Overseas-trained staff: the critical issues

Overseas-trained clinical personnel play a vital role as part of the fabric of the NHS. With a chronic shortage of doctors, nurses and allied health professionals in the UK, and not enough new entrants into the profession to meet the increasing demands of the growing and ageing population, the NHS has long since been reliant on the skills of healthcare professionals who were born and trained overseas. This trend is set to grow exponentially in the coming years. Sometimes, however, this has proven controversial. Recent high profile cases, such as the substandard practice which led to the tragic death of David Gray1, have encouraged heated debate about how overseas professionals can effectively demonstrate their competence to work within the health service. The challenge for procurement heads is how to achieve the best outcomes when recruiting overseas professionals to their hospital or clinic; how to identify the right people for the right roles; and provide a smooth and effective induction.

Immigration and the NHS

International healthcare professionals have been fundamental to the infrastructure of the NHS since its earliest days. Its inception in postwar Britain coincided with the beginning of a wave of immigration from the Commonwealth and Colonies. The burgeoning health service welcomed skilled new arrivals with open arms. The 1960s saw a deliberate policy of encouraging the immigration of overseas health staff to ensure the smooth running of the NHS, and this continued into the following decades. Today, General Medical Council figures show that more than 91,000 of the UK’s 243,900 registered doctors gained their medical qualification outside Britain. Last year, 1,800 EU nurses who received their training outside the UK joined the Nursing and Midwifery Council Register, along with 500 nurses who trained outside the EU. This trend is set to grow as there are simply not enough UK school leavers entering the caring professions to keep up with the healthcare needs of a population in which pensioners now outnumber under-16-year-olds. More recently, the introduction of the European Working Time Directive, which limits junior doctors to a 48-hour working week, has put a significant strain on hospital rotas and resulted in some disgruntled juniors leaving the NHS for work abroad, where they can receive more comprehensive on-the-job training. Against this background, the UK needs international healthcare professionals more than ever and without them, the NHS would not be able to function. It is little wonder, therefore, that the Government’s proposed cap on immigration is causing great concern among many NHS Trusts who fear that they will not be allowed to recruit as many overseas professionals as they need for the smooth running of their hospitals and a high standard of patient care. With the existing UK healthcare workforce ageing (over a third of nurses, for example, will retire in the next decade), and junior doctors leaving the NHS in ever larger numbers, it is to be hoped that the Government will re-think the cap when it comes to vital international healthcare staff.