The Ward Round: Ramping up international recruitment in a pandemic

The NHS has long been reliant on its international workforce. Before the pandemic hit last year, it was one of the most important recruitment levers in hitting the government’s ambitious workforce targets.

The coronavirus pandemic derailed these plans and NHS workforce leaders warned of the knock-on impact this would have on boosting workforce numbers. At the end of last year, chief nurse for England Ruth May called on trusts to “collectively… increase annual international recruitment by 41 per cent to significantly reduce our nursing vacancies” although she recognised how the pandemic had made interviewing candidates difficult and prevented them from arriving in the UK. 

Last week, the government published important changes in a new code of practice, which set out how the UK recruits health and care staff from abroad. The government argues these changes will enable the 50,000 more nurses ambition to be met by 2024.

So what has changed? In summary, the UK has aligned with the World Health Organisation’s advice on ethical recruitment. According to the Department of Health and Social Care, this will provide “increasing numbers of international staff with the opportunity to come and work in the UK’s health and social care sectors”.

Before these changes were made, there were 152 countries from which the NHS was not allowed to actively recruit from. This has now been reduced to 47 countries, which are on the WHO’s support and safeguard list, also known as red list countries.

HSJ understands this final figure was a result of some last-minute negotiations between the DHSC and the Foreign, Commonwealth and Development Office; original plans were for there to be around 100 countries on the list, but ministers wanted to see as few countries as possible.

The new code

The new code of practice has five “guiding principles”: international migration should strengthen the health system of the country of origin and destination; opportunities exist for individuals to train and enhance their practice; no active recruitment from countries on the list; recruitment must be monitored by a cross-Whitehall steering group; and international workers will have the same legal rights as domestic workers.

There are also various other benchmarks to meet, including recruitment agencies not charging international healthcare workers fees for UK employment, the need for language testing, health checks and registration.

However, with so many recruitment agencies active abroad, ensuring this code of practice is always met will be a challenge.

Billy Palmer, senior fellow in health policy at the Nuffield Trust, explains it will be critical to ensure a “transparent, consistent and timely process for updating the list of countries where we should not be actively recruiting from”.

Dr Palmer added: “Another side of it is how do we ensure the [red] list is nimble enough to change when other countries suffer particular challenges.”

Of course, the NHS and recruiters are not allowed to actively recruit from the red list countries, but this does not prevent individual health and care workers from deciding to emigrate for work independently.

“You could have a huge number of people from these countries finding their own way on to the NHS jobs website and applying,” Dr Palmer said. “In that scenario, is that protection sufficient?”

He said it is key that when we do recruit from overseas — whether passively or actively — there is, if appropriate, compensation to ensure the country of origin is not unduly affected.

Rebecca Smith, managing director of NHS Employers — the organisation responsible for making sure NHS organisations involved in recruiting from outside the UK are aware of the revised code of practice — said she expected employers to welcome the revised code’s “improved clarity”.

She added international recruits now had better access to support, when they previously faced a “difficult journey” to the UK. 

And on the context of this change during a pandemic? Ms Smith said: “We recognise that enabling both ethical international recruitment and supporting health systems to achieve universal health coverage is complex.

“We therefore fully support the intent of the cross-Whitehall group to review the data on workforce flows and the possible impact on low- or middle-income countries and fragile and conflict-affected states, as part of the review process.”

The 152 countries undoubtedly needed updating — I have been told Yugoslavia was on the old list — but, as Ms Smith stressed, the cross-Whitehall group’s work reviewing the workflow impact will be vital in making sure potentially fragile health systems overseas do not suffer because of this rapid expansion. Global health should not suffer as a result of the NHS’ need to recruit more staff.