The question of how the UK can recruit enough nurses to meet its needs has been at the forefront of health policy for many years. The Conservative Party’s commitment to recruit 50,000 nurses was a high-profile part of its 2019 election manifesto, and attention to the issue has intensified because of the coronavirus pandemic.

Recruiting nurses from overseas is one way in which countries can meet their healthcare staffing needs. However, if these nurses are leaving countries which themselves have unmet demand for nurses, such recruitment can be considered unethical. The World Health Organisation (WHO) has projected that by 2030 its member countries could experience shortfalls of approximately 50,000 midwives, 750,000 doctors and 1.1 million nurses.

Do we need more nurses?

The NHS nursing workforce in England has been growing both in the short-term (over the last year) and in the long-term (over the last ten years). There were 3.5 percent more full-time equivalent (FTE) hospital and community health service nurses and health visitors in December 2020 than in December 2019. There were 0.5% fewer primary care nurses in December 2020 than in December 2019. Looking at longer-term trends, the number of hospital and community health service nurses grew 9.3 percent between December 2010 and December 2020.

However, demand for the NHS’s services in England has also been increasing. Between 2010/11 and 2018/19, the number of hospital admissions rose by 15% and the number of people going to major accident and emergency departments rose 13%. The number of people receiving a first treatment for cancer rose by 27%. The number of urgent GP referrals for suspected cancer more than doubled.

The Health Foundation argues that the number of nurses has not kept up with the increase in demand, pointing to 38,000 FTE unfilled nursing vacancies in June 2020, meaning that approximately 10 percent of all nursing posts (FTE) were unfilled. Shortages are particularly acute in some nursing specialties, such as mental health nursing.

The Government acknowledges the need for more nurses. In its 2019 general election manifesto, the Conservative Party promised it would “deliver 50,000 more nurses”. It was reported in the press that the Government planned for approximately 12,500 of this increase to come from nurses recruited from overseas.

A joint report by the King’s Fund, the Health Foundation and the Nuffield Trust concluded that reducing nursing vacancy rates to five percent by 2023/24 would require recruiting approximately 5,000 international nurses per year.

What proportion of our nurses currently come from overseas?

As at January 2020, 18% of NHS nurses in England reported a non-British nationality or did not declare a nationality. Asian nationalities were the biggest group after British nationalities, at 8.7%. Of these, almost 94% were either Filipino or Indian. In addition, 6% of nurses reported an EU nationality. Of these, 52% were Irish, Spanish or Portuguese.

The House of Commons Library has emphasised that because data on nationality of NHS staff has improved significantly over time, it is not possible to draw accurate conclusions about trends in the nationality of NHS staff.

What is the Government’s policy on recruiting from overseas?

The Government introduced guidelines on international recruitment in 1999. This was in response to concerns about the impact of recruitment of healthcare professionals from developing countries on their healthcare systems. In 2001, these guidelines were replaced by a code of practice which required NHS employers not to actively recruit from any developing country unless there was an agreement with its government expressly permitting it. The code has been updated periodically since.

In February 2021, the code was revised to exclude the principle that there must be no recruitment from any developing country without a government-to-government agreement. Instead, the revised code now forbids recruitment from any countries on the World Health Organisation’s Health Workforce Support and Safeguard List, which currently includes 47 countries. This is fewer than the 126 countries the United Nations currently classifies as “developing”. The code forbids only active recruitment from countries on the list. If an individual from a country on the list applies directly and of their own volition to work in the UK, then they can be considered for employment.

International recruitment is a part of the NHS People Plan 2020/21’s recruitment strategy, alongside local recruitment and encouraging people to return to practicing nursing. According to NHS England and NHS Improvement (NHSE and I), its “earn, learn and return” scheme for international nurses offers an opportunity for overseas nurses to develop skills which can be taken back to the countries they were recruited from. Covid-19 and disruptions to international travel have hindered international recruitment of nurses in 2020 and 2021. However, NHSE and I said in evidence to the House of Commons Public Accounts Committee that it expects international recruitment to open up again very rapidly.

Cover image by Luis Melendez on Unsplash.