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NHS to rely on migrants after Brexit – Until they train more UK nurses

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NHS buckling under the weight of rising demand and is facing severe staffing shortages

With recruits from the European Union beginning to leave the NHS in greater numbers, the question of how to staff English hospitals and care homes becomes more acute.  More than 40,000 nursing roles are currently unfilled amid a sector-wide crisis.  Experts warn three things need to happen simultaneously to begin to bridge the gap: 

  • more recruits from abroad
  • training more UK nurses, and
  • keeping hold of the current workforce

After visa restrictions were relaxed in 2018, last year saw the number of nurses arriving from outside the European Economic Area double to more than 8,000, but with average nursing wages in the UK lagging behind competitors, and an historic reliance on migrant labour, solving the staffing shortage will be an uphill battle.

Mark Dayan, policy analyst at health think tank the Nuffield Trust, said continued migration into the UK is critical.  “The NHS has a long-term tendency to rely on non-UK migration,” he said. “The NHS is also more dependent on migrants than other sections of the economy are on average.”

But Ben Gershlick, senior economist at the Health Foundation, said international recruitment will not be enough to solve the staffing crisis alone.   “A continued over-reliance on nurses from abroad places the UK in a precarious position for the future,” he said. “It is crucial for the future of the health service that the government secures the long-term supply of new nurses in the UK.”

The NHS staffing crisis is most acute among nurses and midwives, with more than 1 in 10 positions going unfilled. That leaves more than 40,000 vacancies across NHS England.  The worst affected area is London, where more than 15 per cent of nursing roles were being advertised in June last year.  It leaves a shortfall of more than 10,000 nursing posts across the capital – a quarter of all vacancies in England.

In their general election manifesto the Conservatives committed to funding 50,000 more nurses over the next five years – increasing nursing numbers from 280,000 to 330,000 by 2024/25.  31,500 of these new posts will be new, including 14,000 newly-trained nurses, 5,000 nursing apprentices and 12,500 nurses from overseas. The remaining 18,500 will be nurses who have been persuaded not to leave, or to return to, the profession.

Measures to shore up the front line have already seen some success. In 2018 doctors and nurses were exempted from the Tier 2 visa cap which limits the number of skilled migrants entering the UK to 20,000 a year.  The result was a net increase of 4,000 nurses a year from outside the EEA.  “In the short- to medium-term more nurses are required from abroad than are currently being attracted in order to keep the NHS running,” said Mr Gershlick.   “The government must therefore ensure that the migration policy does not put barriers in the way of recruiting nurses from both EU and non-EU countries.”

The fresh influx of nurses from outside the EU is generally benefiting the capital, the East and the Midlands – the areas with some of the highest vacancy rates for doctors and nurses, and reliance on migrant labour.  Those areas have seen the number of nurses from abroad rise by more than 1,000 a year since 2018, while northern England struggles to attract fresh talent from overseas.

Migration alone won’t solve the problem. Many more nurses also need to be trained in the UK – something seen as a key opportunity from Brexit.  In June 2015, nurses from the UK were leaving NHS England at a rate of more than 2,500 a year. At the same time, the number of EU nurses increased by 3,500.  In the four years since, after the EU referendum vote, the trend has reversed.  In the year to June 2019, nurses from outside the EEA increased by more than 4,000, while European nurses begin to leave the NHS.

For the first time in years more UK nationals are joining the NHS after a drive to encourage staff to return and boost retention rates.  Almost 1,500 more UK nurses joined NHS England than left in the 12 months to June, but more are needed.  “The NHS is failing to train and recruit enough new nurses domestically and retain enough of those it has,” said Mr Gershlick.

“While the number of people in England starting nursing degrees was up in 2018, this was still some way short of the additional 4,000 nurses in training by 2023/24 pledged in the long term plan for the NHS.”  Sources of recruitment have always fluctuated, according to Mr Dayan, but “there is a level of dependence we have built up on migrant nurses”.   “There have been cycles of the NHS having workforce shortages, either because they haven’t trained enough people or there haven’t been staff to match vacancies,” he said.   “We then need to recruit from overseas in waves to match it.  “In the 2000s when we had large increases in the NHS budget we used non-EU migrants quite heavily to grow the workforce in every area.  “In the middle of the last decade we had a spike in EEA migration, which got up to nearly 10,000 a year, but dropped off a cliff with Brexit and the language test.”

Difficulties attracting new recruits into training or moving to the UK to work in the NHS have various factors, including pay.  The Government has pledged to reintroduce nursing bursaries, worth up to £8,000, to try to entice more students to train in the UK. This would give every student nurse an annual bursary of £5,000 for living costs, with up to £3,000 more for those in particular areas of need.  But once they are in the profession, average wages for nurses in the UK measure poorly against the health services in other countries.  According to OECD data, nurses in the UK are paid in line with the average UK salary.  It amounts to less compared to average wages in countries including Greece, Ireland, Australia, the United States and Chile, where nurses are paid 1.5 times the national average wage.

Mr Gershlick said: “A global nursing shortage means the UK is competing internationally for scarce nurses and this is likely to become increasingly challenging as other high income countries such as Germany become more active recruiters.”  While staff from the EU dry up, the NHS is falling back on historically reliable sources of recruitment.  Staff from the Philippines and India now make up the bulk of nurses from overseas, with more than 30,000 of those registered with the Nursing and Midwifery Council from the Philippines.  The UK has pledged not to recruit from Indian states which are in receipt of aid from the British Government, but the rest of India is not covered by the agreement.

And Britain has a memorandum of understanding with the Philippine Government allowing it to target healthcare professionals.  In the last two years, the number of Filipino recruits has grown by more than 20 per cent, while those from Spain, Portugal and Romania quit.  And while the Asian labour market can provide a vast recruitment pool, there are concerns around the ethics of sourcing staff from poorer countries.   “In both India and the Philippines the recruitment pool is quite deep,” said Mr Dayan. But he added there is a concern over sourcing recruitment from less-developed countries where they are needed.

Experts warn that poor performance in hospital waiting times are directly impacted by the staffing crisis, and that the only way to deal with this is through a combination of improved training, retention and migration.  “The only chance to deliver the 50,000 nurses the Prime Minister promised is increased training, better retention and higher migration,” said Mr Dayan. “It would need about 5,000 additional migrants a year.”  Stopping nurses leaving the profession is just as important. Since 2011/12, around 30,000 more NHS staff are resigning each year, according to workforce data.

Andrea Sutcliffe CBE, chief executive and registrar for the Nursing and Midwifery Council, said: “More needs to be done to address the pressures nurses and midwives face to successfully attract and retain the workforce we need.  “In our last survey of those leaving the register, one third cited too much pressure leading to stress and poor mental health as a reason for leaving.

“These are system-wide challenges that require a system-wide solution – including effective workforce planning, a joined up approach across health and social care and ongoing support for continuing professional development both to benefit people who use services, and create an attractive career pathway for new recruits and existing staff.  “While recent investment by the Government in establishing a grant for student nurses and midwives is a step in the right direction, there is still much more to be done.” 

An NHS spokesperson said: “It’s no secret that the NHS needs more beds, which means we need more nurses from home and abroad.  “This is why the NHS has funded thousands more clinical placements for those in training, delivered a 6 per cent increase in nursing applications as a result of the largest ever recruitment campaign, and rolled out a successful nurse retention programme which has reduced turnover rates.” 

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Brexit: NHS faces uncertainty as health workers leave UK

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International Career Opportunities Looming In the UK

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Half of 50,000 nurses promised by Boris Johnson would need to come from overseas

Yesterday we published a blog post on the new rules for fast track visas for doctors and nurses in the UK which is timely, as it appears now there are going to be significant international opportunities for healthcare professionals in the NHS in the near future.

The Health Foundation Chief Executive has said that even with improvements in all other areas of recruitment and training, the Conservatives will need to recruit almost 25,000 nurses from overseas to honour their pledge of an extra 50,000 NHS nurses, in a bid to plug the existing vacancy gap of more than 43,000.

She added: “This will be challenging and means migration policy must not be a barrier and with the number of qualified permanent full-time equivalent GPs having decreased by around 5% since the last target was set, there must be realism about what can be achieved in the timescales set out.”

The Tories said the extra 50,000 nurses would be brought in over the parliament through a combination of training and extra university places, also nurse apprenticeships which allow people to train as they work, and there will be some recruitment from overseas with the new NHS visa.  

Donna Kinnair, general secretary of the Royal College of Nursing, said: “The current shortage of 43,000 registered nurses can only be filled by registered nurses – with degree-level education.  “It is unfair on staff and inappropriate for patients to try to plug this gap with other staff.”

She said “more detail” was needed on where the 50,000 nurses would come from, adding: “The emphasis must be firmly on growing the domestic workforce, as while we welcome nursing colleagues from around the world, an over-reliance on international recruitment is neither sustainable nor ethical in the long-term.”  And she said money was needed for tuition fees for trainee nurses, not just cost-of-living grants.

So it appears there will be significant international career opportunities for  healthcare professionall in the UK in the near future.

Contact us for a confidential discussion and refer family, friends and colleagues and be rewarded.

Conservatives promise to 'add' 50,000 more nurses ahead of UK election

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UK Govt Unveils New Rules For Fast-Track Visas For Doctors And Nurses

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How the fast-track UK visa for doctors and nurses will work

The UK government on Thursday confirmed plans to introduce a new visa for qualified doctors and nurses from countries around the world to address workforce shortages in the state-funded National Health Service (NHS).

Prime Minister Boris Johnson had made references to such a new so-called “NHS visa” on the election campaign trail, which was confirmed as part of the Queen’s Speech in Parliament on Thursday – the formal process of Queen Elizabeth II laying out the parliamentary agenda of the newly-elected Boris Johnson led Conservative Party government.

“Steps will be taken to grow and support the National Health Service’s workforce and a new visa will ensure qualified doctors, nurses and health professionals have fast-track entry to the United Kingdom,” her speech notes.  “A modern, fair, points-based immigration system will welcome skilled workers from across the world to contribute to the United Kingdom’s economy, communities and public services,” it adds, in reference to another Johnson pledge ahead of the December 12 General Election – to introduce an Australian-style points-based immigration system to attract the “brightest and best” from around the world.

An accompanying government briefing paper elaborates that under its “NHS People Plan”, qualified doctors, nurses and allied health professionals with a job offer from the NHS, and who have been trained to a recognised standard, will be offered fast-track entry, reduced visa fees and dedicated support to come to the UK.

The British government has claimed that its new visa and immigration system, which would be in place post-Brexit once Britain has left the European Union (EU) next year, would be “fairer” as it would put skilled migrants from around the world at par once the EU’s freedom of movement rules no longer apply to the UK.

The Plan mentions the aim to increase the nursing workforce by over 40,000 by 2024, and to reduce vacancies to 5 per cent by 2028. The Plan underlines the need to increase international recruitment in the short and medium term, among other measures. The government’s “NHS People Plan” mentions the “significant staff shortages” at many places. An increase in the numbers of nurses is the “single biggest and most urgent” need of the NHS.

The post-Brexit scenario for the NHS may be grim, since it will restrict the movement of a number of doctors from the EU into Britain.

Contact us for a confidential discussion and refer family, friends and colleagues and be rewarded.

Boris Johnson promises to fast track NHS visas for overseas doctors

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Immigration In The UK – What Does A Conservative Majority Mean?

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What is the likely direction of travel on future immigration policy?

With the Conservative Party securing a clear majority in last week’s election, there is now a degree of certainty as to the UK’s future immigration policy – although things are far from crystal clear in a number of areas.

 

Brexit

Brexit has been a key issue during the election campaign and it now seems certain that the UK will depart the EU on 31 January 2020. If so the residence deadline for applications to the EU Settlement Scheme will be 31 December 2020. Statistics are suggesting that there has been a trend towards EU migrants returning to their home countries since the Brexit referendum, so it remains to be seen whether the degree of certainty that is now in place will attract EU migrants to the UK in advance of the residence deadline.

If employers have not already done so, it would be wise to carry out an audit of staff to establish the extent of reliance on staff working in the UK under current free movement rules. Any audits already carried out should be kept accurate and up to date. Whilst employers should be aware that unregulated immigration advice should not be provided to employees, it would be wise to emphasise the need for Scheme applications to be made to secure ongoing residence in the UK.

 

Post-Brexit

The Conservative Party manifesto included a clear commitment to introduce an “Australian-style points based system” in place of the UK’s current immigration arrangements. The new system would bring EU migrants (who are not covered by the EU Settlement Scheme rules) and non-EU migrants under the same umbrella, with implementation likely to take place in early 2021 after the EU’s free movement rules cease to apply to the UK.

Although described as an Australian-style system, there remains a lack of clarity as to what precise form this will take. It is clear from the Conservative manifesto that the system will actually be quite different to the current Australian system in some respects. For example; a concrete job offer is not always required to secure an Australian visa, but the manifesto notes that a clear job offer will be needed under the proposed new system.

Firm details of the proposal remain thin on the ground, but we can expect more specifics once the Migration Advisory Committee provides its report on the issue (which is expected early next year). There is also the lingering question of whether any points-based system will be regionalised, or apply uniformly across the UK. In particular, recent statistics show that Scotland is reliant on net migration to maintain its current level of working population. Whilst there is currently a fairly limited Scotland-specific Shortage Occupation List for Tier 2 (General) sponsorship, the current system otherwise generally applies uniformly across the UK.

Given the significant focus placed on immigration matters during the Brexit process and the commitments included in the Conservative manifesto, we would anticipate that any new system will ultimately be designed with a view to reducing overall net migration to the UK. It is, however, clear that access for highly skilled migrants would be prioritised under the proposals.

 

NHS surcharge

The Conservatives have proposed an increase to the Immigration Health Surcharge – a fee payable by certain migrant workers for access to NHS services. This would clearly add to the overall cost of the visa application process. The surcharge was already doubled at the start of 2019 and currently sits at £400 per year for the majority of applicants that are required to pay.

 

Bespoke visa schemes

The Conservative manifesto includes reference to a number of bespoke visa schemes. For example, it is suggested that qualified trained professionals with a job offer in the NHS and the ability to speak English will be given “fast track” visa options. There is also a commitment to reduced visa fees for such applicants. The manifesto further suggests that priority will be given to the recruitment of genuine leaders in their particular fields (for example, exceptional technology and science graduates).

Overall; given the backdrop to this election, control of the UK’s borders was inevitably going to be a key issue at the polls. There does, however, appear to be a clear tension between investing in public sector recruitment (such as in the NHS) whilst at the same time reducing net migration. Indeed, questions have been raised about whether significant increases in public sector recruitment will be possible with a potentially reduced pool of migrant workers. A reduction in lower-skilled migrant workers could also significantly impact the leisure, tourism and hospitality sectors. Ultimately, further clarity on the Government’s proposed new immigration system is required as a matter of priority to allow businesses to effectively plan for the future.

Johnson pledges to cut UK immigration

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The UK Election Is Done And Dusted – So Where Does That Leave The NHS?

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But What Happens Now For The NHS?

So the results are in and the conservatives have won a large majority in the election, meaning Boris Johnson will remain as Prime Minister and the Tory manifesto will be implemented, but what happens now for the NHS?

Their strengthened position in Parliament means there are no excuses for them to be able to move forward with implementing their manifesto pledges.  These include items on Brexit, the environment, crime and the NHS.  But let’s wait and see.

One of the key factors in the outcome of the election has been the future of the NHS, with all parties pledging to make changes, increase funding or aid the health service in one way or another.  It was a campaigning point for many, with promises to safeguard the National Health Service for future generations.

Increasing staffing numbers, reducing waiting times and solving the social care crisis were among pledges given in manifestos across the political spectrum.  In the Conservative manifesto, there were several aims for the NHS and social care.  These include:

  • 50,000 extra nurses to be recruited
  • 6,000 more doctors in GP surgeries
  • 6,000 more primary care staff like physiotherapists and pharmacists
  • 50 million extra GP appointments a year increasing the current average by 15 percent
  • £33.9 billion extra funding a year for NHS
  • Cross-party agreement sought to solve social care crisis
  • 40 new hospitals
  • Free hospital parking for selected patients and staff
  • Reintroduction of bursaries of up to £8,000, which were cut four years ago, to help training nurses with living costs
  • An extra £1 billion of funding for more social care and better infrastructure.
  • Pass legislation to ensure an extra £33.9billion per year is put into the NHS by law.

In addition to this the conservatives are also promising an immigration system based upon the Australian model.  On the surface it sounds fantastic for both short and long term career opportunities for healthcare professionals and we are well placed to assist you in this regard with representation in Australia, South Africa and the UK.

However it is only early days and governments are inherently slow to act and furthermore not deliver on their election promises. In a previous blog post we posed the question “Should I stay or should I go” whether already inside the UK thinking about staying or leaving, or outside the UK thinking about going there or staying where you are, still remains relevant and our recommendation is still the same – WAIT AND SEE – but this doesn’t necessarily mean do nothing.  We suggest you prepare early and position yourself for the opportunities that may arise either inside or outside the UK.  That’s where we can assist.  Please do not hesitate in contacting us for a confidential discussion.

Johnson Calls NHS the Conservative Government’s ‘Top Priority’

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Thinking Of Moving To The UK To Work In The NHS? – It Might Be Good Timing

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The Tory’s Have A Plan To Attract More NHS Staff From Abroad

The Conservatives say they will make it easier for doctors and nurses from around the world to work in the UK after Brexit, if they win the election.

The party would introduce an “NHS visa” as part of a promised “points-based immigration system”.  But Labour said the policy was “full of holes,” with nothing to say about low-paid nurses and other hospital staff.  And the Royal College of Nursing said “more ambitious” plans were needed to address NHS staffing shortages.

The Conservatives plan to end free movement of workers from EU countries when the UK leaves the EU – something they have promised will happen on 31 January if they are returned to power on 12 December.

The party would introduce a “points-based system” for migrant workers from EU and non-EU countries.  It has yet to spell out in detail how this will work – but it has announced that extra points will be awarded for coming to work in the NHS.

The cost of applying for a visa would also be reduced from £928 to £464 for medical professionals, and they would be guaranteed a decision within two weeks, under Tory plans.  Those granted an NHS visa would also be allowed to pay the annual £400 compulsory health insurance charge out of their salary.

Prime Minister Boris Johnson said the proposals would make it easier for “talented” medical staff to get visas.

The Conservatives have already announced a fast-track visa route to attract specialists in science, engineering and technology.  They have also previously said they will scrap the cap on the number of skilled workers, such as doctors, from the EU and elsewhere, after Brexit.  The party is considering scrapping the minimum salary requirement of £30,000 for skilled migrants seeking five-year visas.

When asked if there would be more people from overseas working in the UK under a future Conservative government, Home Secretary Priti Patel did not answer directly but said the public wanted “controlled immigration”.

Finding staff from outside the UK to come to work in the health service is as important as ever.  But those who wish to do so are often surprised at the fees they have to pay for the privilege.  To address this, the Conservatives plan to halve the £928 visa cost for NHS staff and their dependents.  But the £400 surcharge to cover their healthcare costs if they are from outside the EU won’t be reduced, nor will the levy paid by the NHS and other employers if they hire foreign workers.  So it may be a move in the right direction, but if the health service badly needs trained doctors, nurses and others from abroad, it might be asked why they should pay any fees for visas or healthcare?

The Cavendish Coalition, representing a range of health and care organisations, says any steps towards tackling the high vacancy rate are welcome, but by not covering social care the policy is not ambitious enough.  These groups want any incoming government to recruit and employ any necessary workers from outside the UK “without criteria”.  The Royal College of Nursing said a failure to train enough nurses was forcing the NHS to “recruit overseas in the short-term”.

RCN chief executive Dame Donna Kinnair said she wanted to see a fairer immigration system that valued skills and did not fixate on “arbitrary targets” and “There are tens of thousands of unfilled nursing jobs and we need more ambitious plans than this to address it.”  She added it was “immoral and heartless” to continue to make nurses contribute towards “the same services they keep running” through the health insurance charge.  “It should be abolished, not spread out every month,” she said.

Labour also attacked the lack of detail in the Conservative plans.  Shadow home secretary Diane Abbott said: “The Tories are tying themselves in knots over immigration. They use dog-whistle anti-migrant rhetoric but are forced to accept we need migrant workers for key sectors, not just the NHS, but many more besides.  “This policy is full of holes, with nothing to say about the nurses earning below their income threshold, as well as all the cooks, cleaners, hospital porters and others who are vital to hospitals, and nothing at all about their right to bring family members here.  “Labour’s immigration policy is rational and fair and will prioritise attracting the people we need, and treat them as human beings.”

Liberal Democrat home affairs spokeswoman Christine Jardine said that, even with the visa application costs reduced for medical professionals, the £464 charge still amounted to a “nurse tax”.

More than 12% of the NHS workforce reported their nationality as not British, according to a report published last year.

The biggest group of foreign NHS workers are from the EU – 56 in every 1,000 – but, the report added, the number of new staff coming from the EU is falling, and that this decline particularly applies to nurses.

For more information see the below videos.

We have representation on the ground in the UK so contact us for a confidential discussion.

Austerity, racism, the NHS and Brexit: Corbyn and Johnson clash in BBC debate

Brexit and the NHS - explained in 4 mins by a doctor on the front line

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