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New immigration rules will deepen nurse shortage and cost NHS millions

Almost 3,500 nurses recruited from overseas will be forced to return home, RCN warns

Caroline White

Monday, 22 June 2015

The new rules on immigration will force thousands of overseas nurses recruited at great expense to the NHS, to return home, the Royal College of Nursing (RCN) has warned.

Under the new rules, which were introduced in April 2012, people from outside the European Economic Area (EEA) must earn at least £35,000 before they are granted indefinite leave to remain.

If they don’t reach this earnings threshold, the maximum period they can spend here is six years.

But new figures* published today by the RCN calculate that up to 3,365 nurses currently working in the UK will potentially be affected by these rule changes, which are set to start taking effect in 2017.

These figures are based on the number of nurses from outside the EEA registered to work in the UK between April 2011 and March 2015.

Most of these nurses are unlikely to reach the required salary threshold within six years, as this would mean being on a middle upper band 7 on the Agenda for Change pay scale. Most of the nurses recruited from outside the EEA are on band 5.

But even if 10% managed it, that would still mean that over 3,000 would have to leave, warns the report.

The future looks even more worrying, particularly if overseas recruitment continues to rise as a result of a shortage of home-grown nurses and a crackdown on agency nurse spending, says the report.

The cost to the NHS of recruiting a single nurse ranges from £2,000 to £12,000, says the report, an average of £6,000 per nurse as its recruitment cost.

If international recruitment stays at current levels, by 2020 the number of nurses affected by the threshold will be 6,620, employed at a cost of £39.7 million to the NHS, based on an average recruitment cost of £6,000 per nurse.

If workforce pressures trigger a higher rate of international recruitment, the number of nurses affected could be 29,755, costing over £178.5 million in recruitment costs.

Spending vast amounts of money on recruiting overseas nurses who will only be in the health system for a short period of time is a waste of valuable NHS time and resources, says the report.

While trusts are forced into relying on international recruitment to make up staffing numbers, the government needs to add nursing to the list of shortage occupations and to reconsider the £35,000 salary threshold, it says.    

And in the longer term, the government must act swiftly to boost the number of UK nurse training places. This will reduce the overreliance on overseas recruitment in the longer term, says the report.

It points out that although most nurses coming to work in the UK have been from within the EEA since 2010, but this labour market is becoming “more fluid,” and at the same time many other established and emerging economies are facing chronic nursing shortages.

Dr Peter Carter, RCN Chief Executive & General Secretary commented: "Due to cuts to nurse training places, trusts are being forced into relying on overseas recruitment, as well as temporary staff, just to provide safe staffing. A cap on agency spending will make one of these options more difficult, and these immigration rules will limit the other.”

"The immigration rules for health care workers will cause chaos for the NHS and other care services. At a time when demand is increasing, the UK is perversely making it harder to employ staff from overseas,” he continued.

“The NHS has spent millions hiring nurses from overseas in order to provide safe staffing levels. These rules will mean that money has just been thrown down the drain," he insisted.

He said that losing the skills and knowledge of nurses who had worked in the UK for six years only to start the process all over again was “completely illogical.”

It means that, effectively, “NHS trusts are being asked to provide safe staffing with both hands tied behind their backs,” he suggested.

There was no shortage of potential home grown recruits he said, pointing out that 37,000 potential nursing students were turned away last year.

“Unless we expand training and have enough nurses in this country, we will also be at the mercy of global trends which we can't control,” he said.

Overseas nurses would continue to play a vital role the NHS, which had benefited from their skills and expertise, he said. “But an over reliance on their recruitment is not in anyone's best long-term interests," he concluded.


* International Recruitment 2015. Royal College of Nursing, 2015.

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