Uncertain overseas recruitment is threatening care, NHS leaders warn

Authors: Gareth Iacobucci 

Publication date:  08 Nov 2017

Continuing uncertainty over the recruitment of staff from other countries in the wake of Brexit is threatening the provision of safe, high quality care in the NHS, hospital leaders have warned.

In a new report NHS Providers, which represents NHS trusts, says that domestic “quick fixes” are not an option for solving severe workforce shortages in the NHS.[1] The report warns that any significant reduction in the number of overseas staff in the next few years would have a “serious and damaging impact” on services.

NHS Providers criticises the Department of Health for England and its national arm’s length bodies for a “slow, disjointed” response to the NHS’s workforce challenges. It calls on them to urgently develop a “clear sighted” and coherent workforce plan for the NHS to ease the pressures on frontline staff.

The report includes findings from a new survey of NHS bosses from acute care, community care, mental health, and ambulance trusts. Chairs and chief executives of more than half (51%) of trusts responded to the poll, with two thirds (66%) of respondents citing workforce concerns as the most pressing challenge in delivering high quality care.

More than eight in 10 respondents (85%) said that it would be important to recruit from outside the UK in the next three years, identifying Brexit as the main barrier to overseas recruitment in this period. The vast majority (90%) expressed doubt that approaches taken by the health department and its arm’s length bodies would help them to recruit and retain the staff they needed.

The report recommends that ministers should set out a fully funded plan to end the NHS pay cap during this parliament, urgently confirm the right to remain of the 60 000 staff from other EU countries working in the NHS, and commit to a future immigration policy that allows trusts to fill posts that cannot be taken—at least for the time being—by the domestic workforce.

It also calls on national leaders to work with NHS trusts to set up an international recruitment programme that they can opt into, to provide greater clarity on the timetable for increasing the domestic supply of clinical staff, and to avoid short term, stopgap solutions to tackle immediate workforce shortages.

NHS trusts themselves should seek to improve their workforce morale by tackling bullying, developing new roles, improving productivity, and providing more flexible working for staff, it says.

Chris Hopson, chief executive of NHS Providers, said, “The staff and skills shortages we now see reflect a fundamental failure at national level on workforce strategy. We don’t have enough staff with the right skills, and we’re asking far too much of our existing staff. NHS trust leaders are telling us there are no quick fixes to improve the supply of UK trained staff, and the outlook for international recruitment is uncertain.

“The government must deliver certainty for EU staff. It should reassure them that their commitment to the NHS is greatly valued and will continue to be welcome. It should also provide assurance on immigration policy so trusts can continue to recruit overseas while we strengthen our workforce here.”


  1. Providers NHS. There for us: A better future for the NHS workforce. Nov 2017. [Link] .

Gareth Iacobucci The BMJ

Cite this as BMJ Careers ; doi: