Why the NHS's new ‘Windrush Generation' must get a better deal

The severity of the staff shortages faced by the NHS are grave. So grave that the secretary of state Matt Hancock recently spoke of the need for “a recruitment drive to attract the brightest and best doctors, nurses, and clinical staff from overseas… a new Windrush Generation.”

Where will these people come from?

Not from Europe, it seems. 2018 witnessed an 87 per cent fall in the number of European nurses coming to the UK, a trend which is echoed in other areas of the workforce. Our concern, expressed in the Tropical Health and Education Trust (THET)’s recent report From Competition to Collaboration: Ethical leadership in an era of health worker mobility, is that such recruitment will come from countries that can ill afford to lose their skilled healthcare workers.

The UK’s own workforce challenges are dwarfed by those in Africa and Asia. Today in South East Asia, there is a shortage of more than 7 million health workers. In Africa, a continent home to 1.3 billion people, there is a need in excess of 4 million additional health workers.

2018 witnessed an 87 per cent fall in the number of European nurses coming to the UK

In theory, there are safeguards in place to prevent such “poaching” of skills, notably the UK’s endorsement of the World Health Organisation’s Code of Practice for International Recruitment. The UK pioneered the development of its own code - UK Code of Practice for International Recruitment – as early as 2001. Both balance the right of health workers to move to other countries whilst discouraging active recruitment by high-income countries of health workers from nations where there is a critical shortage.

However, a study carried out in June 2018 showed that of the top 15 countries NHS staff are most commonly recruited from, seven are from resource-poor countries.

Violation of breaking the code

Mr Hancock’s call to increase international recruitment risks exacerbating this situation and undermining the UK’s generous use of overseas aid funds to build resilient health systems in – often – the very same countries we are recruiting from. It is a case of one arm of government not talking to the other.

We gained some insight into what is happening while researching our report. One of the biggest problems is not with NHS Employers, custodians of the code in the UK, but rather with private recruitment agencies that are regularly flouting the code. For example, as part of our analysis we investigated the work of a recruitment agency called Adevia which is actively recruiting Ugandan nurses for the UK and US in defiance of the code.

27 per cent of all doctors registering to work in the UK came from countries on the ”banned” list of countries

Further evidence was uncovered by a team from The Telegraph recently. They found the “NHS breaking recruitment rules with one in four new doctors coming from ‘banned’ developing countries.” In total, 27 per cent of all doctors registering to work in the UK came from countries on the ”banned” list of countries. In 2014, it was just 13 per cent. The investigation went on to state that “NHS trusts have used agencies to recruit doctors from such countries.”

That is why one of our key recommendations is that the UK should help to strengthen the code and for NHS Employers to ban international recruitment agencies who use subcontractors to recruit from low- and middle-income countries.

But our report goes further. It articulates a more positive vision of how we can shape the mobility and migration of health workers, and in the process, position the NHS as a global leader in workforce development.

Earn, Learn, Return

That is why we support the scaling up of training schemes such as The Medical Training Initiative , or Earn, Learn, Return. These schemes bring doctors and nurses to the UK to work here with a view to returning to their countries of origin with improved clinical skills. But we must ensure that such training schemes are far more rigorously evaluated and also ensure that they support the health professionals’ countries of heritage, not just the UK.

For its part, THET has long been a champion of the contribution NHS staff can make to the development of health services in resource-poor countries, through such schemes as the UK Aid-funded Health Partnership Scheme. This has seen over 2,000 NHS staff volunteer their time in Africa and Asia to train over 93,000 health workers in just eight years.

What is imperative, however, is that all these initiatives are guided by a strong ethical viewpoint which reconciles our imperative to staff the NHS with our desire to contribute to building strong health systems overseas.

Not so much a revolution in recruitment, more a revolution in the education and training of health workers built on an appreciation that there is much for us to learn in the UK from people who do more, with less, and much for us to share, as custodians of the world’s oldest and largest universal healthcare service.