How the pound’s collapse could scuttle the UK’s international nursing recruitment drive


A weaker pound could scuttle Government plans to hire thousands of international nurses to man the NHS during its worst ever staffing crisis, experts warn.

For years, health secretaries have turned to the foreign sector as an easy quick-fix solution to shore up staff numbers.

But last month’s disastrous mini-budget from Chancellor Kwasi Kwarteng, which sent the pound into a rout and sparked economic chaos, has shown the fragility of the UK’s overreliance on foreign nursing labour.

The budget, which included axing the 45 per cent higher rate of income tax for those earning more than £150,000, saw Britain’s currency sink to its lowest level ever against the US dollar, at one point only buying $1.035.

It similarly crashed in value against the Philippine peso and the Indian rupee, two of the countries Britain is most reliant on for foreign nurses. 

While the pound has recovered somewhat there could be further volatility to come as No10 tries to get a handle on both the cost-of-living crisis and deliver its growth agenda. 

NHS recruiters and ministers have always been able to lean on the pound’s value to tempt nurses from the developing world to come to the UK.

But Professor Alison Leary, an expert in healthcare and workforce modelling from London South Bank University, said the recent currency crash demonstrated the vulnerability of Britain’s nursing recruitment strategy.

The number of internationally trained nurses joining the NHS has skyrocketed over recent years. Numbers have increased year-on-year, minus a blip of the Covid pandemic which hampered immigration, data from the Nursing and Midwifery Council shows. The number of international nurse recruits is now almost equal to the number of British nurses joining the profession for the first time

India and the Philippines account for the lion's share of international nurse recruits for 2021-22 but a fifth came from 'red listed' countries where the NHS is banned from actively poaching nurses. These were Nigeria, Ghana, Nepal, and Pakistan. This data, from the UK's Nursing and Midwifery Council, covers the period before Britain struck a special deal with Nepal to allow the NHS to recruit nurses from the country

India and the Philippines account for the lion’s share of international nurse recruits for 2021-22 but a fifth came from ‘red listed’ countries where the NHS is banned from actively poaching nurses. These were Nigeria, Ghana, Nepal, and Pakistan. This data, from the UK’s Nursing and Midwifery Council, covers the period before Britain struck a special deal with Nepal to allow the NHS to recruit nurses from the country 

While the headcount of full-time-equivalent adult nurses, who account for most nurses in the NHS in England, has gone up the number of total nursing vacancies has remained stubbornly high, official figures show. This has left the NHS essential treading water in terms of addressing staffing shortages

While the headcount of full-time-equivalent adult nurses, who account for most nurses in the NHS in England, has gone up the number of total nursing vacancies has remained stubbornly high, official figures show. This has left the NHS essential treading water in terms of addressing staffing shortages 

Only way to stop nurses striking is to stump up an extra ‘£1.4BILLION’: Union pushing for first mass walk-out in its 106-year history wants 17 PER CENT pay rise for its 300,000 members 

Britain’s nursing union is demanding No10 gives its members an extra £1.4billion or they’ll go on strike.

The Royal College of Nurses (RCN) today sent its 300,000 members a ballot, urging them to vote for industrial action for the first time in its 106-year history, to force the Government to up its offer.

If nurses take to the picket line, it would be the first ever UK-wide walk-out and could lead to thousands of operations and procedures being cancelled.

Union bosses are demanding nurses get a salary uplift of at least five per cent above inflation, which currently sits at 12.3 per cent.

This would grant the average nurse, who earns roughly £35,600 each year according to the Government, an extra £6,150.

In comparison, the Government has offered NHS nurses a salary rise of roughly four per cent, giving the average nurse an extra £1,400. 

But to meet the RCN’s demand, the Government would have to stump up, in theory, an extra £4,750 per nurse, a colossal £1.4billion in total.

John O’Connell, chief executive of the TaxPayers’ Alliance, said: ‘Ministers must be wary of nodding through each and every pay demand.

‘NHS nurses do an admirable job, but inflation-busting pay hikes would ultimately have to be taken from struggling taxpayers or siphoned off patient services.

‘Government urgently needs to get a grip on budgets and set out more sensible offers.’ 

Speaking today, RCN general secretary Pat Cullen said giving nurses a ‘decent wage’ was the only way to stop them fleeing the NHS.

She added it would help plug thousands of vacancies across the health service.

‘It will make the UK less attractive’, she said.

‘If the pound becomes worth less then it makes less sense for people to come and work here.’

She said nurses are already being offered higher salaries in places like the US, and if the pound weakens an increasing numbers of nursing recruits will shun the UK.

Many internationally trained nurses send some of the money they earn back to family members, meaning how much the money they earn is worth when converted to their native currency can be critically important. 

‘If we’re going to rely on international recruitment we’re going to need to be able to compete in the labour market,’ she said.

Professor Leary, a registered nurse herself, said the situation showed how vulnerable the UK had made itself in its overreliance on international nursing recruitment.

‘It was a short-term solution but is now the primary solution,’ she said.

This is reflected in data from the British nurse regulator, the Nursing and Midwifery Council (NMC).

Nurses must register with the NMC to work in the UK, and the latest data shows the number of international recruits has skyrocketed in the last five years.

From April 2021 to March this year, 23,367 internationally-trained nurses joined the NMC.

This is more than double the previous year’s 9,884 and almost seven-fold higher than the 2017-18 figure of 3,489.

Shockingly, the number of international nursing recruits is now almost reaching parity with the number of British trained joiners for the first time.

Between April 2021 and March this year, 25,028 British trained nurses joined the NMC nursing register for the first time, just 2,000 above their internationally trained colleagues.

India was the biggest source of foreign-trained nurses with 9,769. 

The NMC data also revealed that the UK has signed on 4,151 nurses from so-called ‘red list’ countries.

‘Red list’ nations are those where the World Health Organization (WHO) has deemed nursing shortages so severe that wealthy countries are forbidden from poaching staff from them.

However, this doesn’t stop the NHS from hiring nurses from these areas if they apply for a job directly.

The total included roughly nurses 3,000 from Nigeria, 800 from Ghana, 200 from Nepal and 100 from Pakistan.

This accounted for almost a fifth of the total international nurses who signed on in the UK that year.

The data precedes the UK signing a controversial nursing recruitment deal with Nepal, which allows the NHS to recruit nurses from the country despite its ‘red list’ status.

This came as part of an international hiring spree to fill around 50,000 nursing and midwifery vacancies in time for winter.

Professor Leary said the fact the UK was hiring nurses from red list nations showed that our demand for international nurses had exceeded available supply.

‘There’s already a global shortage of nurses, we’ve reached that Rubicon,’ she said.

Professor Leary anticipated that ministers would be making further recruitment deals, like the one with Nepal, in the coming months to bypass competitors and fill staffing gaps.

The pound crashed to historic lows against the US dollar last month, at one point hitting a new all-time low of $1.03 before recovering slightly (source Exchangerates.org.uk)

The pound crashed to historic lows against the US dollar last month, at one point hitting a new all-time low of $1.03 before recovering slightly (source Exchangerates.org.uk)

This chart shows how the value of the pound collapsed compared to the Philippine peso

A similar pattern can be seen with the pound versus the rupee following the 'mini-budget' in late September

These charts show the impact the ‘mini-budget’ had on the British pound versus the Philippine peso (left) and the Indian rupee (right). Some experts say a weakened pound could put some nurses off coming to work in the UK (source Exchangerates.org.uk)

Foreign nurses who fail English test can still be hired by NHS after industry regulator waters down rules 

Foreign-trained nurses and midwives will be able to practise in the NHS even if they fail English language tests under controversial new rules.

Campaigners warn patients may be at increased risk of harm after the Nursing and Midwifery Council (NMC) watered down its requirements.

The regulator will currently only register staff trained abroad if they achieve a certain score in independently assessed reading, writing, listening and speaking exams. But they have agreed to admit those who marginally fail to make the grade if they obtain a letter from an employer vouching for their English skills.

The NMC announced on social media that its committee approved the change last week, with the new rules coming into effect from January.

It comes as the NHS is critically short of more than 50,000 nurses and midwives, with one in ten nursing posts vacant. Health bosses are becoming more reliant on overseas recruitment to plug dangerous rota gaps.

‘I don’t see that there many other options,’ she said.

Experts have estimated there will be a global shortage of 13million nurses by 2030, with levels particularly short in South East Asia and Africa.

The International Council of Nurses, a federation of 130 national nurses associations, has condemned the UK’s international recruitment practises.

Its chief executive, Howard Catton, said currency fluctuations will make the UK less attractive to some nurses, compared to other wealthy countries. 

He added that Britain’s continual plundering of nurses from other parts of the world was both unsustainable and unethical.

‘The NHS has at least 40,000 nurse vacancies, so it is obviously nowhere near being self-sufficient. But its reliance on overseas-trained nurses is unsustainable,’ he said.

‘The wholesale recruitment of nurses from countries such as Nepal, which are on the WHO’s “no recruitment red list” because they cannot afford to lose any more nurses, is unacceptable.’

Mr Catton said such recruitment tactics may permitted but that didn’t make them right.

‘This risks further weakening the already fragile health systems in Nepal, which has only about 60,000 nurses compared to the UKs more than 600,000.

‘Just because it is possible to recruit from red list countries doesn’t make it right: it risks damaging healthcare in those countries, but also tarnishes the UK’s global standing.’

Professor Leary said the UK’s dependence on international nurses was linked to our failure to keep the nurses we already have.

A recent analysis found a record 40,000 nurses quit the health service in the past year – nearly a tenth of the workforce according to official data.

Many leavers were highly skilled and knowledgeable with years more potential work left in their nursing careers.

Some left for better paid roles in retail, while others sought a better work-life balance, analysts said.

This churn of staff created a scenario where the NHS turned to international recruits to continually top up staffing levels, rather than address why nurses were quitting in the first place.

‘Until you address the underlying cause, you’re just going to recreate the same scenario,’ Professor Leary said.

NHS data shows efforts to get more nurses into the health service are only barely keeping pace with the number of experienced nurses quitting

NHS data shows efforts to get more nurses into the health service are only barely keeping pace with the number of experienced nurses quitting

The show the proportion of doctors and nurses joining the NHS in England based on where they originally trained. In both professions the number of UK trained joiners has decreased over time (red lines) whereas the number of non-EU trained professionals has increased (yellow lines). The proportion of EU professionals joining the NHS has declined over time, taking a sharp dive in the years after the 2016  Brexit vote

These charts, based on NHS workforce data, show the proportion of doctors and nurses joining the NHS in England based on where they originally trained. In both professions the number of UK trained joiners has decreased over time (red lines) whereas the number of non-EU trained professionals has increased (yellow lines)

Nursing pay was thrust into the spotlight this week, with hundreds of thousands of British nurses set to vote on whether to hold a strike over salary levels.

The Royal College of Nursing (RCN) sent out ballots to its 300,000 members, asking if they want to take UK-wide industrial action.

The 106-year-old union is urging nurses to vote in favour of the ‘once in a generation’ ballot after the Government refused to meet its pay demands — warning ‘enough is enough’. It could see thousands of operations and appointments cancelled.

It is demanding nurses receive a salary uplift of at least five per cent above inflation, which currently sits as 12.3 per cent.

Under the union’s proposed figure, the average nurse, who earns roughly £35,600 each year, would get an extra £6,150.

The Government has offered to increase pay by £1,400, a rise of around four per cent.

But the RCN argues this effectively amounts to a pay cut due to inflation.

The union also argued that poor pay is fuelling the NHS staffing crisis.

Eight in 10 nurses have warned there are too few medics to treat patients safely and effectively.

It comes as UK Governments once again turns to international recruitment to boost staffing levels.

Just this week Scottish Health Secretary Humza Yousaf pledged £8million to recruit 750 more nurses ahead of this winter.

And late last month, NHS England offered to pay trusts £7,000 per overseas nurse they signed on, to help with recruitment costs like flights and accommodation.

The promise of delivering 50,000 more nurses was key Conservative pledge in the last election.

While Tory MPs have boasted how there are more nurses working in the NHS than ever before, official data shows this is barely keeping up with vacancy levels.

Nursing vacancies in the NHS in England have been roughly stable for years, about 40,000.

So, despite the headcount of individual nurses going up, the gap between the staff numbers we have and the number we need has remained roughly the same.

In addition to hiring more international nurses, the UK also recently lowered its English language requirements for new recruits.

Previous rules set by the NMC meant nurses trained abroad could only be registered to work in the UK if they achieved a minimum score in independently assessed English reading, writing, listening, and speaking exams.

But the regulator has now agreed to let those who marginally fail to make the grade register if they obtain a letter from an employer vouching for their English skills.

Some campaigners have warned patients could be at increased risk of harm from the lowering of the standards.

The rule change will come into effect in January, just as NHS trusts will be feeling the bite of winter pressures and motivated to retain as many staff as possible.

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