Is there a national shortage of nurses? Which specialties are mainly affected?
sir david metcalf
Would it be sensible to fill vacancies by attracting extra nurses from outside of the EU? These are the main questions the home secretary asked the Migration Advisory Committee (MAC) to examine earlier this year. The MAC will report in February 2016.
The background to this commission is as follows. The MAC analysed NHS nurse numbers in late 2014, reported to the government at the end of January 2015 and published its report in February. The Centre for Workforce Intelligence (CfWI), which distils NHS evidence on behalf of the Department of Health, did not recommend placing adult nurses on the Shortage Occupation List (SOL). Occupations on the SOL get priority for skilled non-EU immigration.
The CfWI also recommended removing specialist nurses working in neonatal or paediatric intensive-care units from the SOL. The MAC typically accepts the CfWI’s recommendations – it knows the health labour market better than we do – so adult nurses were not put on the SOL. On the basis of evidence received, the MAC also did not recommend specialist nurses working in operating theatres and non-medical nurse endoscopists for inclusion.
This had two consequences. First, in order to recruit non-EU nurses, the trust or care home had to use the resident labour market test (RLMT). But RLMT migrants are not given priority. Once the overall Tier 2 general monthly quota was reached in June, jobs with higher pay displaced most nurse applications where pay was lower.
Second, to gain indefinite leave to remain in the UK, a Tier 2 worker must be earning £35,000 a year or more, but that does not apply to jobs on the SOL. Health employers and migrant nurses were concerned that that was too high for nurses, and that many would have to leave the UK. When the MAC recommended that threshold, we said there would need to be some exceptions, specifically mentioning nurses. The home secretary has put nurses on the SOL, pending the MAC review.
The MAC is keen to get evidence from nurses, employers, unions, umbrella trade bodies and the DH. Evidence on a shortage of nurses can take many forms, including vacancy rates, staff turnover and the use of expensive agency staff.
Home Office management information shows that some trusts are major non-EU nurse recruiters, whereas their neighbours recruit almost none from outside the EU. This could suggest there is no national shortage – a requirement for inclusion on the SOL – but specific local shortages.
Public-sector pay restraint inhibits the scope for general pay rises but is there any scope for local initiatives? Even if it is agreed there is a national shortage of nurses, or national shortages in specific specialties, it does not follow that it is sensible to fill the vacancies with non-EU labour. At least, convincing answers will be needed to various questions.
Why did the DH cut training places? Why are so many qualified and/or registered nurses not working in the profession? What family-friendly initiatives are being pursued to reduce wastage? Is EU recruitment a possible alternative to non-EU recruitment? If it believes there is a national shortage, will the DH be arguing for a relatively high pay rise for nurses in its evidence to the Pay Review Body?
● For MAC’s Call for Evidence, go to bit.ly/MACcallevidence.
Send evidence to email@example.com or to Migration Advisory Committee, 3rd Floor, Seacole Building, 2 Marsham Street, London SW1P 4DF, by noon on 31 December 2015.
Sir David Metcalf is emeritus professor, Centre for Economic Performance, London School of Economics, and chair, Migration Advisory Committee