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Nursing numbers rise but ‘red list’ recruitment sparks fresh concern

Nursing numbers rise but ‘red list’ recruitment sparks fresh concern

There are a record 808,488 nurses, midwives and nursing associates eligible to practise in the UK, according to new data released by the Nursing and Midwifery Council (NMC).

The number on the register represents a record, according to NMC, with a rise of more than 19,857 (2.5%) from the figure six months ago, and 114,874 (16.6%) over a five-year period.

However, concerns have been raised over data showing an upward trend in joiners from the so-called ‘red list’ countries, where active recruitment is prohibited by the UK Government’s code of practice.

The NMC register mid-year update shows there were 30,103 new joiners in the six months to September 2023 – 27.7% more than in the same period in 2022 (23,565), and more than twice as many as in the corresponding period five years ago (14,311).

Just over half (15,067) of these new joiners were educated in the UK, representing the highest number of domestic joiners ever in the first half of a financial year, and nearly 25% higher than in the same period last year (12,104).

However, it is understood that the rise in UK educated joiners is partly because, since 2020, the NMC has clarified for education institutions that newly qualified professionals can join the register once they have finished their programmes – for example, after three academic years rather than waiting until the end of three calendar years.

The number of international joiners was almost identical to UK joiners, at 15,036. India moved further ahead as the biggest single source of international recruitment, with 7,223 joiners in the last six months, compared to 4,849 between April and September last year – a 49% rise.

However, the NMC said the rise in the number of people joining the register from red list countries was ‘concerning’. This included joiners from Nigeria (1,536), Ghana (886), Zimbabwe (283), Zambia (189) and Pakistan (110) over the last six months.

It should be noted, however, that while Department of Health and Social Care (DHSC) and Scottish Government codes of practice prohibit active recruitment from nations on the red list, they do not prevent individual health workers from those countries seeking employment independently.

The concerns over red list recruitment follow the uncovering of evidence of ‘widespread fraudulent activity’ at a testing site in Nigeria used by some internationally educated nurses before joining the Nursing and Midwifery Council (NMC) register.

Reacting to the figures, Professor Nicola Ranger, chief nurse from the Royal College of Nursing (RCN) said: ‘The government’s over-reliance on unethical international recruitment from red-list countries has become the norm and cannot continue. It’s a false economy.’

Professor Ranger also expressed the view that the headline figures from NMC ‘don’t reflect what nurses are seeing on the NHS frontline’.

She added: ‘Since 2019, the NHS waiting list has grown four times faster than the nurse workforce, meaning there aren’t enough staff to provide the outstanding care patients deserve.’

NHS Providers also expressed concern over the rise in joiners from red list countries, as well as disparities in supply and demand.

‘International recruitment must be done ethically, in line with the DHSC’s code of practice,’ said Miriam Deakin, NHS Providers’ director of policy and strategy.

‘The NHS Long Term Workforce Plan aims to drive domestic training alongside international recruitment. For this to be realised, the plan must be adequately funded by the government,’ she added.

Ms Deakin welcomed the overall rise in nurses, midwives and nursing associates, describing it as a ‘welcome boost for a depleted workforce’, but also observed that demand on healthcare services has risen since the pandemic, maintaining a ‘mismatch’ between demand and capacity.

‘Recruiting more staff only goes so far to address this,’ she said. ‘We also need to focus on retaining staff by continuing to improve workplace culture, which includes stamping out racism and discrimination.’

Meanwhile, chief executive of the International Council of Nurses Howard Catton, added: ‘Around the world demand for healthcare is outstripping the supply of nurses and as a result we have seen a relatively small number of richer countries, including the UK, at the forefront of a significant increase in international recruitment.’

He noted that at a  recent meeting of nursing associations, nurse leaders told of ‘deep unease and concern about the impact of recruitment activity that was further weakening already vulnerable health systems and also resulting in poor and exploitative recruitment practices’.

The register shows a steady retention rate, with a total of 13,308 professionals having left since April – equivalent to 1.7% of the total. In the same period last year, 13,164 people left, representing the same percentage.

The NMC noted that the ethnic profile of the register continues to change, with more international professionals joining the register and UK joiners becoming more ethnically diverse – a quarter of the UK joiners since April are from Black and minority ethnic backgrounds.

The proportion of all registered professionals from Black and minority ethnic backgrounds now stands at 29.1%, compared with 27.7% in April and 19.1% in 2018.

The figures also show ‘a slow but steady change’ in the age profile of the register. The total proportion of professionals aged 21 to 40 is now 43.5%, compared to 42.7% six months ago, and 37.7% in September 2018.

Commenting on the latest data, Andrea Sutcliffe, NMC chief executive and registrar, said the headline figure was ‘very encouraging given the well-publicised pressure on health and care services at a time of rising demand for care’.

While insisting that all of the professionals on the register make a ‘vital and welcome contribution to people’s health and wellbeing’, Ms Sutcliffe emphasised that it was important that employers continue to be mindful of the government’s ethical recruitment code regarding countries on the red list.

‘People from across the world want to come and work in the UK. However, employers must not undermine health systems in countries with the most pressing workforce challenges through active recruitment,’ she said.

A Department of Health and Social Care spokesperson said: ‘There were a record number of homegrown nurses joining the NHS in the first half of this year and that number is increasing.

‘There are now over 17,600 more NHS nurses working than this time last year, and we are on track to deliver 50,000 more compared with September 2019.’

They said the NHS Long Term Workforce Plan would also ‘deliver around 24,000 more nurse and midwife training places a year by 2031’.

‘Our published Code of Practice is clear that whilst recognising an individual’s right to migrate, organisations should not actively recruit from WHO red list countries,’ they added.

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