The rhetoric and criticism surrounding the increasing use of overseas nurses to cope with NHS staffing shortages has been described as “insulting” by a senior health service manager.
Danny Mortimer, chief executive of the NHS Employers organisation, said some of the language used by commentators about the issue of recruiting nurses from abroad was “slightly unfortunate” and “poorly chosen”.
Three quarters of NHS hospitals recruited almost 6,000 overseas nurses in just 12 months, according to figures revealed in December. Data gathered from all 140 acute hospitals in England showed the majority had actively sought nurses from abroad over the last 12 months.
“The idea that [we are] panic buying nurses I thought, to be frank, was pretty insulting to the senior nurses that go out and recruit nurses”
In his first major interview since taking up post at NHS Employers at the end of last year, Mr Mortimer claimed that the number of overseas nurses recruited by the NHS was “relatively small”, compared to the overall nursing workforce.
“Nurses coming from overseas to work or train in this country is not a new thing,” he said, noting that his own mother had come from Ireland to train and work as a nurse in the Midlands.
He was especially critical of suggestions that nurse managers were “panic buying” overseas nurses and “plundering” European countries hit by the financial crisis.
“The idea that [we are] panic buying nurses I thought, to be frank, was pretty insulting to the senior nurses that go out and recruit nurses,” he said. “The nursing colleagues who did that work, who did the [job] interviews, took it really seriously indeed.”
However, he acknowledged that the recruitment of overseas nurses was the result of need to plan better for NHS workforce needs by trusts facing patients with greater dependency and safety concerns following the publication in 2013 of the Francis report into care failings at the former Mid Staffordshire Foundation Trust.
“It does speak to the fact is that we just haven’t got our planning as perfected as it needs to be,” he said.
“What no one anticipated was both the response to Francis, in terms of the correct investment in nursing numbers, and also the demands that there would be to increase emergency capacity, particularly in the acute sector.”
“It’s about how they respond – not being defensive, being open about how they investigate it… so it doesn’t feel as if it’s disappearing off into a black hole”
But Mr Mortimer, who has previous experience of working as a healthcare assistant and whose wife is a nurse, said the focus on international recruitment was leading to a “broader debate about actually what do we need to do to recruit and retain the right levels of nursing workforce”.
“I think employers are starting to look at their employment practices again,” he said. “Are we as flexible as we could be, are we responsive to different needs that members of the workforce would have?”
He added: “Employers will get better at understanding what’s important to the nurses they are recruiting and embedding them in the community and keeping them. International recruitment will be with us a while yet at that kind of scale.”
Mr Mortimer, who was formerly director of workforce and strategy at Nottingham University Hospitals NHS Trust, acknowledged that some trusts were struggling to retain the nurses they had recruited from overseas, as highlighted by a recent Nursing Times investigation.
He argued that each individual trust had “its selling points” to attract and retain international recruits.
But he added: “The thing that we get fed back the most is actually is proximity to transport, airports, that’s the thing that seems particularly important.”
Spending on agency and bank nurses
Mr Mortimer also defended high levels of spending on agency nursing staff by trusts, which was criticised recently by the Royal College of Nursing and also last week by NHS England chief executive Simon Stevens in an interview with Nursing Times.
Mr Mortimer acknowledged that the “level of spend is noticeably higher than it was two years ago”, but said that in a “situation where there isn’t enough supply of nurses, we’re going to look to agencies and bank”.
“Trusts are looking to fill gaps in rotas, they’re looking to fill shifts, and that means more times than not, there are enough nurses on a shift looking after patients, and what’s what we want,” he said.
“The level of spend isn’t because the agencies are ramping up their rates it’s because we are using more and more people,” he told Nursing Times.
He highlighted the existence of a number of framework agreements in place and different parts of the country between trusts and agencies. “In fairness to agencies most, if not all of them, realise the importance of trying to work together in a structured way,” he added.
In May last year, NHS Employers itself revealed that 83% of health service organisations in England were facing nursing shortages. The review was based on questionnaires completed by 104 trusts.
Mr Mortimer admitted that would “still be picture” this May. “People are rightly investing in numbers… but the supply of staff isn’t at the level of demand,” he said.
“So yes, I think people will still be struggling but I know that employers and nurse leaders are doing everything they can to source people and keep the people they’ve got and welcome people back to practice,” he said.
Asked how he viewed the mood of the frontline NHS workforce, Mr Mortimer described it as a “paradox” of two things at the same time.
“I see a genuine pride and commitment from people who work in healthcare organisations in what they do,” he said.
“At the same time, there is a real sense of pressure in the system, particularly around the demands of emergency care,” he said. “Every bit of the system is working really hard – really hard.”
Preparation for nurse revalidation
Mr Mortimer also discussed preparations for the forthcoming system of checks on nursing standards, called revalidation, which is due to replace PREP from the end of the year.
He noted that questions remained on what the new system would look like and the exact criteria that would be used.
However, he commended the Nursing and Midwifery Council for its “thoughtful” and “measured” approach to introducing the revalidation system. “They are going to pilot the process, which clearly is the right thing to do,” he said.
But he added that organisations did “worry about” some aspects of the new system. “People are very keen to learn about how the system is going to work in practice – just to try and ease the administrative burden, both on employers and hopefully on the nurses and midwives themselves,” he said.
He noted that trusts had gained experience from the previous introduction of revalidation for doctors in December 2012, and that it had been “manageable”, though involving a smaller group of health professionals.
“While there’s a time element, it’s not been perhaps as onerous as people first feared when the General Medical Council first proposed revalidation,” he said, adding that discussions on nurse revalidation had been “calmer” as a result.
“Let’s see what lessons come out of the pilots,” he said. “Some of the concern for my wife and her friends is actually, we don’t know enough about this yet and what is it going to mean in practice.”
Progress on culture change in the NHS
Mr Mortimer also discussed changing the culture of the NHS around raising concerns in the wake of the Francis report.
He said the view of NHS Employers was “very much like” that of Nursing Times, which has been running the Speak Out Safely campaign since 2013, with the aim of making it easier for staff to raise concerns.
“It’s about creating a culture so that people can speak up… and I think employers increasingly recognise the things they have to do to help create that culture,” he said.
“It’s about how they respond – not being defensive, being open about how they investigate it, how they feedback to people when they’ve raised a concern… so it doesn’t feel as if it’s disappearing off into a black hole.”
He highlighted that his former trust had introduced “a very effective joint group with undergraduate nurses, which was about both raising concerns but also developing areas of practice”.
“The students as a group had done a fantastic piece of work on pressure ulcers and raising awareness among the student cohort about pressure ulcers,” he said.
Asked if he thought there had been any change in culture about raising concerns since the Francis report was published in February 2013.
“The short answer is yes I do,” he said. “Lots of trusts have looked at what they were doing and realised they could do more, and shared that practice.”
However, he noted that it was important to understand there was a “pretty inconsistent picture across the service”.
“There are some exceptional organisations where they are actually pretty close to where they need to be in terms of that kind of culture. And there are others where we still haven’t got that kind of consistency of experience,” he said.
“What I hear from colleagues is that it’s improving, but one can never be complacent,” he told Nursing Times.