Growing nursing staff numbers amidst concern over ‘red

New data from the Nursing and Midwifery Council (NMC) reveals a historic high of 808,488 eligible nurses, midwives, and nursing associates in the UK. The NMC notes a notable increase of 19,857 (2.5%) within the past six months and a substantial growth of 114,874 (16.6%) over the last five years.

Despite these record numbers, there are apprehensions about the rising trend of individuals joining from countries on the 'red list.' These are nations where active recruitment is restricted by the UK Government's code of practice, prompting concerns within the healthcare community.

The mid-year update from the NMC register reveals a total of 30,103 individuals joined in the six months leading up to September 2023. This reflects a substantial increase of 27.7% compared to the same period in 2022 (23,565) and more than double the figures recorded five years ago (14,311).

Of these new registrants, 15,067 received their education in the UK, marking the highest number of domestic joiners ever recorded in the first half of a financial year. This figure is nearly 25% higher than the corresponding period in the previous year (12,104).

It's worth noting that the surge in UK-educated joiners is partially attributed to a clarification made by the NMC to educational institutions since 2020. This clarification allows newly qualified professionals to join the register upon completing their programs, which could be as early as three academic years, rather than waiting until the end of three calendar years.

International Joiners

The number of international joiners closely mirrored that of the UK, totalling 15,036. India emerged as the leading single source of international recruitment, contributing 7,223 new joiners in the last six months. This represents a significant 49% increase compared to the period between April and September of the previous year when 4,849 individuals joined from India.

Nevertheless, the NMC expressed concern about the increasing number of individuals registering from countries on the red list. This trend included new registrants from Nigeria (1,536), Ghana (886), Zimbabwe (283), Zambia (189), and Pakistan (110) over the past six months.

It is important to highlight that, despite the codes of practice established by the Department of Health and Social Care (DHSC) and the Scottish Government, which prohibit active recruitment from red list nations, they do not prevent individual health workers from those countries from independently seeking employment.

The apprehensions surrounding recruitment from red list countries stem from the discovery of 'widespread fraudulent activity' at a testing site in Nigeria, utilised 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 voiced worry about the increasing number of individuals arriving from countries on the red list, along with notable imbalances in the supply and demand dynamics.

‘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.’

During a recent gathering of nursing associations, nurse leaders expressed significant apprehension about the repercussions of recruitment efforts that were exacerbating the vulnerability of health systems and contributing to substandard and exploitative hiring practices.

The registration data indicates a consistent retention rate, with 13,308 professionals having departed since April, equivalent to 1.7% of the total. This departure rate aligns closely with the figures from the same period the previous year when 13,164 individuals, representing the same percentage, left the profession.

The Nursing and Midwifery Council (NMC) observed a shifting ethnic composition within the register, marked by an increasing number of international professionals joining, and a more ethnically diverse group of UK professionals, with a quarter of the UK joiners since April being from Black and minority ethnic backgrounds.

The overall percentage of registered professionals from Black and minority ethnic backgrounds now stands at 29.1%, compared to 27.7% in April and 19.1% in 2018.

Additionally, there is a gradual transformation in the age distribution of registered professionals, indicating 'a slow but steady change.' Currently, 43.5% of professionals fall within the 21 to 40 age bracket, as opposed 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.