The NHS has a long history of recruiting international staff to enhance its domestically educated workforce. In 2022-2023 the number of UK-educated joiners on the Nursing and Midwifery Council (NMC) Register rose by 8.5% to 27 142. The remaining 25 006 were internationally educated, a 6.8% rise. The number of professionals on the NMC register whose initial registration was outside the UK grew from 142 432 in March 2022 to 164 198 in March 2023. Five years earlier, there were 3522 international joiners to the register. International recruitment continues at such a significant rate, professionals educated around the world account for one in five nurses, midwives and nursing associates who can practise in the UK – of those, more than four in five were educated outside Europe (NMC, 2023).
Our NHS would not be able to function without its international workforce, who account for one in every six people who work in the health service. Increased ethical international recruitment will be vital to addressing the current workforce crisis (The King's Fund, 2023a). The shortage of registered nurses is not a localised issue. According to the World Health Organization (2020), the world is facing a shortage of around 6 million nurses, with demand projected to rise further due to ageing populations and increasing healthcare needs. The adult social care workforce comprises 1.6 million people and 16% are international staff, without whom the system would struggle to function. There are still 165 000 vacancies across the sector (The King's Fund, 2023b).
In England, some regions are more reliant on international staff than others. International staff make up 28% of the workforce in London, compared with just 9% in the North East and Yorkshire. Some job roles are more reliant on international staff. The King's Fund (2023) reported that international staff make up more than one-third of the medical workforce (33.6%), compared with less than 5% of managers. Nurses and health visitors account for 25.3% and midwives 6.9%.
The workforce crisis has been a well-known issue for years, however, there has been little determined action from governments to address the challenge. For nearly two decades there has been no clear plan to address the crisis and the gaps in staffing continue to get worse, because, for whatever reason, the UK political system appears to be unable to provide a competent response to what is a very real and pressing public concern.
It is acknowledged that there are no silver bullets – educating, sourcing and recruiting nurses takes a long time. There are not enough nurses in the NHS to meet actual levels of demand during winter, when we see increased focus on international recruitment to help bolster the nursing workforce, but this stop gap is just that, and not a solution. Resolving the workforce crisis, developing a sustainable supply of nurses into the NHS while boosting retention by improving the NHS offer to its staff, will take years. A multi-year, fully funded workforce plan can ensure that we do not find ourselves in the same place year after year.
International recruitment is not a standalone solution and in the long term there is an urgent need for greater strategic investment in training and staff development, together with concerted efforts to improve retention rates, so as to provide the numbers of staff that our NHS needs.
International nursing staff must be supported to work to the full extent of their capabilities and to enhance their knowledge and skills during their employment in the UK. This approach will ultimately lead to their retention, a sense of belonging and professional fulfilment of the nurse's true potential.