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Exclusive: Nursing shortage drives hospitals overseas

At least a third of hospital trusts in England have turned to actively recruiting nurses from overseas as they struggle to keep wards adequately staffed, an investigation by Nursing Times has found.

Workforce experts say the findings are proof of the start of a new NHS registered nurse shortage, which has led some trusts to recruit dozens of nurses from across Europe and further afield.

Of the 105 acute trusts that responded to a Freedom of Information request by Nursing Times, 40 had actively recruited nurses from overseas in the last 12 months – leading to more than 1,360 nurses coming to work in England.

A further 41 hospital trusts said they planned to actively recruit nurses from overseas in the next 12 months.

The investigation follows growing documentary evidence from trusts that nurse managers were being sent to recruitment fairs in Europe.   

Nurses involved in recruitment told Nursing Times that hospital trusts were now struggling to get enough nursing staff to apply for posts and warned that wards could have to close if no action was taken.

Nottingham University Hospitals Trust currently has around 200 nurse vacancies. Maria Bentley, who oversees nurse recruitment at the trust, said: “We are definitely in the midst of a nursing shortage.

“It has become more acute over the last year but it’s been going in a general direction over the last couple of years. In the last six months we are just not getting applicants [for vacancies],” she said.

Ms Bentley told Nursing Times her trust had recruited 30 nurses from Portugal and had plans to return there before Christmas.

She added: “It is staffing that keeps me up at night. If we carry on the way we are, the only thing we can do is to start to shut wards if we can’t staff them.”

Spain and Portugal have so far proved to be the most popular countries targeted by trusts seeking nurses. Overall 29 nations have contributed nurses to the UK health service.

According to the data supplied to Nursing Times, the 40 trusts recruited a total of 503 nurses from Portugal, 472 from Spain, 155 from Ireland and 111 from the Philippines.

In addition, 32 nurses have come from Italy and around a dozen each from India, Greece and Poland. Smaller numbers have also come from Australia, Canada, the US and Switzerland.

The largest overseas recruiter identified by Nursing Times was University Hospital Southampton Foundation Trust, which gained a total of 144 nurses, 90 from Portugal and 54 from Spain. Not far behind was King’s College Hospital Foundation Trust, in South London, which recruited 96 nurses from the Philippines.

Weston Area Health Trust in Somerset has recruited 39 Spanish nurses to work at its hospital. Supporting the move, trust director of nursing Christine Perry said: “Safety has to be the biggest concern.

“The most safe and practical solution for us was to go abroad and recruit internationally. I think across the NHS, international recruitment will have to continue.”

However, she noted that trusts needed “robust” induction processes to deal with cultural differences and ensure overseas nurses were up to the standard required by the NHS.

The findings follow warnings made earlier this year of an impending nursing shortage in the NHS, sparked by repeated reductions in the number of education places in recent years.

The number of places on nursing courses has fallen by 2,500 in the three years between 2010 and 2013, tempered slightly by a small increase of 334 for 2013-14.

As previously reported by Nursing Times, the Centre for Workforce Intelligence has also predicted a likely shortage of 47,500 nurses by 2016.

Our findings echo those of a separate, as yet unpublished investigation by the Royal College of Nursing. It found 37 trusts had sent managers to a recruitment event abroad and a further 12 were planning to hire from overseas.

RCN director of policy Howard Catton said: “When employers are getting on planes to recruit nurses you know you have a crisis in workforce supply that is happening right here, right now.”

He said there would need to be “tough decisions” made in coming months on the number of education places commissioned.

“We need to see a significant increase, around 10% in the number of commissions,” he said.

Professor Jim Buchan, from the School of Health at Edinburgh’s Queen Margaret University, said: “What we are seeing is trusts resorting to the quick fix of international recruitment because they are not able to rapidly resource nurses from the local labour market. They are looking to fill positions as quick as they can.

“A national shortage doesn’t happen overnight but what we are seeing now is the pendulum beginning to shift towards a shortage.”

The recruitment problems come against a background of an actual drop in the number of nursing posts in the years since the coalition government took office in 2010.

Latest figures from the Health and Social Care Information Centre show the number of full time equivalent nursing posts in the NHS fell by 3,000 since 2010, while the total headcount has reduced by more than 5,000.

Professor Buchan suggested that the previous holders of these posts had now disappeared from the recruitment market, with some retiring, transferring to independent providers or choosing to leave the profession.

In 2010 the UK signed up to a World Health Organization commitment that it would be self-sufficient in supplying its healthcare workforce to avoid other countries health systems being devastated by large numbers of nurses leaving.

A spokesman for the Department of Health said: “Recruiting from abroad is nothing new. Overseas nurses make a very valuable contribution to NHS patient care. However, they should only ever work in the NHS if they have proven their competence and language skills.”



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Readers' comments (35)

  • Get in! More english speaking (sort of), "locally tuned in to the dialect" nurses!
    Good luck nursing some old geezer from the Collieries/Tyneside - lets see if your 'English' is up to much then! (Most UK nurses struggle with it!)

    Good flipping job Government....if we don't make it attractive to our own 'home grown' nurses, then who can blame people for not wanting to or can't come into nursing (sh*t bursary etc...).

    No wonder we can't fill our 'own' posts!
    (and I'm not being rascist etc..before you start)

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  • British nurses abroad and it not surprising hospitals then have to go abroad and seek others to fill their posts. I would have liked a job in the UK to match my years of experience, skills and qualifications but found better opportunities outside the UK where nurses are valued and paid according to the above and where I experienced none of the serious problems facing the NHS as described in these pages and the media.

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  • looks like the job is being done by the eton mafia

    drive our nurses abroad or make them take early retirement by driving down thier living standards

    then recruit nurses from abroad on cheaper wages and contracts...well done dave and jeremy!!!!

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  • Anonymous | 14-Oct-2013 9:54 am

    I don't think it works that way and the influences on the national and global labour markets and the changing demographics and needs of society cannot be blamed solely on one party or one person. the problems of nursing recruitment and retention have been going on for over a decade and have been in the making for much longer.

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  • This is the result of grossly incompetent "Nurse Managers" !

    Drive down the number of nursing students and then devote time and energy to abusing and bullying the remaining few RNs who through force of personal circumstance have to remain within the NHS!

    Anyone who is able should emigrate. Many places welcome UK educated RN's !

    The NHS and its hordes of overpaid and useless managers is dying !

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  • I have just advised my daughter not to persue a career in the nhs

    I advised her that its dying on its knees and wont be around much longer!!

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  • I have heard that the Skills4nurses event in Glasgow this Thursday have over 36 NHS Trusts in attendance with over 5000 vacancies, NOT 1 SCOTTISH TRUST has bothered to come along, hell mend them when they find that all there nursing staff are moving down south. The same company Skills4Nurses also went to Lisbon & Madrid on behalf of 3 NHS Trusts and recruited 88 nurses at someone is is doing something that is pro-active.

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  • Dont put your daughter at the bedside, Mrs Worthington! Seriously this position reflects two things 1) The myth of the ring fence in respect of training and the shake out of nursing staff over the last 4 years; 2) the panic following the Francis report on Mid Staffs which exposed the under provision of qualified nurses.

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  • Those of us who have been around for a while have worked-out that nursing is a cyclical affair: qualify (no jobs), recruitment freezes, staff redundancies, ooh better reduce the student nurses places.

    12-18 months later, people have retired or moved on or left as they are so sick then bugger-me outstanding posts, recruitment and retention problems, expensive agency staff or overtime (if you're lucky) staff still leaving due to the stress of being short-staffed, trusts start looking abroad as they know that there's hardly any staff qualifying in the next few years.

    Poor personnel management and work-force planning it's been going on for all the years I can remember since hospitals stopped training their own nurses.

    My worry is that the government will use this chronic shortage as an excuse to plug the qualified gaps with these newly registered HCAs gawd help us!

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  • Anonymous | 14-Oct-2013 3:27 pm

    I don't think members of the government involved with the NHS understand the difference between an HCA whether qualified or not and the role of an experienced qualified nurse, other than to do the paper work. as long as they have a pair of hands, legs and feet that seems, in their mind to suffice. or maybe they do understand, but because of the costs involved in recruiting and retaining highly qualified staff, they merely refuse to acknowledge it!

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  • For as long as I can remember the majority of nurse managers have been the harsh bullying type, or the type that hide away from it all.
    I often wonder why they are like that, or feel that they have to be like that.
    We need more nurse friendly managers who will try their best to support their staff in the work place, with training, A/Leave, Request and lead by example.

    One has to be the manager's friend these days to get A/Leave when one wants it, or shifts that don't mess up your social life.
    Working night and day with not a thought for work life balance.

    Our young people only have look at all the problems within nursing to stay well away from getting in.

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  • Nice to see that the clearly incompetent managers and HR types are being sent on jolly jaunts to Europe as punishment for their crapness.

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  • Its neither wonder there is reduced interest in pursuing nursing as a career, very few people who realise the state of the NHS want to enter nursing and a good proportion of those of us who were fool enough to train in last 2 decades are now wishing that we hadn't bothered and I for one wish I could afford to leave and start again!
    This is due to year upon year of rising housing/energy/food and other associated costs with year upon year of pay freezes increased demands on our time often feeling obligated to work (unpaid/unreimbursed) beyond our shift to help out on understaffed wards which eventually leads to burnout and depression.
    Recruiting from abroad does little to solve the problem and often leaves other countries with nuring shortages themserlves and as there will as one previous comment points out there may be language barriers particularly with cultural differences and dialects etc which could then lead to misunderstandings.
    Its not just the present government to blame but the previous one as well for years of failure to invest in and develop the NHS to its true potential and to investigate why some companies awarded lucrative NHS contracts think that it gives them the right to write their own cheques with NHS footing the bill without question.
    Its neither wonder with all the waste that goes on that trusts cannot afford to pay nurses a living wage. q

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  • Anon 14/10/13 10:59pm - I agree with every word you have written: that's exactly how I feel. I regret wasting my time training to be a nurse, when in reality I'm little more than a tablet-dispensing, complaints managing, bed-juggling scribe! I hate it and want out, but as my qualification is worth naff-all I'm stuck!

    I can't remember the last time I went into work and had a good shift, indeed, I can't remember the last time I felt like id actually helped someone!

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  • This is very intersting. Recruiting nurses from overseas, more often than not from countries where nurses are regarded significantly more subservient and malleable than their British counterparts. It would appear that any slight deficiencies in linguistic expression would prevent the forgien nurses from raising concerns? Many NHS managers may prefer that?
    Before becoming a nurse I lived and worked in Spain (Madrid) and later Portugal (Porto) for nearly 10 years. Speak spanish fluently and Portugeuse terribly. My experiences of healthcare in both countries with regard to Nurses, highlighted a tendency that they were treated with derision, destain and disrespect by medics, AHPs, relatives and patients alike. It is no suprise to me that many would chose to work in the UK, provided they have the verbal and written skills.
    Having said that, I don't think indigenous front line nurses are paid the respect they are due in the UK, especially by their 'similarly' NMC registered Nurse Managers? It would be ideal for the latter to have a new team of 'culturally unsullied' nurses that may not have the gumption to complain about anything. Perhaps the recruitment strategy is more elegant than we give them credit for? A patient or family cannot raise concerns if the Nurses on duty do not know what they are talking about.
    I love nursing and I'm going to keep at it. Get the rotten shifts and holidays because I complain about staffing levels and 'hands-off' managers all the time. Ask them to help on the ward with patient washes and feeding, some mysteriously make a phone call, then the old belt bleeper (aka get out of everything free card) goes off. Mind you, looking forward to speaking Spanish and Portugese with my new colleagues?

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  • How are they getting on with regard to recruiting Australian, New Zealander, Canadian and American Nurses? Many of them would bite your hand off to work in the UK, surely?

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  • "Smaller numbers have also come from Australia, Canada, the US and Switzerland."

    In Switzerland, according to a report on Swiss TV news, last evening the crisis is Europe wide and one in three nurses is a foreigner in Switzerland. I can't imagine many lasting long in the UK system. I'm not sure whether it has changed recently but their qualifications and registration with the Swiss Red Cross, despite a very high standard of training, were not recognised by a number of countries.

    Germany are now looking to China for recruits and student nurses are being trained to high International standards and offered German language courses.

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  • If Chinese nurses can quickly and proficiently become fluent in German, I'm going to Gemany. The languages are 'apples and oranges' Must be an intensive course? Should put us to shame. Why can't British nurses learn to speak German? Very simliar and you get paid better and treated as a 'professional', accountable to a competent regulator. Great standard of living in Germany too.
    Poor Swiss Nurses though, difficult to get the army knives through SSU.

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  • What happen to Malaysian nurses? There used to be many of them taking courses in the UK and staying behind to work?

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  • Sadly I have had to deal with complaints at two different trusts about the care of family members. I trained as a nurse over 35 years ago. I am thoroughly disheartened at the number of managers wheeled out to deal with my cases. The tick box mentality they use to defend their practices and utter lack of concern shown for the "client" ie patient at the heart of the complaint is frightening. Frequent reference to MONITOR CQC and the involvement of commissioning groups in the care is unbelievably depressing. Is there any wonder there is a nursing shortage.

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