Shaping ethical recruitment

Around the world, health systems are struggling to recover from the impact of the COVID-19 pandemic. Despite huge efforts to train more nurses and considerable progress made in many countries, the World Health Organization (WHO) estimates that the world will face a shortage of 4.5 million nurses by 2030.

As the world’s largest nursing trade union and professional body, we must be a voice for nursing staff everywhere. Ongoing staffing shortages in the UK are detrimental to both patient safety and the health and wellbeing of the nursing workforce. In workplaces across the UK, in every specialism, every clinical setting, NHS or independent sector, staffing is an issue. In our 2024 Last Shift Survey, 81% of you reported that there weren’t sufficient numbers of nurses to safely meet the needs of your patients.

Yet many countries around the world face even more critical situations. 

In 2010, the WHO introduced the Global Code of Practice on the International Recruitment of Health Personnel to address the harmful impacts of migration and provide safeguards for low-and middle-income countries struggling to retain the health care workers they need. The Code sets out the ethical principles that should guide international recruitment and lists 55 countries (sometimes known as the ‘red list’) with the most pressing health related workforce shortages. that should not be actively recruited from.

Internationally educated nurses (IENs) make a crucial contribution to health and care services across the UK. They now make up 22.7% of the NMC register and nearly half of all new joiners to the register last year were trained outside the UK. The UK’s health and care systems simply could not function without IENs. 

However, given the backdrop of global nursing shortages, current levels of international recruitment to the UK are unethical and unsustainable.

That’s why we were keen to respond to the WHO’s recent consultation on the Global Code which independent stakeholders from across the globe, such as the RCN, are invited to contribute to every three years.

Since the last time we responded to this consultation in 2021, the total number of people on the NMC register that received their initial training in a red list country has almost trebled, from around 12,000 to just under 33,000. In the six months to March 2024, 1 in 10 people joining the NMC register for the first time were trained in red list countries. The loss of these skilled nursing professionals from affected countries can have disastrous consequences on health outcomes. 

However, despite the UK’s growing reliance on the internationally educated workforce, IENs from all countries continue to face punitive and unfair immigration polices introduced by the last government. Rising visa costs, restrictions on family visas, and a ban on access to public funds have made the UK an increasingly unattractive place to live and work.

For UK health systems, this poses a real risk to our ability to recruit ethically from overseas in the future, and we’re already seeing signs of this in data shared by the Home Office. The number of internationally educated nurses applying for visas in the first three months of this year was less than half the number that applied in the same period last year.

The challenges created by the UK’s immigration system also leave internationally educated nurses vulnerable to exploitation. Here at the RCN, we are receiving increased reports of members experiencing exploitative employment practices – particularly from those working in the care sector. Members have told us about repayment fees as high as £16,000 being levied against them if they try to leave their employment before a specified time. Our members also report being targeted with fraudulent job offers or scammed by illegal work-finding fees of up to £20,000.

We are clear then, that whilst we recognise the enormous value that the internationally educated workforce brings to the UK, it cannot be at the cost of red list countries, or the individuals who themselves come here to care for our friends, families and loved ones.

International recruitment must be conducted fairly and ethically. This means growing our workforce self-sufficiency so we’re not as reliant on overseas recruitment. It means protecting red list countries and the health needs of their populations. And it means ensuring that all those who come to the UK to work in our health and care systems feel safe, valued and welcome.

We will continue to engage with members and agree how we can advocate for nurses around the world and secure an ethical and sustainable recruitment model for the future.