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Is NHS reliance on overseas recruitment healthy?

With new analysis showing the reliance of the NHS on overseas healthcare staff, we examine the outlook for the NHS and the Government’s response to this trend.

Figures from NHS Digital have found NHS trusts across England are increasingly reliant on the recruitment of healthcare staff from outside the UK and European Union (EU). The UK has always been proud of the contributions of overseas healthcare staff – but given the fall in EU staff since Brexit, the NHS will be concerned given the deep issues around recruitment and retention of healthcare staff.

The analysis found that the share of UK doctors joining the health service had fallen from 69 per cent in 2016 to 58 per cent in 2021. At the same time, the share of doctors from outside the UK and the EU rose from 18 per cent to 34 per cent. Over the same period, the share of new UK nurses decreased from 74 per cent to 61 per cent, while the share of nurses from outside the UK and the EU rose from 7 per cent to 34 per cent.

The share of new staff joining from the EU decreased from 11 per cent in 2015 to 6 per cent in 2021.

Response from the professionals

The analysis provoked criticism from a host of health care professional and civil society organisations.

Patricia Marquis, Royal College of Nursing (RCN) director for England, said ministers must do more to reduce the “disproportionate reliance” on international recruits.

In addition, Danny Mortimer, Chief Executive of NHS Employers, said it was “high time for the government to commit to a fully-funded, long-term workforce plan for the NHS” to tackle “chronic workforce shortages”.

Furthermore, the British Medical Association has said that the NHS is struggling to retain staff recruited from abroad, with “punishing workloads” and the cost of visas cited as reasons why. Statistics show that the percentage of doctors leaving the NHS from non-UK and EU countries increased from 15 per cent in 2015 to 25 per cent in 2021.

Staff shortages have been well documented within the NHS for a long time but it seems that the Government are unable to get a grip on the issue. The problem compounds as shortages put further strain on remaining staff which in turn leads to turnover.

Government response

The Government have responded claiming overseas recruitment has always been part of its strategy in the NHS, and that it was actively boosting recruitment of staff within the UK.

The Department of Health and Social Care (DHSC) said the decrease in EU national recruits could be linked to more rigorous language tests introduced by the Nursing and Midwifery Council (NMC), with the economic recovery of some southern Europeans countries also cited as a reason, with many nurses returning home now there was more opportunity to work.

However, the Government are keen to show they are proactively taking steps to improve recruitment of nurses from within the UK. The Conservative Government have promised they are funding an additional 1,500 undergraduate medical school places each year for domestic students in England – a 25% increase over three years.

Final thought

The recent analysis shows the gravity of the reliance on overseas health care staff, but this fact is not a new revelation. The issues of recruitment and retention of NHS staff, particularly nurses, is one of the biggest challenges the NHS currently faces. As the country recovers from the pandemic with record waiting times and declining standards of care in areas such as Oncology. the outlook for the universal healthcare system looks very bleak.

In recent weeks the Government has announced a 5% increase in basic pay for newly qualified nurses, however given the rate of inflation this represents a real-terms cut. Worse, the money has been found from existing budgets, so this increase will mean cuts elsewhere.

Achieving integration between healthcare services would be an positive first step to improving such issues in the short-term, a feature inquiry session of Curia’s NHS Innovation & Life Sciences Commission.

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