that some healthcare workers can’t come to South Africa because of this agreement,” Delihlazo said.
“We understand that these healthcare workers are plying their trade in their countries where the conditions are really challenging for them. In fact, it’s the same challenges that our healthcare workers here in South Africa are experiencing and some of them end up looking for greener pastures in the likes of the UK,” he said.
The Guardian reports that the UK government has pledged to increase the number of NHS nurses by 50,000 by 2025. NHS England announced funding of £28m in September last year, to recruit nurses from overseas and to help pay for accommodation, flights and quarantine.
The upfront cost of recruiting a nurse from overseas is between £10,000 and £12,000. By comparison, it takes three years to train a nurse in the UK and costs from £50,000 to £70,000. The government does not pay tuition fees, but provides maintenance grants worth at least £5,000 a year.
There is a global shortage of nurses, and consequently there has been criticism of trusts recruiting from overseas instead of training more UK staff. Even the new care and mental health minister, Gillian Keegan, is reported to have called it “unbelievably inefficient and also wrong and just bizarre”.
Ministers are being warned of a mounting workforce crisis in Englandʼs hospitals as they struggle to recruit staff for tens of thousands of nursing vacancies, with one in five nursing posts on some wards now unfilled. The nursing shortfall has been worsened by a collapse in the numbers of recruits from Europe, including Spain and Italy.
The most recent NHS figures reveal there are about one in 10 nursing posts unfilled on acute wards in London and one in five nursing posts empty on mental health wards in the south-east.
The number of nurses from the European Economic Area joining the Nursing and Midwifery Council register has fallen more than 90%, from 9,389 in the year to 31 March 2016 to 810 in the year to 31 March 2021. Thousands of nursing shifts each week cannot be filled because of staff shortages, according to hospital safe staffing reports.
Prime minister Boris Johnson is already under pressure over worker shortages in the UK after Brexit, from lorry drivers to farm workers. Concerns among health bosses about the impact on patient care of acute staff shortages are revealed as experts warned last week that flu could kill up to 60,000 this winter.
NHS trusts are being paid by NHS England up to £7,000 for each vacant post to try to recruit nurses from overseas countries. Patricia Marquis, England director for the Royal College of Nursing (RCN), said: “There just arenʼt enough staff to deliver the care that is needed, and we now have a nursing workforce crisis. We should never have got into a position where we were so dependent on international nurses. We are on a knife-edge.”
Hospital trusts struggling to fill nursing posts include:
University Hospitals of North Midlands NHS trust, which runs Royal Stoke university hospital and Staffordʼs county hospital, and which has reported 401 unfilled nursing posts to its board, a vacancy rate of 12%. The trust temporarily suspended non-emergency operations last month because of high demand and staff shortages. It is recruiting nurses from overseas, including from India and Ghana.
Leeds Teaching Hospitals NHS trust, which has reported nearly 700 vacancies for nurses, midwives and operating department practitioners, a vacancy rate of 13%. It postponed 287 operations in July and August and appealed last weekend for nurses to work extra shifts because of “staffing shortfalls in our critical care wards”.
Mid and South Essex NHS foundation trust, with a 17% vacancy rate for nurses, one of the highest in the country. It has 2,269 full-time clinical and non-clinical vacancies. The trust reported that over the summer up to 1,850 patients a month were waiting longer than four hours in A&E because of staff shortages.
A survey by the union Unite of 188 critical care staff at Guyʼs and St Thomasʼ NHS foundation trust has uncovered staff concerns of “chronic” nursing shortages and risks to patient safety. Nine out of 10 staff reported understaffing in their department on every shift.
A report by the Nuffield Trust think tank commissioned by the NHS and published last week, said significant overseas recruitment would be required if the government nursing target were to be met. Saffron Cordery, deputy chief executive of NHS Providers, called for a fully costed workforce plan in the governmentʼs spending review this month.
She said: “Weʼve had workforce shortages for many years, and weʼve seen that exacerbated by Brexit. The workforce is the engine of any hospital and when you have shifts that arenʼt filled, thatʼs a huge challenge.”
Danny Mortimer, chief executive of NHS Employers, part of the NHS Confederation, said: “We have experienced the pressure we would usually see in the winter months over the summer. Many staff are predicting that this will be one of the most difficult winters the NHS has ever faced.”
A survey of more than 1,000 NHS staff by the Healthcare Workersʼ Foundation, a charity that supports health service employees, found 73% considered leaving in the past year. Nearly one in three frontline staff said they were likely to leave in the next year.
The total number of full-time equivalent vacancies in the NHS in England has increased from 83,203 in June 2020 to 93,806 in June 2021, according to figures from NHS Digital, the governmentʼs health and information centre. Over the same period, nursing post vacancies rose from 37,760 to 38,952.
Hospital trusts say they are recruiting staff from overseas to help fill posts. University Hospitals of North Midlands NHS trust said it had recently hired nearly 300 extra nurses, including 93 from overseas. Leeds teaching hospitals NHS trust said staffing was an “ongoing challenge”, but it was successfully recruiting new staff. Mid and South Essex NHS foundation trust said its gaps were filled by agency and temporary staff.
A spokesperson for Guyʼs and the St Thomas NHS foundation trust confirmed 118 nurses left this year, but said 97 started and another 30 were going through pre-employment checks. They said the trust was listening to all concerns raised by staff.
“The safety of our patients and well-being of our staff are our top priorities. We are investing in recruiting more nurses, as well as continuing to provide extensive health and well-being support to our staff.”
The Guardian reports health experts as saying the overall NHS workforce is growing, but not enough to keep up with demand, and the proportion of unfilled jobs across NHS England has grown over the year.
The NHS said: “The NHS is committed to reducing nursing vacancies, including through international recruitment, and increasing wellbeing support for existing staff to boost retention. The nursing and midwifery workforce grew by more than 2.7% over the past year, with more than 330,000 extra full-time staff delivering care, and 80,000 people across the country applied for a nursing course this year.”
A Department of Health and Social Care spokesperson said: “We are seeing record numbers of nurses working in the NHS and applications to study nursing and midwifery have risen by 21% this year alone. We will continue to support our NHS workforce to grow to tackle the backlog, with 50,000 more nurses by the end of this parliament.
“We are working closely with Health Education England, NHS England, Skills for Care and the wider sector to make sure we have staff with the right skills up and down the country. This includes improving retention, investing in and diversifying our training pipeline, and continuing to ethically recruit from overseas.”
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