Biggest ever survey of overseas nurses working in London highlights that many are thinking of leaving the UK

The NHS in London could face a staffing crisis in the future with more than four out of every 10 overseas nurses working in the capital admitting they are considering leaving the health service to take up posts in other countries.

That is the key finding from the biggest ever survey of internationally recruited nurses working in the capital, which has been published today by The King's Fund and the Royal College of Nursing. A major concern of the survey is that two thirds of Filipino nurses working in London – one of the largest overseas nursing staff groups - are considering leaving the UK to work in the US.

Report author Professor James Buchan said:

'The NHS and independent health care sectors rely heavily on overseas nurses to deliver health care – without them, parts of the health service would collapse. They perform a crucial and valuable role but our survey shows the NHS is playing a high risk game by relying on these overseas staff to commit long term to the NHS.

'Many of these nurses are considering leaving the NHS and that would pose real problems. It's clear the NHS needs to up its efforts to grow its own workforce to ensure we have the right number of nurses for the future. The good news is that many of these nurses also signal that they could stay on if their UK employer treats them well.'

Almost 400 nurses took part in the survey from more than 30 different countries. It sought to find out why overseas nurses choose to work in the UK, where they are working and how long they are intending to stay. Among the key findings are:

Exploitation: many of the nurses surveyed, especially those from sub Saharan Africa, believe they are under-graded and underpaid in relation to their experience and responsibilities, while many reported being treated unfairly by the recruitment agencies that brought them to the UK. This shows bad practice persists in some organisations (mainly outside the NHS) and that some nurses are still being exploited.

Back-door recruitment: despite a government clampdown on the 'active' recruitment of nurses from developing countries, the survey revealed clear evidence of 'back-door recruitment' with many nurses reporting they had initially worked in the UK for private sector employers before moving quickly, or immediately on completion of their adaptation course, to work in the NHS. Some nurses, mainly from sub Saharan Africa, also reported that they had to pay for some of the services provided by agencies and that they even went without pay during this period of work.

Motivation: although nurses coming to the UK can hope to earn many times more than they can in the developing countries of sub Saharan Africa, the survey revealed that many are here primarily for professional development or to take the opportunity to travel. Almost two thirds of nurses for whom finance is a significant factor reported that they were the sole or main breadwinner, and more than half said they regularly sent money back to family and friends in their home countries.

RCN general secretary Beverly Malone said:

'This is further compelling evidence of the weakness in the government's Code of Practice. With two-thirds of nurses reporting that a recruitment agency has been involved in their move to the UK, it is imperative the government takes urgent steps to extend the Code to cover the private and independent sector.'

Following the survey findings, The King's Fund and RCN are calling for:

  • The Department of Health should implement House of Commons Select Committee recommendations and track the number of overseas nurses the NHS recruits and employs. It should be more transparent about how many overseas nurses it plans to recruit in the future.
  • All UK employers should work with each international nurse they recruit to draw up individual career plans to ensure these nurses can work effectively and meet their career aspirations.
  • The 'back door' recruitment via the private sector undermines the DoH Code of Practice on international recruitment. As a result, the NHS should commit to making available sufficient resources for the necessary number of adaptation and supervised practice placements within the NHS, rather than relying on nurses to pay for nursing home-based adaptation and then recruiting them soon afterwards.

The King's Fund chief executive Niall Dickson added:

'This survey shows there are big problems with the way international nurses are being treated - it's clear many of them feel underpaid and exploited. We've got to find a better way of treating this vital group of workers if their experience in the UK is to be a positive one both for them and for our health system. Unless we address this issue fast those nurses thinking of moving to another country are more likely to make the move and that could have serious consequences for the NHS.'

The first findings of the survey are published today in the Nursing Standard.

Notes to editors: 

1. For further information or interviews, please contact The King's Fund media and public relations office on 020 7307 2585, 020 7307 2581 or 07831 554927. An ISDN line is available for interviews on 020 7637 0185. For the RCN press office, please contact Rachel Dufton on 0207 647 3633.

2. The survey findings are published today in the Nursing Standard. It is a major strand of a research programme The King's Fund, in partnership with the NHS in London, is carrying out into international NHS recruitment in the capital.

3. Survey facts and figures

  • Returns were analysed from 380 international nurses who were London-based RCN members. They came from more than 30 different countries. The Philippines, Nigeria and South Africa were the three most commonly reported countries of training
  • There was a broad age profile of international nurses. While most nurses from Australia and New Zealand were aged 34 or less; more than 60 per cent of nurses from sub Saharan Africa were aged 40 or older - usually with many years of clinical experience
  • At the time of the survey 69 per cent of the nurse respondents were working in NHS hospitals in London, 13 per cent were working in the independent sector and 10 per cent were working in nursing homes
  • In the last four years almost 60,000 international nurses have registered with the Nurses and Midwives Council in the UK – nearly half of all the new nurses registering to practice. It is believed that one in four nurses working in London is from overseas.
  • The Code of Practice for the international recruitment of healthcare professionals was published in December 2004 to set out standards and guiding principles for the recruitment and employment of healthcare professionals from abroad.

4. The King's Fund is an independent charitable foundation working for better health, especially in London. We carry out research, policy analysis and development activities, working on our own, in partnerships, and through grants. We are a major resource to people working in health, offering leadership and education courses; seminars and workshops; publications; information and library services; and conference and meeting facilities.

5. Royal College of Nursing (RCN) is the voice of nursing across the UK and is the largest professional union of nursing staff in the world. The RCN promotes the interest of nurses and patients on a wide range of issues and helps shape healthcare policy by working closely with the UK Government and other national and international institutions, trade unions, professional bodies and voluntary organisations.