Nursing body warns recruitment from poorer countries 'out of control'

International Health Service: Global nursing body warns NHS recruitment from poorer countries like Ghana is ‘out of control’

  • International nursing body says rich countries driving ‘intense recruitment’
  • Ghana is one of the worst-hit, with hospitals saying workforce has been slashed

The recruitment of nurses from poor countries by rich nations such as the UK is ‘out of control’, a global nursing body has warned.

The International Council of Nurses (ICN) said six or seven high-income countries are driving ‘intense recruitment’ from places that ‘can ill-afford to lose their nurses’.

Ghana is one of the worst-hit, with hospitals warning their workforce has been slashed as staff rush to fill NHS posts that they have come across on social media. 

Data from NHS England, which has 112,000 vacancies, shows that two-thirds of staff hired since 2019 were trained abroad.

Officials have warned that the health service is becoming reliable on foreign medics and that the practice is ‘not sustainable’. 

India and the Philippines account for the lion’s share of international nurse recruits for 2021-22 but a fifth came from ‘red listed’ countries where the NHS is banned from actively poaching nurses. These were Nigeria, Ghana, Nepal, and Pakistan. This data, from the UK’s Nursing and Midwifery Council, covers the period before Britain struck a special deal with Nepal to allow the NHS to recruit nurses from the country 

While the headcount of full-time-equivalent adult nurses, who account for most nurses in the NHS in England, has gone up the number of total nursing vacancies has remained stubbornly high, official figures show. This has left the NHS essential treading water in terms of addressing staffing shortages 

Howard Catton, chief executive of the ICN told the BBC: ‘My sense is that the situation currently is out of control.

‘We have intense recruitment taking place mainly driven by six or seven high-income countries but with recruitment from countries which are some of the weakest and most vulnerable which can ill-afford to lose their nurses.’

Latest NHS England data shows that the service is recruiting more nurses from abroad than ever before, with 44,000 joining the health service since 2019, compared to 22,000 UK-trained nurses. 

Most recruits were from India, the Philippines, Nigeria, Zimbabwe and Ghana. 

Nurses in Ghana, who talked to the BBC, say making extra cash is the main draw, with salaries seven-times higher in Britain compared to Ghana. Medics also cited poor working conditions. 

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Gifty Aryee, head of nursing at Greater Accra Regional Hospital, told the BBC that her intensive care unit has lost 20 nurses to the UK and US over the last six months.

She said: ‘Care is affected as we are not able to take any more patients. There are delays and it costs more in mortality – patients die.’

Patients face delays in emergency departments due to the nurse shortage, she said. 

One hospital nurse told the broadcaster that half of the nurses she had studied with had since move abroad, which she also planned to do. 

Caroline Agbodza, deputy director of nursing at Cape Coast Municipal Hospital, told the BBC that 22 of her nurse colleagues had moved to the UK in the last 12 months.

This includes all of the hospital’s critical care and experienced nurses, meaning only newly hired staff are left, she said. 

‘Even if the government recruits, we have to go through the pain of training nurses again, Ms Agbodza said.

Two experienced nurses at Ewim Health Clinic in Cape Coast have also left for the UK, impacting patient care.

Dr Justice Arthur, the clinic’s chief doctor, said: ‘Let’s take services like immunisation of children. If we lose public health nurses, then the babies that have to be immunised will not get their immunisation and we are going to have babies die.’

Adults are also at risk, as there are too few nurses to monitor patients after operations, he warned.

Perpetual Ofori-Ampofo, head of the Ghana Registered Nurses and Midwives Association, called on the Ghanian Government to act to keep nurses working in the country.

It is ‘not ethical for the UK to recruit from Ghana’ due to its low numbers of experienced nurses, she added. 

Analysis of the Nursing and Midwifery Council figures by the Nuffield Trust found international recruits account for two-thirds of all new nursing and midwifery staff in the three years since September 2019. Despite falls in the number of staff from the EU, some 43,736 recruits were non-UK staff, while just 22,226 had been trained in the UK

The number of internationally trained nurses joining the NHS has skyrocketed over recent years. Numbers have increased year-on-year, minus a blip of the Covid pandemic which hampered immigration, data from the Nursing and Midwifery Council shows. The number of international nurse recruits is now almost equal to the number of British nurses joining the profession for the first time

NHS data shows efforts to get more nurses into the health service are only barely keeping pace with the number of experienced nurses quitting

The World Health Organization (WHO) has labelled Ghana a ‘red list’ nation, meaning nurse shortages are severe so wealthy countries should not poach its staff.

But the code does not prevent individual health workers from ‘red list’ countries from seeking employment independently. 

UK rules prevent ‘active recruitment’ from Ghana but medics can apply for vacancies, which can be shared by trusts on social media. 

Last month, the UK gave £15million to support healthcare workforces in Ghana, Kenya and Nigeria. 

The UK is now looking a entering a formal deal with Ghana to recruit its nurses in return for a £1,000 fee per medic hired. It already has a similar deal with Nepal. 

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But Mr Catton said these deals are ‘trying to create a veneer of ethical respectability’ and does not reflect the true cost for the countries losing nurses. 

Jim Campbell, the WHO’s director of workforce, told the BBC that Brexit is one reason why the UK has turned to African nations to fill the gaps in its staffing. 

He said the UK has ‘closed off’ the labour market from the EU and is therefore attracting people from the Commenwealth and other nations.

Pat Cullen, chief executive of the Royal College of Nursing, previously warned that while internationally educated nurses are a ‘vital and valued part of the NHS’, there is an overreliance on staff from overseas that is ‘not sustainable’. 

Experts have estimated there will be a global shortage of 13million nurses by 2030, with levels particularly short in South East Asia and Africa. 

Currently, around a fifth (19 per cent) of the UK’s nursing and midwifery workforce is accounted for by those trained overseas. 

Health bodies said the figure signals that the NHS is leaning on foreign recruits too heavily to plug vital staffing issues. 

Separate figures from the Nursing and Midwifery Council (NMC) last month revealed that there are 788,638 nurses, midwives and nursing associates registered to work in the UK — the highest number ever recorded. More than half of the 30,000 new registrants trained overseas.

It comes as Rishi Sunak is expected to pledge £1billion to train 24,000 more nurses and midwives by 2030, as well as 2,000 trainee GPs and thousands more dentists.

An NHS workforce plan, which has been repeatedly delayed, is being finalised by Mr Sunak and could be announced by July 5 – the 75th anniversary of the NHS.

Chancellor Jeremy Hunt has been negotiating the plan directly with Amanda Pritchard, chief executive of NHS England.

Health Secretary Steve Barclay has demanded the NHS improve productivity and efficiency in return for the increase in its budget. 

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