Rachel Reeves, our mendacious Chancellor of the Exchequer, is now lying only to herself if she thinks cutting the number of UK nurses entering nursing programmes in the UK, with the shortfall being made up by overseas nurses, will fix the NHS. The £108 million cut to the Strategic Priorities Grant made by the Department of Education, which means a 7% cut to the budgets of universities, will include cuts in medical and related programmes, including nursing.
Not to worry, our Rachel says, let’s just buy them in from other countries. And one of those other countries from which 2.5% of our nurses already hail – Nigeria – has taken note. This year 14,000 Nigerian nurses are preparing to up sticks and come to work in the UK. Already nearly 30% of nurses in the NHS are from overseas. If Rachel Reeves has her way, this can only increase.
It is customary at this point in such articles to issue the clichéd virtue signal about how our NHS simply could not run without overseas nursing. This is undoubtedly correct as little appears to have been done to ensure otherwise. However, it is barely ever mentioned we would also be unable to run our NHS without the over 70% of nurses who are from the UK. I should also say, some of my best friends are overseas nurses.
Boom, Bust and the Betrayal of Nursing
Nursing is ever a political football. Praised one day as ‘angels’, nurses are often castigated the next for being responsible for all the ills of the NHS. By comparison, however, nursing education is a political ping-pong ball being alternately injected with cash and then starved of resources, often within a few years. International expert on nursing workforce, Professor Jim Buchan, has described the pattern of funding of nursing education as “boom and bust”.
In the early 2000s the funding provision for nursing education was doubled, leading to a doubling of teaching loads with multiple intakes and years split into two groups. The same set of lectures was often delivered four times a year. Naturally, university vice-chancellors, recognising a cash cow when they saw one, began milking it. State-of-the-art premises were built in many universities; huge schools of nursing grew as staff were hired on the boom.
Within about three years the funding was halved, with the inevitable redundancies and subsequent low morale. Some vice-chancellors, understandably, became less enthusiastic about their large nursing schools and, for example by 2005, the University of Sheffield closed its five-star rated undergraduate nursing school, transferring staff and students to the nearby Sheffield Hallam University.
False Promises and Global Scavenging
A period of instability in nursing education followed. The number of nurses graduating from programmes, even if they completed them, was insufficient to meet the demands of the NHS. To meet demands, the number of international nurses – already high in the mid-2000s – began to rise and peaked in 2023. This has been accompanied by much political rhetoric about how we should be growing our own and not depleting the supply of nurses in the countries – largely developing countries – from which they came.
The issue of depleting developing countries of nurses is not straightforward. Some countries, notably the Philippines, are dependent on overproducing nurses with 40,000 working in the NHS. This constitutes an important aspect of the Philippine economy as these nurses send money home to their families. India and some parts of Africa also have a surplus of nurses seeking employment overseas.
Efforts were made to recruit from within the EU, when we were still a member. Recruitment drives took place in Spain and Italy, whereby NHS staff visited to sell the wonders of the UK NHS to these nurses. But it did not work. I know from sources in the Nursing Board of Rome, these recruitment drives were not welcome. Moreover, enticed with pictures of bucolic landscapes, Buckingham Palace and the Royal Mile in Edinburgh, the reality of the cities like my hometown of Hull and other northern cities where they largely ended up did not match expectations. Most of these nurses are now back home.
Back to Square One: Manufactured Dependence
And so, we come full circle to the prospect of massive recruitment of overseas nurses to the NHS. This time it is deliberate and will be an enforced solution as policy also dictates, deliberately, fewer home-grown nurses will graduate.
It is easy to see why recruiting overseas nurses is attractive. They come ready-made. Only a short period of induction into the ways of the NHS is required, where they learn about equality, diversity and the location of the single-sex toilets. This is cheaper than the three years it takes to educate a Registered Nurse. During this time, these recruits can work as nursing assistants.
Attrition and the Leaky Pipeline
The issue of early departure from the profession is hard to quantify because, remarkably, our professional body – the Nursing and Midwifery Council – does not keep records from which this may be ascertained. It does not track where Registered Nurses are employed and, unless someone actively states he or she is leaving the register, or is struck off for professional misconduct, he or she remains on the register, albeit as inactive. But within 10 years after registering an estimated 11,000 nurses leave the register.
Why Importing Isn’t a Cure-All
The issue of professional misconduct segues neatly back to the recruitment of overseas nurses. Employing overseas nurses in the NHS is not without its problems. This is twofold: patients are less satisfied with their care in hospitals where a higher proportion of the nurses are not UK-educated; and overseas nurses are overrepresented in disciplinary hearings by the Nursing and Midwifery Council.
The 2015 study on patient satisfaction was led by US expert on nursing workforce Professor Linda Aiken and included leading researchers from King’s College London and Southampton University, including our newest nursing peer, Baroness Rafferty of Kirkcaldy. Remarkably, it went almost unnoticed, except on my Google Blogger site where I included it in a blog entry on the employment of overseas nurses in the UK.
Many explanations for the overrepresentation of overseas nurses in NMC disciplinary hearings are offered by the NMC. Not included is the possibility overseas nurses are not as good as UK-educated nurses or that six months of indoctrination by diversity, inclusion and equality officers is not sufficient to ensure quality of care. It is all explained by bias (both conscious and unconscious) and ‘weaponising’ of the Nursing and Midwifery referral procedures by racist managers. Perhaps this is the explanation; God help anyone who says otherwise.
The continued reliance on overseas nurses is a short-term fix masking the deeper, systemic failings of UK nursing education and workforce planning. While international recruitment may appear cost-effective and convenient, it neither addresses the root causes of domestic underproduction nor ensures long-term sustainability. Instead of exporting our workforce shortages to other nations, we must invest in nurturing and retaining our own nursing talent.
Dr Roger Watson is Professor of Nursing at Saint Francis University, Hong Kong SAR, China. He has a PhD in biochemistry. He writes in a personal capacity.
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