The Ward Round: A stop-gap with questionable ethics

Staffing is the issue keeping NHS leaders awake at night – and which consumes two-thirds of trusts’ spending. The fortnightly The Ward Round newsletter, by HSJ workforce correspondent Annabelle Collins, ensures you are tuned in to the daily pressures on staff, and the wider trends and policies shaping the workforce.

Eyebrows were raised earlier this month when it emerged the Department of Health and Social Care is recruiting 100 nurses from Nepal, after the two governments reached a bilateral agreement.

The 15-month pilot scheme will see the nurses work at Hampshire Hospitals Foundation Trust, which runs services in Winchester, Basingstoke and Andover. It also saw Nepal move from the “red list” (a list of countries from which the NHS must not actively recruit) to the “amber list” (which includes countries where a specific recruitment agreement has been reached between governments).

The memorandum of understanding sets out that the Nepalese nurses can only work in Hampshire Hospitals and no other trust can carry out active recruitment in Nepal. It adds further “government-to-government” talks will be held on widening recruitment to other employers and other health workers. 

The red-list was last amended in 2021, increasing the global market from which the NHS can recruit dramatically. The 152 prohibited countries were reduced to 47. This aligned more closely with the World Health Organisation’s code of practice. 

However, discussing the agreement, the Nepalese press questioned why the government is sending registered nurses to work in the UK, when Nepal is suffering from its own shortages and does not meet the WHO recommended nurse-patient ratio. Needless to say, the impact and fallout from the coronavirus pandemic is still acutely felt in the country.

Of course, the situation is complicated. The red list means the NHS cannot actively recruit from a country deemed to be in shortage, but there is also the matter of free will; healthcare professionals are at liberty to decide where they want to live and work in the world.

Lucina Rolewicz, researcher at The Nuffield Trust, said there has been “significant” recruitment from red-list countries. In the year to March 2022, 3,000 new joiners on the Nursing and Midwifery Council Register were from Nigeria and 800 from Ghana.

“More understanding of recruitment from red-list countries is needed, and it may be the case for the UK to consider compensation to those countries on the red list where it is clear that they continue to lose their home-grown clinical expertise to opportunities to work in the NHS,” she said.

Just in time for winter?

The Ward Round understands concern is felt among senior leaders and nursing directors about the heavy international focus in solving the NHS’s recruitment problems.

The NHS is in stiff competition with other Anglophone countries to attract overseas healthcare workers. With global healthcare worker shortages estimated by WHO to hit 18 million by 2030, how much longer can the NHS’s international recruitment safety net exist?

Although Ms Rolewicz agrees international recruitment works as a short-term plug, she stresses there is “much uncertainty” around how successful it can be in the longer-term, and warns the UK is becoming less competitive than the US and Australia, particularly when it comes to pay.

Not only does the NHS’s ability to recruit 50,000 more nurses by 2024 depend on “ramping up” international recruitment, the DHSC has pointed to it as a more immediate solution for the extreme pressures experienced in urgent and emergency care this winter.

A letter sent to NHS local leaders in mid-August set out that the NHS would “utilise international support for UEC recovery, identifying shortages of key roles and skills and targeting recruitment as such”.

Health secretary Steve Barclay has also set up an international recruitment taskforce to “drive up” international recruitment into critical roles and it has been reported there are plans for an “overseas hiring spree” for care workers using an online hub to match people abroad with UK employers who are short-staffed.

However, The Ward Round understands it could take a minimum of 12 weeks from interviewing a candidate to their arrival in the UK, so increasing international recruitment is not expected to have much of an impact before January.

The number of international staff in the NHS is at an all-time high. In the year to March 2022, 28 per cent of NHS joiners had a non-UK nationality and the government has decided recruiting yet more staff from abroad is still the answer. Meanwhile, the long-term workforce strategy for the NHS appears to have been kicked into the long grass.

Will a new health secretary change this direction of travel? Considering the Treasury’s reluctance to commit to any long-term workforce spending, it seems unlikely.