To Recruit from Overseas or Not to Recruit from Overseas…is it still a question?

To Recruit from Overseas or Not to Recruit from Overseas…is it still a question?

One of the key concerns healthcare employers have when considering whether to recruit from overseas is the upfront cost involved in relocating candidates from overseas, including costs such as the Immigration Skills Charge, flights and accommodation on arrival, not to mention the costs associated with NMC registration. 


However, according to research conducted by Nuffield Health (2021), the upfront costs of international recruitment “need to be considered in the context of national funding to support such activities, and the longer-term or broader costs of alternative routes to increase nurse numbers, such as use of agency nurses or increasing domestic training numbers.” 


The charity-funded body goes on to state that, 


“Overseas recruitment costs equate to around £1,000 per year – or 3% of the mean annual nurse salary – if considered over the typical average NHS career of a nurse from outside the EU (or in the region of £1,500 per year if spread over the expected time employed in the recruiting organisation). 


While the upfront cost of employing a nurse trained domestically may be low for a Trust, seeking to meet the bold ambitions to increase nurse numbers and reduce the vacancy rate solely through the homegrown workforce would be expensive for the public purse. The government spends at least £26,000 (and sometimes far more) on a typical single nurse undergraduate training post and not all trainees will necessarily graduate Return on investment of overseas nurse recruitment: lessons for the NHS 3 or join the NHS. Other sources of nurses are also needed as a short-term solution to current high vacancy levels given that an undergraduate pre-registration nurse degree course is typically 3 years. Looking at other routes, it can cost a Trust around £140,000 over and above the levy for a nurse apprenticeship.” 


The challenge is, the alternative to international recruitment isn’t particularly attractive. Temporary staff are expensive and recruiting locally can be a challenge. Indeed the evidence suggests that some “golden hellos” have “comparable costs to recruiting from overseas”. 


Yet if employers do nothing, they risk losing further staff to overwork and a loss in reputation as they struggle to maintain standards.  


Most UK employers who have recruited internationally for a number of years find the return on investment worthwhile, and have built international recruitment into a sustainable strategy for responding to increased demand. 


However, according to the King’s Fund, there should be a more collaborative approach to international recruitment that allows employers to benefit from economies of scale, 


“NHS England and Health Education England should establish a regionally led but nationally funded and co-ordinated programme of ethical international recruitment. Local and regional organisations should work together to understand local need for international recruits and ensure that recruitment is regionally led. National bodies should co-ordinate elements of the recruitment, such as visa processing, and make the most of economies of scale. National bodies need to grow existing national schemes for doctors and nurses to come to the NHS, like the Medical Training Initiative. There should be robust evaluation of these schemes to understand their impact on domestic and international health workforces. Regions should be compensated for international recruitment through existing funding routes, to ensure that international recruitment costs employers no more than employing domestically.” 


Indeed we have seen such collaborations take place in initiatives such as the Capital Nurse project in London, and also to an extent via NHS frameworks such as Health Trust Europe. However, not all UK employers are able to access such initiatives, typically NHS organisations are prioritised above private organisations, and feedback from such schemes has indicated that sometimes the standardised approach has disadvantaged some of the smaller employers who have not been able to benefit from a more tailored recruitment approach based on their specific needs.  


In many ways, international nurse recruitment is not a choice but a necessity in the current market, but one that still has significant potential to be optimised, particularly in the private sector, in order to ensure that all employers can benefit from the proven return on investment and progress a sustainable workforce strategy. 

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