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Exclusive: NHS nurse staffing crisis fuels global recruitment


Three quarters of NHS hospitals recruited almost 6,000 overseas nurses in just 12 months, exposing a deepening crisis in nurse staffing levels, Nursing Times can reveal.

Data gathered from all 140 acute hospitals in England showed the majority had actively sought nurses from abroad over the last 12 months, while at the same time increasing their nursing establishments.

Last year Nursing Times found 40 out of 105 trusts recruited 1,360 overseas nurses across a similar timescale, suggesting the desperation of trusts to fill their vacant posts has substantially increased.

“The Francis Inquiry was a catalyst to uncover what had been until then a more hidden problem”

Jane Ball

The mass recruitment drive comes in the wake of the Francis report into care failings at Mid Staffordshire Foundation Trust from 2013 and, earlier this year, new safe staffing guidance from the National Institute for Health and Care Excellence and rules on staffing level transparency from NHS England.

In the 12 months to September, a total 5,778 nurses were actively recruited from overseas to come and work for more than 100 NHS hospitals.

The most popular countries for recruitment were Spain, Portugal and the Philippines, which together contributed more than 3,700 nurses. The largest number, 1,925, came from Spain.

Fourteen trusts recruited more than 100 overseas nurses each, with King’s College Hospital Foundation Trust recruiting a total of 276, of which 240 came from the Philippines.

The 14 trusts also included three organisations that were formerly in the “special measures” failure regime – Basildon and Thurrock University Hospitals Foundation Trust, Buckinghamshire Healthcare Trust and Northern Lincolnshire and Goole Hospitals Foundation Trust.


The overseas trend shows no signs of abating, with 93 acute trusts telling Nursing Times they planned to recruit overseas in the next year and 32 predicting they will find jobs for 1,800 nurses.

The data also reveals details of the recent rise in staffing levels – the so-called “Francis effect” – with 107 acute trusts increasing their nursing establishment – 11 by more than 10%.

“The big risk is that we can’t know how long these people will stay with us”

Howard Catton

Professor Jane Ball, a nursing workforce expert at the University of Southampton, said: “We are in a serious shortage of nurses and it is a shortage that has been waiting to be realised, it is not new or sudden. The Francis Inquiry was a catalyst to uncover what had been until then a more hidden problem.

“This is about uncovering what has been a growing, deepening problem that the NHS decided not to focus on because of financial pressures and other challenges,” she told Nursing Times.

She labelled the overseas recruitment drives as a “band aid” for the problem of staffing shortages, adding that it was “a short-term stop-gap and so inefficient”.

Howard Catton, policy director at the Royal College of Nursing, said the new data was “powerful evidence of a shortage of nurses”.

He said the number of training places for UK nurses needed to increase by up to 9% a year for three or four years to improve supply.

Mr Catton added: “This is demand driven and the result of organisations looking much more seriously at their establishments and whether it is fit for purpose. It is the classic boom and bust cycle and short term response. The big risk is that we can’t know how long these people will stay with us.”

The increase in nursing establishment numbers was welcomed by Unison’s head of health Christina McAnea, who said the shortage was the result of a “lack of focus on workforce planning over a number of years”.

But she warned: “While it is good news to see trusts increasing numbers of nurses, we can’t keep asking NHS staff to pay for it.”

Danny Mortimer, chief executive of the NHS Employers organisation, said the figures reinforced those from its own survey, published in May, that showed employers were using international recruitment to address the increasing demand for nursing posts.

“Employers do not embark on international recruitment activity lightly and unless they have explored all other avenues first to meet their needs,” he said.

“We know that employers have robust recruitment processes in place to cover not only the technical aspects of nursing but also communications skills, values and behaviours.”

He added: “We also need to keep this in perspective. Six thousand nurses from overseas equates to less than 2% of the whole NHS nursing and midwifery workforce.”


Most popular countries for recruitment  

Spain – 1,925

Portugal – 1,240

Philippines – 567

Italy – 566

Ireland – 517


Quick facts

  • 103 out of 140 trusts are recruiting overseas            
  • 276 – largest number of overseas nurses recuited by on trust – Kings College          
  • 5,788 – total number of foreign nurses recruited
  • 32 trusts recruited between 50 and 100  
  • 57 trusts recruited between 1 and 49       
  • 93 trusts say it is likely they will recruit overseas in the 12 months to Sept 2015      
  • 32 trusts say they aim to recruit 1864 in next 12 months   
  • 107 trusts increased their funded establishment by 1% or more     
  • 18 trusts reduced their funded establishment       
  • In 2013, 40 out of 105 acute trusts recruited from overseas and a further 41 said they planned to
  • In 2013, a total of 1,360 overseas nurses were recruited



Readers' comments (14)

  • don't be a nurse be an get all your perks and 11% pay rise!!!

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  • hunt doesn't want uk nurses

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  • Still struggling to recruit enough nurses into hospitals, and no figures for community care. Training and maintaining excellent staff takes a long time. Not just 3 years at university. Development and further training must be continued after initial qualification + registration.
    Recruiting nurses from other countries are draining those countries of their excellent nurses too. But they are very likely to go back/elsewhere after a few years or so, therefore much longer term planning and better retention of staff needs to be done.

    Systematic undervaluing of nurses does not help recruitment. This is clearly demonstrated by the ongoing poor terms and conditions, especially with pay, for the amount of knowledge, skills and experience that is expected to deliver high standards of modern healthcare.

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  • Bring back the diploma course, and offer these courses to the best of HCA's. RGN degree course should be only for nurses with ambitions to work as band 6, 7, nursing home deputy managers, etc.

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  • We recently got two new nurses on our ward from Spain & Italy, and the workload for the ward nurses has increased as continuous teaching is involved. For us to feel the benefit
    of these nurses I think it will take at least six months. Meanwhile the workload is unbearable. The young Italian however, hinted that he will be moving on once he feels more confident.

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  • recruit from Jamaica, we are competent and ambitious, we speak, write and understand English. plus we will stay until retirement.

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  • can you blame people for not becoming nurses? silly shift patterns, long hours, governing body that takes money and not much else, bad press constantly, high stress, and for working your fingers to the bone a man who has no idea how a hospital works (Mr Hunt) then says you wont get paid for it. unless you wear a suit to work then you can print your own money.

    come from engineering to nursing now going back to engineering. NHS is broken in an unmendable way.

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  • Do we know if these nurses are paid the same as and are on the same terms and conditions as established NHS staff?

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  • The answer to the question posed by Anonymous 19-Dec-2014 9:19 is yes. What happens is that the nurses are paid basic HCA wages until they are able to register with the NMC, this can take weeks or months. They are then often paid the lowest point on the band 5 scale. Many of these nurses are very experienced in specialities, so the NHS gets them on the cheap. However being mobile there is nothing at all to keep them at the hospital they start at, or even in the country, so many move on quickly. There is no lack of applicants to nurse training in this country but too few places available with total disregard for the future. Unfortunately even those nurses who are trained in this county do not always stay in nursing because the very unsocial hours, unbearably heavy workload and responsibilities coupled with the low levels of pay are enough to frighten off all but the most dedicated person. If that was not enough then the way nurses are portrayed in the media should make any young woman wary of taking on the role. It is 66 years since the NHS gave every person the right to decent health care, I wonder what the next 66 years will bring!

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  • Carol Ellison | 19-Dec-2014 1:40 pm

    you say that many of these overseas nurses move on quickly. I heard a similar tale in which many are coming over here find out about the working conditions and quickly go back home. But at least some of the mangers got a nice trip abroad to recruit them so all is not lost.
    103 days until I leave the NHS and I cant wait

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