The NHS has a major workforce crisis, with over 132,000 vacancies overall and over 47,000 vacancies for registered nurses.
The recruitment of nurses and other staff from overseas is often promoted as a quick fix for some of the staffing issues. Most recently, Therese Coffey, in her brief spell at the DHSC, commented that if nurses left the NHS, overseas recruitment could fill those places.
In September 2022, NHS England announced additional funding for NHS trusts in England for overseas recruitment. They are now able to claim £7,000 from NHS England per overseas nurse recruited between 1 January and 31 March 2023. In Scotland an additional £8m will be spent on recruiting nurses from overseas to help ease the workforce crisis in Scotland this winter.
This may ease the troubles of the NHS somewhat, but with the shortage of healthcare personnel, in particular nurses and midwives, now global, according to the WHO, should overseas recruitment take place at all.
The global trade in healthcare staff, in particular nurses and midwives, is huge and has been going on for decades. The UK is not the only country to rely on overseas recruitment, the USA, Canada and many other developed nations have healthcare systems that are heavily reliant on a steady stream of staff trained overseas, in particular nurses.
Over many years a hierarchy has developed in healthcare staff recruitment, and it is the richest countries, including the USA, Canada, Australia and the UK, that have occupied a top position for a long time, whilst low income countries are the ones that train staff, but then see them quickly lured away by the richer nations.
In Caribbean countries, for example, 40% of nursing positions were vacant, mostly as a result of nurse migration, according to research published in 2020. Jamaica’s Ministry of Health noted in its 2016-2017 annual report:
“Over the last three years, Jamaica lost 29% of its critical care nursing workforce to migration, which has severely hindered the capacity to deliver efficient and effective care.”
For most countries that ‘export’ nurses, the exodus has depleted and prevented the development of an adequate healthcare system. Its affect led the World Health Organization (WHO) to set up a red and amber list of countries to try and apply a code of practice to healthcare recruitment.
Last updated in 2021, the Red List contains 47 countries where no active recruitment should take place, due to the very low numbers of healthcare personnel in the country. The amber list contains countries where an agreement exists between two countries for recruitment, but no recruitment outside of this agreement can take place. Of course none of this stops individuals in these countries applying for jobs in the richer nations.
The Philippines, as many people will know, set themselves up as the world’s leading exporter of nurses, but even here limits on ‘exports’ were introduced in 2020, mainly as a result of the high number of Covid patients needing care. In 2019, around 17,000 Filipino nurses took up jobs in other countries, the limit was set at 5,000 in 2020, although it has since been increased somewhat.
International nurse leaders have called for richer countries to invest in home-grown staff and address the retention of staff. In September 2022, the chief nursing officer of the WHO Elizabeth Iro, Speaking at the Queen’s Nursing Institute’s (QNI) annual conference, urged the governments of developed nations to “really make the investment in nursing, and grow your own workforce”.
Her pleas were echoed by Howard Catton, Chief executive of the International Council of Nurses (ICN) who agreed that wealthier countries, including the UK, should invest more in training up their domestic workforce instead of relying on international recruitment.
However, despite the pleas from international nurse leaders, the UK continues to encourage recruitment from overseas, and worse still from countries on the WHO ‘red list’, including Nigeria, Pakistan, and Ghana. Nursing Times reported that an examination of the Nursing and Midwifery Council (NMC) register between April 2021 and March 2022 found that three of the top seven countries from which the UK recruits overseas nurses are on the WHO’s Red List.
In September 2022 it emerged that the DHSC has signed a deal with the red-listed Nepal. The 15-month deal is for nurses to work at Hampshire Hospitals Foundation Trust, which runs services in Winchester, Basingstoke and Andover. As a result of the deal Nepal was moved to the Amber List. Nepalese media were quick to question why registered nurses are being sent to work in the UK, when Nepal has its own shortages and does not meet the WHO recommended nurse-patient ratio.
It is a difficult balancing act for the governments of developing countries, however. They lose trained staff, but it is difficult to deny their citizens the right to migrate and for those nurses who leave it is a life-changing experience, not only for them, but for those they leave behind as money is nearly always sent back to family, which can make a big difference.
However, as the global shortage of healthcare staff increases it is difficult to see how a rich nation, such as the UK, which has had years in which to invest in training staff, but chose not to, can justify destabilizing another country’s healthcare system. Furthermore, these poorer countries are also the ones that are now suffering the negative consequences of climate change, which means it is even more important that they develop good healthcare systems and retain educated citizens.
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