Overseas nurse recruitment and the NHS

The recruitment of nurses from overseas is vital for securing the staff we need in order to meet ambitious national goals to expand the workforce - but what are the benefits and costs? This major new research commissioned by NHS England and NHS Improvement explores the business case for overseas recruitment and looks at the factors that attract or deter nurses from choosing to work in the UK.

There are some 342,300 nurses working in NHS hospital and community health services, and 23,900 working in general practice.1 Yet vacancies are widespread: there were 39,000 full-time equivalent nurse vacancies by mid-2021, representing a 10% vacancy rate. The equivalent figure for doctors is 7%.

The 2019 NHS Long Term Plan committed to reducing the nursing vacancy rate to 5% by 2028. Later that year, the government pledged to increase the number of NHS nurses by 50,000 by 2025. Achieving these ambitious goals will require sustained effort using a variety of approaches, including improved retention, an increase in the number of nurses being trained domestically, and attracting previous NHS workers back into practice and employment. However, given the time required taken to train new nurses, recruitment of international staff remains vital for addressing the current widespread vacancies. 

This new research, commissioned by NHS England and NHS Improvement, explores the business case for overseas nurse recruitment, quantifying the various costs and how long recruits stay in post. 

In this briefing, we consider lessons for the NHS. Our research report presents the data and analysis we carried out in more depth.

We have also conducted a review on factors that attract or deter staff from choosing to work in the NHS in England, based on interviews, data analysis and a literature review. The report draws out the contribution of overseas recruitment to the supply of staff and some of the key push and pull factors in the decision to move. We also looked at what influences nurses' selection of a particular trust or region and how the recruitment process works. 

Key points 

  1. As of mid-2021, the vacancy rate for nurses was 10%, equivalent to 39,000 full-time posts. 
  2. Nurses from outside the UK or EU are more likely to remain in the NHS as a whole than nurses of UK nationality (93% versus 90%) and more likely to remain in the same organisation (89% versus 84%), based on data for the year to October 2019.  
  3. In a given year, typically around 1 in 16 nurses (around 6%) are recorded as moving to another NHS organisation. 
  4. Nurses recruited from outside the UK are contracted, on average, to work more hours than those from the UK. On average, nurses with EU nationality work 93% of a full-time contract, while nurses from outside the EU and the UK work 97%, compared to 88% for nurses with UK nationality. It is not clear whether higher participation is due to desire or lack of opportunity. 
  5. We estimate that, in the case of a nurse joining the NHS aged 30, on average we may expect an EU national to work in hospital and community services for 6 years before leaving, compared to 9 years for a UK national and 12 years for someone from the rest of the world. 
  6. While there are considerable upfront costs in recruiting nurses from overseas (around £10,000 to £12,000), this needs to be considered in the context of national funding to support such activities, and the longer-term or broader costs of alternative routes to increase nurse numbers, such as use of agency nurses or increasing domestic training numbers.
  7. It is expensive to use temporary staff to fill vacancies. Any savings from not recruiting internationally would typically be written off within six months to two-and-a-half years. 
  8. Overseas recruitment will have to be a major contributor if the goals on increasing nurse numbers are to be met in the short and medium term. In the long-term there is potential for international recruitment to return to lower levels, encouraging cultural exchange but not overreliance.
Download the briefing [PDF 269.4KB]

Download report on drivers affecting international recruitment [PDF 350.4KB]

There was a full research report delivered to NHS England which can be downloaded here.

Suggested citation

Palmer W, Leone C and Appleby J (2021) Return on investment of overseas nurse recruitment: lessons for the NHS Briefing, Nuffield Trust

Palmer W, Leone C, Pew A, Davies M and Appleby J (2021) Recruitment of nurses from overseas: return on investment Research report, Nuffield Trust

Palmer W, Leone C and Appleby J (2021) Recruitment of nurses from overseas: Exploring the factors affecting levels of international recruitment Research report, Nuffield Trust

Excludes the small number employed by primary care networks. The numbers for those working the NHS are for December 2020. Based on NHS Digital workforce statistics and General Practice workforce data.