• Registered nurses are the biggest area of workforce shortages in the NHS in England. Compared with many other OECD countries, the NHS relies heavily on international recruitment as a route to increasing nurse numbers.
  • Recent Nursing and Midwifery Council data underline this reliance on international nurses, showing that the proportion of new UK nurse registrants trained in other countries reached a two-decade high in 2021/22. Since the Brexit vote, the number of new nurse registrants from outside the European Economic Area (EEA) has increased significantly and reached a 30-year high in 2021/22.
  • A comprehensive, fully funded long term workforce strategy for the NHS and social care is urgently needed if longstanding shortages in the nursing workforce are to be effectively addressed.

Registered nurses are the biggest area of workforce shortages in the NHS in England. While they account for around one in four full-time equivalent staff in the overall NHS hospital and community service sector, they account for nearly two in five full-time equivalent vacancies. OECD data show that the proportion of UK nurses trained abroad is well above many comparable OECD countries.

In that context, it is vital to understand how the extent to which the NHS relies on nurses trained in other countries has changed over time. Data provided by the Nursing and Midwifery Council (NMC) on the country of training of new nurse registrants provide useful insights. Between 1990/91 and 2021/22, nurses trained outside the UK have accounted for between 10% and 53% of the overall annual number of new NMC registrants. The most recent NMC data, released in May 2022, show that nearly half (48%) of new registrants in 2021/22 were trained outside the UK, which is a two-decade high (Figure 1).

The ‘mix’ of the countries of training of new NMC nurse registrants has evolved over time. In the latter half of the 1990s and the early 2000s, there was a rapid increase in non-EEA international nurse recruitment, notably from the Philippines and India. Subsequently, the period 2010-2016 saw a switch to rapid growth in the recruitment of nurses trained in EEA countries. In the years since 2016, which saw the Brexit vote and new English language test requirements being introduced for nurses, international nurse recruitment from non-EEA countries has grown substantially, while that from EEA countries has fallen (see chart below). The NMC’s recent data release shows that in 2021/22, the number of new registrants trained in non-EEA countries reached a 30-year high (22,745).

As it usually takes three years to train a registered nurse in the UK, active international recruitment has long been regarded as a ‘quick fix’ to addressing the longstanding NHS nurse shortfall because it takes months rather than years. It is also cheaper as the cost of training is borne by other countries. OECD data suggest that the UK trains only one third as many nurses per capita as does Australia, and only half the graduation rate of USA. It is important for effective national nurse workforce policy to be able to assess how the substantial recent increases in new non-EEA nurse registrations might impact domestic supply capacity. There is also a need to ensure that recruitment from lower resource source countries (eg Nigeria and Ghana) complies with NHS ethical recruitment guidelines.

Nursing shortages across the NHS and social care are a huge risk to the post-pandemic recovery. A comprehensive long term – and fully funded – workforce strategy for the NHS and social care, which aligns effective domestic training with effective and ethical international recruitment, is urgently needed.

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