England’s CNO warns overseas recruitment must reduce

The international recruitment of nurses to work in the UK cannot continue at the same high level that it is now, England’s chief nursing officer (CNO) has warned.

Dame Ruth May said that all overseas nurses were welcome in this country but added that it would “not be right” for the NHS to carry on recruiting 20,000 internationally educated nurses every year.

Speaking at an event on Monday, Dame Ruth noted that the government’s ‘50,000 more nurses’ commitment had been met and that the number of additional nurses had now reached 60,000.

This expansion in the workforce should be celebrated, but while recognising that more nurses were still needed, the CNO told delegates at the event.

“I’m not standing in front of you to say that’s enough,” she said. “I’m not standing in front of you to say I’m complacent, ‘we’ve done the target, let’s move on’. I’m not saying that at all,” she said.

“What I am saying there is, we do stand today having 60,000 more nurses than we did. But I know we need more.”

However, she also revealed that more than 90% of the 50,000-target had been met with nurses from overseas.

Since the pledge was made as part of the Conservative Party’s 2019 election manifesto, international nurse recruitment has been scaled up from 5,000-6,000 a year to 20,000 now.

“And they’re all welcome,” said Dame Ruth, who was speaking at the Celebrating Preceptorship event in London.

But she added: “Now that can’t continue. I don’t think it’s right for us to continue at that level of recruitment.

“We will continue international recruitment, of course, they’re very valued parts of our teams, but not at that amount.”

She said focus and investment needed to be placed in future on boosting the domestic supply of nurses and retaining existing staff, and pointed to the ambitions in the NHS Long Term Workforce Plan.

The plan is seeking to increase the number of nursing training places by 34% to 40,000 by 2028-29 and 53,858 (80%) by 2031-32.

However, Dame Ruth acknowledged that the latest data from the Universities and Colleges Admissions Service (UCAS) on applications to study nursing at university presented a “challenge”.

Figures released last month showed that, as of the January deadline, 24,680 people had applied to study nursing in England for 2024-25 – a decline of 10% from the year before and 26% when compared with 2022 and 32% from 2021.

Although one thing Dame Ruth said she was “proud” of what the fact that 60% of nursing associates were now carrying on their training to become registered nurses.

“That’s something to be proud of, how we’re… being able to widen the access to people coming into our professions,” she said.

Retention in the nursing workforce had also got better, said Dame Ruth, who noted that the leaver rate was now back down to pre-pandemic levels at 5.8%.

She cited improvements to preceptorship and retire-and-return policies as factors that had helped with retention.

A general election is expected to take place this year and Dame Ruth said elections provided an “opportunity to ensure that money flows into our profession”.

She hinted that an investment into nursing apprenticeships may be on the horizon.

It came after a clinical education lead in the audience at the event called for more support for employers to cope with the associated costs of taking on an apprentice.

The delegate said: “If you put yourself into the shoes of an 18-year-old school leaver, a potential nurse of the future, it is a buyers’ market.

“UCAS applications are down 25% and for a lot of organisations, this means that the apprenticeship route is going to have to become a much more significant part of our offer.

“One of our big blockers for that is the backfill costs. So election year or no election year, what can be done to look at salary support for apprenticeships?”

In response, Dame Ruth said she backed apprenticeships “110%” and highlighted the “big increase” in nursing apprenticeships promised in the long-term workforce plan.

The plan advocates for the proportion of student nurses training through apprenticeships to increase from the current 9% to 28% by 2031-32.

“But it can’t be done unless we sort the funding model out,” admitted Dame Ruth.

“I’m hoping to see some movement on that this month; that we’ll see a big investment in apprenticeship funding, because that’s the way I think we will get the social mobility that’s needed.”

Dame Ruth was also questioned during the event about the clinical educator workforce and how it would be developed.

She acknowledged that, in order to achieve the ambitions of the workforce plan, “we’re going to have to have clinical educators on steroids, because we’re going to need lots”.

She flagged early conversations that she was having with the Royal College of Nursing about encouraging nurses from the NHS to be seconded to academic institutions “to support clinical practice in the future”.

However, Dame Ruth said there was “a lot more to do… to make some of that a reality”.

On the subject of international recruitment, a preceptorship lead from an NHS trust, who also described themselves as an international nurse, asked the CNO what national strategies were in place to retain those recruited from overseas.

Dame Ruth said the international nursing and midwifery associations (INMAs) in England were key, as they provided overseas nurses with access to support from “people who know their culture and their background. which is really important”.

The number of INMAs in the UK had grown significantly from just three before the pandemic to 36 now, she noted.

However, she said there was also more that employers could do to recognise the prior experience of internationally educated nurses – an issue that has come to the fore in the last few years.

“There are lots of people who are coming over on a band 5 but actually, they’ve been an ITU sister, they’ve been in an organisation very senior, and we don’t always recognise that experience,” she said.

Recognising prior experience of international nurses would mean “we'd be able to retain them because we’d be paying them at the appropriate grade”, said Dame Ruth.