A quarter of all new nurses in the UK were trained in poorer countries with more severe staffing shortages, openDemocracy can reveal.

Since 2017, 50,000 of the nurses who registered to practise in the UK were trained in countries that have too few of their own nurses to provide the standard of healthcare recommended by the United Nations. 

Once registered, nurses can be employed in the NHS or the private sector. It is likely that the majority join the NHS, with 38,000 new NHS England nurses reporting their nationalities as countries with severe staffing shortages in the past five years – though it is not known where they trained.

This includes thousands of Ghanian, Nigerian and Nepalese nurses, despite the World Health Organization (WHO) discouraging active international recruitment from all three countries. 

The UK Department of Health and Social Care denied it has actively recruited nurses from Ghana, though Ghanaian nurses may still have sought NHS jobs. The department did not deny actively hiring Nigerian and Nepalese nurses.

openDemocracy’s analysis of data from the Nursing and Midwifery Council and the WHO comes amid a record shortfall of NHS nurses, with 46,828 empty posts in September. Yesterday, nurses in the UK voted to strike after the government refused their request for an above-inflation pay rise.

The number of foreign-trained nurses registering to work in the UK has increased sixfold since the government axed a fund for training NHS nurses in England in 2016. Then-chancellor George Osborne scrapped £800m worth of bursaries that covered the tuition fees and part of the living costs of students training to be nurses.

The move led to a drop in the number of students training to become nurses that recovered only when Boris Johnson partially reversed the cuts by restoring grants for living costs, but not tuition fees, in 2019.

The costs of recruiting a nurse trained abroad are likely between £10,000 to £12,000, far less than the £26,000 it costs the government to train a nurse in the UK, according to analysis by the Nuffield Trust.

James Asamani, a scientist working for the WHO’s African regional office, told openDemocracy that workforce migration has contributed to the continent’s shortage of 5.3 million health workers.

“The adverse impact is already experienced in some countries such as Zimbabwe, Ghana, and Nigeria, among others, increasing the vulnerabilities of health systems already suffering from low health workforce densities to achieve critical targets,” he said.

‘Recruiting at the expense of others’

Nurses trained in India and the Philippines make up the majority of foreign-trained new recruits since 2017, both of which are experiencing nursing shortages.

More than 21,000 Indian nurses have registered to practise in the UK – all of whom paid for their training – despite India needing to recruit 4.3 million more nurses by 2024 to make up a growing shortfall. According to the WHO, countries need at least 27.4 nurses per 10,000 people – but India has just 17 per 10,000. 

More than 17,000 Filipino nurses have registered to practise in the UK in the past five years – almost 13,00 of whom joined the NHS – despite the Philippine Department of Health facing a shortage of 100,000 nurses.

This is despite the UK government saying it would take “into consideration the national demand for healthcare vis-a-vis the number of healthcare workers in the Philippines” in a memorandum of understanding with the Philippine government in 2021. 

More than 5,000 nurses from Ghana, Nigeria, Nepal, Uganda and Pakistan have registered to work in the UK since those countries were placed on the WHO’s Health Workforce Support and Safeguards List in 2020. The WHO advises against international recruitment of nurses from countries on the list because they face the most pressing health workforce challenges. 

Florence worked as a nurse in Kenya for 12 years before she was recruited to join the NHS in 2020 in the middle of the pandemic. 

“[The UK] has been recruiting at the expense of poorer countries,” she told openDemocracy. “There are shortages in the countries that we have left behind. But I think in the long run, we are all looking for a better life. And if I could get the money that I am getting at the moment, in my home country, I would have no problem going back.”

In February 2021, the government banned the NHS from running recruitment campaigns in countries on the list in its revised code of practice for overseas recruitment. Doctors and nurses from the listed countries can still join the NHS of their own accord.

But the UK government has continued to agree recruitment deals with governments of countries on the list, a practice that is not banned by the WHO. In September it announced a deal to recruit 100 nurses from Nepal – which has 21 nurses per 10,000 people, compared with the UK’s 84 per 10,000.

Last week, Labour leader Keir Starmer said the UK is “recruiting too many people from overseas” into the NHS and pledged to take on 7,500 more medical students “from here” under a Labour government.

“Nobody was saying that when we were on the front line during Covid and we were dying. Why didn’t he say it then?” Neomi Bennett, the founder of campaign group Equality 4 Black Nurses, told openDemocracy. 

She added that the Labour leader’s comments were “irresponsible” in the context of rising xenophobia and abuse towards migrant nurses. “We are fighting to keep migrant nurses safe because they’re being attacked in their place of work.”

A Department of Health and Social Care spokesperson said: “It is misleading to suggest that the UK actively recruits nurses from countries where there is a shortage of nursing staff.

“We updated our Code of Practice for International Recruitment – in line with latest advice from the World Health Organisation – to guarantee the most stringent ethical standards when recruiting health and social care staff from overseas. This code prohibits active recruitment from countries with shortages of nursing staff, and all NHS organisations sign up to this code. 

“International recruitment is only one part of our plans to grow the NHS workforce, and the supply of homegrown staff is increasing. The NHS has also reduced spending on agency staff, which has dropped by a third since 2015/16.”