With Brexit looming ever-closer on the horizon, overseas recruitment of nurses is in danger of an unhealthy decline. Deborah Hely, partner in the employment and pensions group at international law firm, DAC Beachcroft LLP, explores how the health sector is working to improve the recruitment and retention of nurses
In January 2018, the Commons Health Select Committee warned of the impact of the increasing shortage of nurses. The independent health sector is acutely affected by this shortage with many staff leaving the profession and the next generation of workers rethinking their career choices following the removal of bursaries and delayed apprenticeship courses. This, combined with the negative impact of Brexit and tough English language tests for overseas workers, has created a significant challenge for the sector.
Overseas recruitment has traditionally been an effective safety valve for the recruitment of nurses. The Labour Market Review by the RCN shows that, in the sector, of its qualified nursing staff 11.7% come from the EU and 29% from outside the EU. However, Brexit has led to a reduction in new EU nurses entering the UK. Nurses were put on the shortage list by the Migration Advisory Committee in 2016 (as a temporary measure) making it easier to recruit from outside the EU. However, the compulsory English language test has proved challenging where, even applicants from English speaking countries have failed the test. In late 2017, the test was adapted. It remains to be seen whether new applicants can now pass the test. Applicants have eight months from starting work in Tier 2 as a pre-registration nurse (with the first sponsor) and needing to obtain NMC registration (ie by passing the CBT, OSCE and English language test), or their leave to remain in the UK will be curtailed.
Given the expense of recruiting from abroad, ideally providers would be able to rely on nurses coming through the training system in the UK. In 2017, the number of new student nurses entering the system dramatically reduced. In September the same year, the system of bursaries for student nurses, providing £9,000 a year in tuition fees, was scrapped and replaced by student loans. The removal was justified by the government as a means to create more training places. However, according to Ucas there have been 700 fewer nurses starting training.
The problem is particularly acute for specialist courses in mental health, learning disabilities and community nursing where some courses have been rendered financially unviable because of a lack of applicants. Cygnet, a leading provider of mental healthcare, has invested in its Preceptorship programme and offered a fully funded fees bursary, some travel expenses and a BSc monthly bursary. Angela Pereira, preceptorship and university partnership lead at Cygnet, said: ‘We have trebled recruitment and more than quadrupled retention of graduate nurses. Also, the first five sponsored health care support worker student nurses qualify with an MSc in mental health nursing who will be taking preceptorship posts at their chosen Cygnet hospitals.’
How are these challenges being addressed? In April 2017 the government introduced the apprenticeship levy that requires employers with a pay bill of over £3m a year to invest in apprenticeships. At 0.5% of the pay bill (less £15,000), this is a significant cost and funds not used are lost. So, the new four year nursing apprenticeship degree looks in theory like an ideal opportunity for employers to invest in training new nurses; however, there are currently only two training providers who have available courses, with more courses planned, but which are not expected to be ready until late 2018.
HEE has introduced a new nursing associate apprenticeship; a qualification that bridges the gap between healthcare assistants and registered nurses. Yet the further rub for providers is that the levy can only be used to fund training costs and the employer must provide a salary during periods of work-based learning. This is a significant increase in costs for employers, where previously the training costs were free and, historically, some employers have not paid a salary for work placements. If the student is working during placements, even without the impact of the levy, it is likely that they are entitled to the National Minimum Wage for that work. A matter that some employers have not appreciated in the past.
Employers cannot claim back course fees paid using its levy funds if the student fails the exam or doesn’t attend the course. It can do this if it funds the training separately to the levy by entering into a contract with the employee.
Levy funding is inevitably a more attractive proposition to nurses than loans. Once the courses are set up it is to be hoped that more students will choose to take up training places and thus, in the years to come, produce more nurses to reduce staffing shortages.
Steps providers can take to reduce the impact of the current crisis are:
- Supporting EU workers by encouraging them to apply for a document confirming their right to live and work in the UK (registration certificate/permanent residence or citizenship);
- Sourcing a provider to ensure an effective use of levy funds in their digital account for apprenticeships.