The NHS People Plan for 2020/21 made several commitments to international recruitment (NHS England/NHS Improvement and Health Education England, 2020: 43). The first of these involved building local hubs for recruitment, recognising the opportunities to recruit at a system level, promising incentives would be available to support these ‘hub’ models. There was a stated aim to build on existing and create new international partnerships for ethical recruitment to increase capacity and support. There was a plan for a new English language training programme based on value-for-money high-quality programmes, including new online modules. NHS England and NHS Improvement would work with the government to establish a new international marketing campaign, to promote the NHS as an employer of choice for international health workers, and the Health and Care visa was launched in August 2020 to make it quicker and cheaper for registered health staff to come from overseas to work in the NHS, and the social care sector.
Working for an organisation with a large number of international nursing colleagues as a valued part of our teams, and with the recent announcement of more government funding for international recruitment, I was keen to review the latest Nuffield Trust publications to consider our ongoing strategy.
Palmer et al (2021a) found that a nurse's decision to migrate is made at a personal level, determined by a complex interplay of professional, local, and national drivers, stating that, typically, the decision involves making a series of comparative judgements between the quality of life, working conditions, and opportunities nurses have in their home country, versus what they could achieve in the destination one. They identified several push and pull factors that influence decision making. Push factors from home countries were: low pay, needing to provide better quality of life for their extended family, poor working conditions, low prospects for career progression, low educational opportunities for their children, and unemployment. On the other side, pull factors drawing nurses to the UK were better pay, employment opportunities and opportunities for career progression, better working conditions and the prospect of long-term financial stability, but also English language familiarity, personal connections and colonial links, established migration networks and active recruitment practices
Another publication by Palmer et al (2021b) included several findings that will shape ongoing strategies, particularly when considering the return on investment:
- Compared with nurses of UK nationality, those from outside the UK or EU are more likely to remain in the NHS as a whole and in the same organisation. This is not the case, on the whole, for nurses with EU nationalities
- Nurses from outside the EU and UK are contracted to work more hours than those from the UK (a 3-hour difference a week), and so are EU nationality nurses, although the reasons for this are not clear
- It was estimated that, in the case of a nurse joining aged 30, on average an EU national may be expected to work in NHS hospital and community services for 6 years before leaving, compared with 9 years for a UK national and 12 years for someone from the rest of the world.
Typically, per international recruit the current cost is £10 000 to £12 000 (currently there is national funding to support such activities), and if the indications about retention hold true, the annual cost is significantly less than other options such as the use of temporary staff.
Although there is a desire to increase domestic recruitment in the longer term, Palmer et al (2021a) pointed out that the government spends at least £26 000 on a typical single nurse undergraduate training post. It is also notes that filling local posts by attracting staff from other providers is zero-sum and can be expensive too, with some ‘golden hellos’ at comparable costs to recruiting from overseas.
In summary, the case for continuing overseas recruitment is that it appears on many levels to continue to benefit the NHS and individuals. The next area of focus for me is one of equality. Ford (2021) reported Duncan Burton, NHS England's Deputy Chief Nursing Officer, telling a conference ‘it should not be the case that nurses joining the NHS from overseas are automatically placed in band 5 roles’ recalling meeting with some nurses who had joined from India last year who told him the reason they had chosen to come and work for the NHS was ‘because of the development opportunities that it offers’.
‘We have to live up to the expectations of those nurses,’ said Mr Burton—and I totally agree that we need a more individualised approach.