Why David Cameron’s immigration rules will worsen nurse shortages


Original post from The Guardian

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It takes time to train NHS nurses so in the meantime, trusts have to recruit from abroad

A scene from the opening ceremony of the 2012 London Olympic Games. There are thousands of vacant nursing posts. Photograph: KeystoneUSA-Zuma/Rex
A scene from the opening ceremony of the 2012 London Olympic Games. There are thousands of vacant nursing posts. Photograph: KeystoneUSA-Zuma/Rex

Recruiting skilled and motivated nurses is key to delivering good quality hospital services. So Newcastle upon Tyne hospital NHS foundation trust was delighted when it found its latest crop of new nursing staff, who, according to chief executive Sir Leonard Fenwick, were expected to become “part of the backbone” of its workforce. Trouble is those nurses are still sitting some 6,500 miles away in the Philippines after the trust’s applications to bring them into the country were rejected.

“It’s a frustration,” says Fenwick. “We have had a great success story with bringing in staff from the Philippines over the past decade. They have been fabulous – they have hit the ground running and they have become indispensable. This is about bringing to the UK calibre people who quickly become thoroughly engaged in our social fabric.”

The Newcastle trust’s problems – it has had three applications for a total of 85 certificates of sponsorship that non-EU staff need to enter the country refused between June and September – are just one example of an issue that NHS trusts say could put patient safety at risk. That’s why 10 hospital trusts, including Newcastle, last week signed up to a letter to the home secretary, Theresa May, calling for an easing of immigration rules. The NHS Employers organisation, which coordinated the letter, estimates that around 1,000 nurses from outside the EU have been rejected by the Home Office to date, with a further 1,000 applications expected over the next six months.

The Home Office disputes the figures and claims NHS trusts have been given more than 1,400 sponsorship certificates for nurses since April this year, but more than 600 of the places allocated to them in April and May this year had been returned unused.

In recent months, when places for Tier 2 visas for nursing and a number of other professions have been oversubscribed, priority has been given to shortage occupations.

“The independent Migration Advisory Committee, which took evidence from a number of NHS trusts and representative bodies from across the UK, recommended against adding nurses to the shortage occupation list earlier this year,” a Home Office spokesperson adds.

But NHS Employers’ chief executive, Danny Mortimer, says hospitals around the country are being affected and that until moves to train more nurses in the UK start to pay off, hospitals need to be able to recruit flexibly.

“There are two principal areas of concern, he says. “The first is if you can’t recruit permanent staff, whether from the UK, the EU or outside the EU, that drives demand for agency staff – and that comes at a premium.

“Then people are looking at their plans for winter and the need to expand capacity and thinking: ‘Gosh, how do we staff that?’ We are not given to the waving of shrouds but it does create a risk. We know the winter period is going to be pressured.”

As well as reconsidering the decision not to add nursing to the shortage occupation list, NHS Employers wants rules on the salary criteria for entry to be eased to reflect the fact that skilled health staff are not paid as much as, say, migrants offered jobs in financial services.

But the problem goes wider than nurses who are not able to enter the country to take up the jobs they are offered – it could also hit thousands already here. The Royal College of Nursing has warned that new rules requiring non-EU workers must be earning at least £35,000 before they are allowed to stay in the UK after six years could “cause chaos” in the NHS. According to RCN research, by 2020 some 6,620 nurses could be forced to leave, wasting almost £40m in recruitment costs.

Then there’s the impact of the tougher climate on care homes, which already find it more difficult than NHS trusts to recruit nurses. Analysis by consultancy Christie & Co suggests that adult social care has a 9% nurse vacancy rate, compared with 7% in the NHS.

“It takes time to train nurses so in the short term we have to get nurses who are already trained into the country,” says Michael Hodges, director of healthcare consultancy at Christie & Co. “Care homes really want to hire nurses from overseas, which in the past has been really successful. The tightening of the system and the fact that some could even be forced to return home doesn’t help matters at all.”

Dr Pete Calveley, chief executive of care home provider Barchester, says that with 15,000 nursing vacancies across the NHS and social care it’s a “nonsense” for nursing not to have official recognition as a shortage occupation. Despite the difficulties with securing their entry, Barchester has returned to trying to recruit nurses from outside the EU because of the shortage in the UK and the fact that EU nurses who join the care sector often move on quickly to the NHS.

“Last year we recruited 800 nurses but lost 1,000,” he says. “The cost of recruiting is absolutely huge. Yes, let’s train more nurses in the UK but let’s also recognise that nursing is hugely in demand and not make the search for them so inappropriately burdensome. Although there are thousands of vacant posts it’s not considered a shortage which seems bizarre.”

We’re running a themed week on nursing on the Healthcare Network. If you’ve got a standout experience you’d like to share about your nursing career, tell us about it here.

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