The growing overreliance on international recruitment is “concerning for the future of the workforce”, the lead for Scotland at the Nursing and Midwifery Council has said.
At a conference around the health and social care workforce in Scotland, Matthew McClelland said that to grow and retain the nursing workforce, the focus must also be on investment in education and training here in the UK.
Mr McClelland, who is also the NMC’s executive director for strategy and insight, described how there is currently a “record” 72,000 nurses and midwives on the NMC register in Scotland.
However, he warned, the number of people leaving the profession also continues to rise, as 2,750 nurses and midwives in Scotland left the register in 2021.
One of the key reasons that people leave is because they are under too much pressure or that workplace culture is having a negative effect on them, said Mr McClelland.
“Finding ways of reducing pressure, creating more positive open cultures, and supporting people’s mental health and wellbeing are all likely to help the people in the professions,” he added.
At a UK level, international recruitment has been the major driver in growth of nurses over the last 10 years, Mr McClelland said, citing that last year nearly half of all newly registered nurses and midwives who joined the NMC register were internationally trained.
He welcomed the investment in international recruitment in Scotland, stating that it is “highly likely” to expand the workforce, but warned there are risks associated with this.
He said: “We have a huge responsibility as one of the richest nations in the world to make sure that our recruitment into our health and social care sector doesn’t come at the expense of the health systems in low and low- and middle-income nations.”
Referring to the World Health Organization’s code of practice, which identifies countries where active recruitment is possible and where it is prohibitive, he said it is “really essential” that international recruitment in Scotland is done in line with ethical best practice.
He said: “Our data at UK level also shows rapidly accelerating growth in numbers of nurses from countries where active recruitment by employers is actually prohibited, and that really is very concerning.”
Another risk associated with increased reliance on overseas recruits is sustainability of supply and being vulnerable to “external shocks”, said Mr McClelland.
Both the UK’s exit from the European Union and travel restrictions imposed due to the coronavirus pandemic were recent “external shocks” which had a serious impact on international recruitment, he warned.
He added: “In that context, overreliance on international recruitment would be concerning for the future of the workforce. It’s really important to focus therefore, not just on international supply, but also on investment in education and training here in the UK.”
In terms of the landscape of both health and social care, Mr McClelland said that while there has been an increase in the proportion of people who have told the NMC that they are working in community settings in Scotland, there has been a drop in the proportion of people reporting that they work in the care home sector.
Therefore, he welcomed an integrated workforce strategy for health and social care and the steps that are being taken to establish a national care service for Scotland. He said a “coordinated and strategic” approach to workforce planning had the potential to “help support a transformational shift” in care.