Nurses working in the NHS who have trained overseas are struggling to cope with the increases in cost of living and are being “pushed into poverty,” according to a new report from the Royal College of Nursing (RCN), as a result many are planning on leaving for other countries where pay and conditions are better.
The RCN is calling on the government to make overseas nurses more welcome and change the rules to allow nurses on temporary visas to claim benefits.
Patricia Marquis, Executive Director of RCN England, said:
“Migrant nursing staff are part of the DNA of our health and care services, they always have been. Every day patients in our hospitals and communities rely on their outstanding care, and they deserve to be treated equally to those educated in the UK.
“As it stands, the current system denies migrants access to vital benefits, despite them paying tax and doing the same work as their domestically trained colleagues. The reality is that migrant nursing staff pushed into poverty will simply choose somewhere else to do their nursing – this is a tragedy for patient care.
“Ministers must lead from the front and show that migrant nursing staff are welcome here and have the same value as their domestic colleagues. The no recourse to public funds condition applied to migrant workers must be ended immediately.”
The current rules mean that workers on temporary visas, such as the Health and Care Worker visa, are subject to the “no recourse to public funds” (NRPF) rule that bars them from claiming any state benefits, including child benefit, housing benefit and universal credit, for at least five years. In cases of long-term sick leave, migrant workers may have no income at all as they have no recourse to means-tested ill-health benefits. This is despite them paying the same tax and national insurance and UK-trained colleagues.
Only after five years can such workers apply for indefinite leave to remain (ILR) and gain access to the full suite of benefits. However, a single ILR application now costs £2,885 per person, which is unaffordable to many migrants and leaves them trapped in poverty under temporary visa arrangements. The RCN is also urging the government to reduce visa fees, including ILR application costs.
The RCN’s report, based on a survey of more than 3,000 internationally-educated nurses (IEN), warns that the current benefits policy “punishes” people for coming to work in the UK and that “despite the UK’s reliance on overseas staff, current immigration policies continue to worsen the financial security of internationally educated nursing staff and undermine the UK’s attractiveness as a destination for nursing careers.” and that this policy is “risking a mass exodus of international nursing staff”.
Recruitment of staff from overseas, in particular nurses, has been encouraged for years by all four nations of the UK and has kept the NHS going as the training and recruitment of UK-educated staff continually failed to keep up with need. Even with international recruitment there are still high vacancies for nurses, with around 40,000 in England and Wales alone.
England has the highest number of nurses trained abroad, at 21.2%, followed by North Ireland at 15%, Wales at 10.8%, and Scotland at 5.3%, according to the NMC register.
The RCN’s IEN survey, conducted in January 2024 was part of the RCN’s much larger 11,000 nurse survey on surviving the cost-of-living crisis. It found that the rising cost of living has been particularly difficult for nurses trained outside of the UK.
The report found that 30% of IENs were struggling with their living costs and increasingly worried about their financial situation. To save money nurses often worked more than their contracted hours or withdrew or reduced contributions to their employer’s pension scheme.
Compared to those trained in the UK, IENs are more likely to be responsible for the financial household burden (43% compared to 37%) and are more likely to have caring responsibilities (46% compared to 39%). But just 44% of IEN with a child under the age of five reported that they could rely on support from family and friends, compared to 66% of UK-trained staff. Over a third (36%) of IEN with a child, or children under 5 years, and 40% of those with a child or children between 5 and 16 years old reported struggling with their living costs and feeling increasingly worried about their finances.
The RCN survey heard from many IENs who highlighted the inequity of being excluded from public support of any kind, despite paying taxes and national insurance the same as their UK-trained colleagues. The way the benefit system is set up implies that the UK is only interested in what IENs can contribute and not in their welfare:
“[…] it is another way of saying ‘we care less about your welfare but interested more about what you have to offer our society’. Immigrants in the UK go above and beyond to maintain their various jobs, including myself, therefore, it is extremely painful to be excluded from gaining access to public funds […] It is a bad policy, in my opinion and discriminatory.”
The RCN report quotes one respondent on the lack of public awareness about the situation and that public perceptions are often at odds with the reality faced by IENs:
“The general public believe that we immigrants have an easy life due to all the benefits we have. [The financial pressures] have affected me to an extent that I am thinking of moving out of the UK.”
The poor pay and lack of help for international staff now means that many see a job in the NHS as just a stepping stone to a better paid job elsewhere, in the USA, Canada, Australia and New Zealand, and are looking to leave for a better life:
“Sometimes I feel trapped in the UK. High cost of living, you can barely support yourself and I am single without any dependents. Most foreign nurses are looking at Australia or the US for better opportunities.”
Recent research by The Health Foundation suggested that the UK is in danger of becoming a ‘staging post’. Globally nurses are in short supply and Australia, New Zealand and the US have all recently announced measures to attract more nurses from overseas, where they will earn substantially more than their counterparts in the UK.
The Health Foundation analysed data from the NMC; the number of overseas nursing staff with intentions to leave the UK was 8,931 in 2022/23, more than 14 times higher than in 2018/2019. The RCN noted that these findings highlight the risks to retention by undervaluing internationally educated staff in health and care.
The UK is at odds with international standards for the treatment of nursing personnel, noted the RCN. The International Labour Organisation (ILO)’s Nursing Personnel Convention states that all nursing staff, regardless of their country of training, should enjoy equal access to social security in their destination country. The RCN is clear that access to public benefits must be a right for all nursing professionals.
As well as the changes to benefit rules, the RCN is also calling for more comprehensive support for IENs, including help with building support networks in the UK to enable them to settle in their community, and the strengthening of their rights in relation to employment, housing and access to healthcare.
Dear Reader,
If you like our content please support our campaigning journalism to protect health care for all.
Our goal is to inform people, hold our politicians to account and help to build change through evidence based ideas.
Everyone should have access to comprehensive healthcare, but our NHS needs support. You can help us to continue to counter bad policy, battle neglect of the NHS and correct dangerous mis-infomation.
Supporters of the NHS are crucial in sustaining our health service and with your help we will be able to engage more people in securing its future.
Please donate to help support our campaigning NHS research and journalism.
Comments are closed.