Health professionals’ migration and the wider public ...

Health professionals’ migration

and the wider public policy context

From Boom to Bust to Boom?

Stephen Bach Department of Management

stephen.bach@kcl.ac.uk

Overview

• What has been the policy context for nurse migration in the UK? • What are trends in nurse migration and how can fluctuations be explained? • What are policy and conceptual implications? - NHS a distinctive case - globalisation

International recruitment: Historical legacy

Received training but… channelled into lower status routes and specialties

30%

14%

36%

19%

35%

22%

10%

15%

20%

25%

30%

35%

40%

Medical Practitioners Nurses Source: WHO 2014

Stock: Foreign-Born Share of Medical and Nursing Occupations, 2000-2012

2000

2006

2012

(Cited in RCN, 2013)

International and UK source as percentage of total new admissions to the UK nursing register, 1990/1 – 2012/3 (Initial Registrations)

Trends in Nurse Migration: ‘Boom’ 1999-2005/6

• Targets for workforce expansion: ‘Each SHA had a target to meet on workforce, it was the responsibility of those IR co-ordinators to assist the trusts on their patch to achieve the target through international recruitment. The nursing target was just hit very quickly. It was easier to get buy in from the NHS to recruit nurses from overseas because there was this long tradition’ • Active overseas recruitment/institutional infrastructure to support recruitment • Permissive work permit regime • Employer preferences: ‘A, there was a gap in the workforce, B, it was a quick fix option and C, particularly with some nationalities we thought they would actually stay’.

Trends in Nurse Migration: ‘Bust’ 2005/6 -?

• Over-recruitment: ‘There has been a disastrous failure of workforce planning. Little if any thought has been given to long term or strategic planning’ (Health Committee, 2007:3) • NHS deficits/foundation status/savings programmes • Shifting government approach: - political sensitivity overseas recruitment - emphasis on self-sufficiency - changes in immigration rules • Unintended consequences: - jobs for newly qualified nurses - integration of overseas nurses into the workforce

1,200

1,400

1,600

1,800

2,000

2,200

2,400

2,600

2,800

3,000

1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014

thou

sand

s, s

easo

nally

adj

uste

d UK Public Sector Employment – Contrasting

NHS and Local Government Trends

Local Gov

NHS

Source: ONS

NHS contradictory pressures on staffing Increasing demands on the NHS

• Reduced nurse commissions

• Impact of government pay freeze and 1% pay policy: - industrial action e.g. midwives - grade-mix & downbanding

• Francis Report: Safe staffing levels

• Increased overseas recruitment: - from EU ‘crisis’ countries - non-EEA but visa restrictions - HCAs ‘informal’ recruitment

Trends 1990/1- Admissions to the UK nursing register from EU countries and non-EU countries, 1990/1 – 2012/3

Conclusions • NHS a distinctive case: - opportunity: centralised financing & control - threat: political sensitivity & short-termism • Influence of globalisation? - global workforce shortages - globalisation narrative legitimates state policy - underplays active state intervention • Policy options: - scale-up - retain – retention/return to nursing - new roles & new ways of working - international recruitment