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NMC register grows but concern over ‘red list’ recruitment

The number of nurses, midwives and nursing associates in the UK has reached a new record high, but international recruitment and retention remain a concern.

The Nursing and Midwifery Council (NMC) released its latest bi-annual report today, which showed that there are now 808,488 professionals on its register.

“Much more must be done to recruit and keep hold of the health and care staff who are so desperately needed.”

Stuart Tuckwood

According to the report, mostly focusing on change between April and September 2023, domestic and international recruitment both increased over the last six months.

There are now 19,857 (2.5%) more registered professionals on the NMC register since April of this year, and 114,874 (16.6%) since September 2018.

New joiners to the register in the last six months are up by 27.7% compared to April-September 2022.

However, it also showed that thousands of nurses and midwives have left the register in the last six months – and that the number of people who have been on the register for more than 30 years is declining.

Following the publication of the last NMC register report, leaders called for more domestic recruitment – and criticised an “over-reliance” on overseas recruitment which risked the UK solving its own workforce shortages by creating them elsewhere.

In the latest data, just over half (15,067) of the new joiners from the last six months were UK-educated. The NMC said this is the highest number of domestic joiners ever, and 25% higher than the same period in 2022.

An almost equal number (15,036) of new registrants were trained overseas, including 345 internationally educated midwives – a rise from 115 midwives in the same period in 2022 and 27 in 2018.

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Of the international recruits, 7,223 were trained in India, which is now the biggest supplier of nurses to the UK, followed by the Philippines and then Nigeria.

Meanwhile, a quarter of UK-educated joiners in that six month period were of Black or minority ethnic backgrounds, meaning the register overall is becoming more diverse.

In total, 29.1% of the register is now made up of Black and minority ethnic people, up 1.4% since April.

“It is important that employers continue to be mindful of the government’s ethical recruitment code”

Andrea Sutcliffe

However, the latest NMC data has also reignited concerns over unethical recruitment.

‘Red list’ countries, from which the UK’s code of practice bans active recruitment, are facing nursing workforce shortages, but numbers on the NMC register from some these countries have increased.

It its report, the NMC said there had been a “significant proportional rises in joiners from Ghana and Zambia, plus a steadily high number from Nigeria”.

It is unclear whether the rises are the result of targeted recruitment from UK employers, or the nurses making a decision independently to migrate, which is allowed under the red list rules.

Unison

Stuart Tuckwood

Unison national nursing officer Stuart Tuckwood warned that, for those who do join from overseas, the experience was becoming more hostile.

“Around half of new nurses are from overseas and without them, the NHS would collapse,” Mr Tuckwood said.

“Ministers must understand there are consequences to demonising migrant workers, who may choose to simply go to more welcoming countries.”

Mr Tuckwood welcomed the overall rise in the number of registrants more broadly, but added: “The NHS workforce crisis hasn’t gone away.

“The number of students starting nursing courses this year in England has plummeted by 12%.

“Much more must be done to recruit and keep hold of the health and care staff who are so desperately needed.”

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Professor Nicola Ranger, chief nurse of the Royal College of Nursing (RCN), said the NMC’s figures showed the UK had become over-reliant on “unethical international recruitment”.

She said: “[This] cannot continue. It’s a false economy. The government should invest in nursing staff in the UK, funding nurse education and fair pay – not destabilising other health care systems.”

Nicola Ranger

Meanwhile, she added: “The headline findings of this report don’t reflect what nurses are seeing on the NHS frontline.

“Since 2019, the NHS waiting list has grown four times faster than the nurse workforce, meaning there aren’t enough staff to provide the outstanding care patients deserve.”

Similarly, Miriam Deakin, director of policy and strategy at NHS Providers, agreed that the “depleted” nursing and midwifery workforce would welcome newcomers – but shared worries about unethical recruitment.

“While overseas healthcare workers in the UK are invaluable, the rise in joiners from ‘red list’ countries is concerning,” she said.

“International recruitment must be done ethically, in line with the Department of Health and Social Care’s Code of Practice.”

The NMC described the retention rate among the nursing and midwifery workforce as “steady”; according to the figures, 13,308 people have left the NMC register since April, equating to 1.7% of the register – down from 2% in 2018.

Miriam Deakin

Ms Deakin said, on retention: “Demand on healthcare services has also risen since the pandemic, so the mismatch between demand and capacity persists.

“Recruiting more staff only goes so far to address this. We also need to focus on retaining staff by continuing to improve workplace culture, which includes stamping out racism and discrimination.”

This was a sentiment shared by Danny Mortimer, chief executive of NHS Employers, who said: “We must continue to improve working conditions to make sure new graduates and existing staff want to stay in the NHS.

“If anything, retention is just as important as attracting new staff into the NHS and will be key in the short term to preventing pressures from worsening and ensuring the recruitment base we are looking to build from has solid foundations.”

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In Scotland, there was a far smaller increase (0.5%) in the number of registered professionals than the UK overall.

RCN Scotland director Colin Poolman said that while this meant the numbers were at an all time high – it was still not enough and pointed to persistently high vacancies in the country.

RCN Wales director Helen Whyley said, in her view, the report showed that recruitment had not kept up with patient need.

Speaking on the figures overall, Andrea Sutcliffe, chief executive and registrar of the NMC, said that the increase in nurses was “encouraging”, but echoed the concerns of other health leaders about high levels of international recruitment – particularly among red list countries.

“It is important that employers continue to be mindful of the government’s ethical recruitment code, since we’re seeing many joiners from ‘red list’ countries,” she warned.

Nursing and Midwifery Council

Andrea Sutcliffe

“People from across the world want to come and work in the UK. However, employers must not undermine health systems in countries with the most pressing workforce challenges through active recruitment.”

The NMC report also showed a decrease in the number of people who have been on the register for a long time.

Registered professionals who have been on the register for 30 years or more decreased by 0.8%, and those who have been on it for 10 to 30 years by 0.3%.

Meanwhile, the number of nurses on the register for five to 10 years increased by 5.2%, and the number increased by 7.8% for those who have been registered for fewer than five years.

The register has also become overall younger: 43.5% of the register is made up of people aged 21-40, down from 42.7% six months ago, and 37.7% in September 2018.

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