Real challenges for London's hospitals with up to one in four nurses trained overseas, according to new research from The King's Fund

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London depends far more on overseas trained health care workers than the rest of the country, according to the first report from a new research programme from The King's Fund into international NHS recruitment in the capital.

One hospital featured in the study revealed that one in four of its nurses was trained overseas. A recent Royal College of Nursing survey found that 14 per cent of its members based in London qualified outside the UK, compared to just four per cent in the UK as a whole.

London Calling? The international recruitment of health workers to the capital provides case studies of three London NHS hospital trusts and their experiences of recruiting overseas nurses. All three had undertaken 'active' recruitment drives in a number of other countries, as well as engaging in 'passive' recruitment of overseas staff who arrive unsolicited. The estimated proportion of internationally qualified nurses working in the three hospitals ranged from 12 per cent to 25 per cent. The majority of the overseas-trained nurses were from the Philippines, Australasia, India, Ghana and Nigeria, but nurses from many other countries were represented. One hospital revealed it employed nurses from 39 different nations on its wards.

Report author Professor James Buchan said:

'International recruitment was initially regarded as a quick-fix but it's now clear this is an integral part of many hospitals' recruitment strategies. While overseas health workers are playing a key role in delivering patient care in the capital, the NHS cannot afford to rely too heavily on them and must do more to recruit people from local communities. This will help provide a more sustainable solution to London's health workforce challenges. The NHS is already doing a lot of positive work in these areas, but some of the challenges presented by international recruitment are unique and need particular attention.'

The research says London's reliance on overseas health workers will bring three key challenges. First, the NHS will need to ensure it is able to support and develop a culturally and ethnically diverse workforce. Second, the capital must be prepared to stave off the threat of growing international competition for its overseas staff from other English-speaking countries looking to boost their health workforces, such as the United States. And finally, the NHS will need to strike an ethical balance between supporting the rights of individual health workers to come to London with the damaging impact this can have on developing countries that are experiencing their own staff shortages.

The King's Fund chief executive Niall Dickson said:

'Nurses and other staff from overseas are helping to provide the vital extra capacity that's needed to improve patient care. Without them the NHS in London would be under even more pressure and patients would suffer. But we need to remember that, while we benefit from international recruitment, other countries are losing out. The current safeguards don't seem to be working - it is time to look again at this issue to ensure that we are not harming patients in developing nations who desperately need these professionals themselves.'

The Department of Health code of practice on international recruitment only covers staff directly recruited to the NHS from overseas - not those who may have first been recruited by private health care services or agencies.

The King's Fund research programme is continuing with a major survey of internationally recruited nurses to find out what their experiences of the NHS are, how long they plan to stay in the capital and whether they are adequately supported by their employers. This forms part of a wider programme of workforce research The King's Fund is carrying out in partnership with the NHS in London.

Read the report: London calling? The international recruitment of health workers to the capital

Notes to editors

1. For further information or interviews, please contact The King's Fund media and public relations office on 020 7307 2585 or 07831 554927.

2. London Calling? The international recruitment of health workers to the capital, by James Buchan, Renu Jobanputra and Pippa Gough, is free to download from Thursday, 15 July 2004.

3. Key NHS workforce facts:

  • In 2003, more than two-thirds of the 15,000 new full registrants on the General Medical Council register were from abroad
  • In 2002/03, 43 per cent of new nurse registrants in the UK were from abroad. More than 27,000 work permits were issued to nurses in 2003 compared with 14,000 in 2000
  • In 2003, the annual survey of Royal College of Nursing members found that 14 per cent of nurses based in London had qualified outside the UK – compared with just four per cent in the UK as a whole
  • One in three of the 71,000 hospital medical staff working in the NHS in England in 2002 had obtained their primary medical qualification in another country, according to the Department of Health
  • In April 2003, 54 per cent of the 849 refugee doctors on the British Medical Association and Refugee Council database of refugee doctors were based in London. 

4. London Calling? The international recruitment of health workers is the latest report to come out of the King's Fund's NHS workforce programme, which seeks to develop effective practice and transfer lessons learned in London to elsewhere in England. It is run in partnership with SHRINE - London's network of HR managers; the workforce arms of London's five strategic health authorities; and the Queen Margaret's University College Edinburgh. The programme's first report, In Capital Health? Creative Solutions to London's NHS workforce challenges, by James Buchan, Belinda Finlayson and Pippa Gough, was published by The King's Fund in July 2003.

5. 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.