How to Tackle the UK's Chronic Nursing Shortage—and Help Development

What if there were a way to reduce the nursing shortage in the UK in a way that is good for the National Health Service (NHS), good for developing countries, and good for nurses? We believe this is possible, with something called a Global Skills Partnership, that uses UK aid in a win-win partnership with developing countries. In this blog post we explain exactly how it could work to relieve the strain on the UK’s beloved NHS, and how such an idea might be replicated in other countries and other contexts.

The NHS is in severe need of more nurses—with approximately 27,000 vacancies for funded positions in England. The UK is highly reliant on foreign labour for healthcare: approximately 15 percent of registered nurses were trained in other countries.

Recent data reveals that new registrations of nurses trained in the European Union with the UK Nursing and Midwifery Council (NMC) have dropped sharply and steadily since the referendum vote to exit the EU in June 2016. New EU nursing registrations have dropped steadily from over 1,000 per month in April 2016 to fewer than 50 per month a year later. Simultaneously, the number of EU-trained nurses leaving the register has doubled from around 200 nurses in the month April 2016 to 400 a month one year later. These figures suggest that the supply line of EU nurses to work in the UK is significantly decreasing.

CGD’s recent policy paper lays out why a Global Skills Partnership (GSP) between the UK and a developing country would be a cost-effective way to supply more nurses to the NHS and promote skill creation to support the health system in a developing country. A GSP combines training funded by a donor with pre-agreed arrangements for qualified graduates to work temporarily overseas in the donor country. Given the healthcare needs of the UK, uncertainty of Brexit, and appetite for new approaches to migration, the timing is ideal to pilot a GSP for nursing between the UK and a partner country.

Brexit uncertainty

There are about 25,000 foreign-trained nurses from EU countries currently practicing in the UK. Nearly all of those face uncertainty about their future status in Britain. Despite the recent government proposals that EU citizens will have a right to apply for “settled status” in the UK, there are dozens of unanswered questions about cut-off dates, rights of family members, and future mobility. Political and press reaction emphasised that the proposals have still left EU citizens in a state of limbo.

Jackie Smith, Chief Executive and Registrar of the NMC, reported that uncertainty about the impact of Brexit on individual nurses was likely one of the contributing factors to the trend of fewer EU-trained nurses joining the register and more leaving.

It already takes longer and costs more to recruit non-European nurses in the UK, as we have written about here. Furthermore, the 2017 Conservative Party Manifesto proposes to double the Immigration Skills Charge levied on companies employing migrant workers, including nurses, to £2,000 per worker per year.

At least for the foreseeable future, it appears the domestically trained nursing supply will remain insufficient to cover increasing demand for British care, the number of EU nurses in the UK may decrease, and foreign recruitment from further abroad may remain obstructed.

New migration approach

A Global Skills Partnership is a framework for bilateral arrangements linking skill creation in a lower-income country with controlled labour mobility to a higher-income country. The framework was originally proposed by our colleague Michael Clemens.

The UK and another developing country could agree to a partnership that would draw from the UK’s aid budget to invest in scaling up training for nurses in the partner country. It is a vital component of the proposal that the total supply of trained nurses would increase in the partner country. Some of those qualifying nurses could apply to work for the NHS in the UK—after obtaining accreditation—on a temporary visa before returning to their home country.

As CGD has reported, the idea of a GSP is gaining international attention and traction. Last month at a meeting in New York, the Canadian government recommended that piloting of GSPs should be included in the Global Compact for Migration. And this week the Global Forum on Migration and Development is hosting their Summit Meeting in Berlin and will dedicate a roundtable discussion to GSPs.

Our policy paper calculates the costs and benefits of an example GSP between the UK and Malawi for nursing and finds potential net benefits of almost £50 million for four cohorts of 100 nurses. Investing in training and enabling mobility delivers dramatic value for money for UK aid, with a ratio of real benefits to costs of more than four to one. That excludes important benefits that are not calculated here: better healthcare and outcomes in both the UK and Malawi.

The timing is ideal to pilot a GSP for nursing between the UK and a partner country. Next steps would be:

1.    Establish a willing partner country that would welcome and benefit from increased nursing training capacity.

2.    Negotiate a bilateral agreement that shows a stable and long-term commitment from both countries.

3.    Set up a cross-government working group in each country to integrate policy elements of workforce planning and training, public health priorities, foreign aid, migration, and border control.

4.    Define the flow and timing of funding to clearly outline the costs that the donor country would be covering, and establish that each country had the financial capacity to pay the salaries of the new nurses. 

5.    Support a streamlined licensing process for GSP nurses to register with the UK’s Nursing and Midwifery Council.

6.    Involve industry groups, unions, and nursing bodies from the design stage to ensure that a GSP is positively received among nurses already practicing in the UK.

7.    Plan for the full life-cycle of employment for a smooth reintegration into the healthcare system for nurses in their country of origin.

Any proposal to promote labour migration can be sensitive in the current political climate, but where the economic analysis is compelling, supporting a win-win opportunity for both sides, it may be time for political leadership to overcome immediate political sensitivities to promote good policy.  


CGD blog posts reflect the views of the authors, drawing on prior research and experience in their areas of expertise. CGD is a nonpartisan, independent organization and does not take institutional positions.

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