Staff shortages in the NHS are a critical issue that needs urgent attention to protect the welfare of the current workforce and their patients. Remedium explains how their approach to NHS international recruitment could provide a sustainable solution
The NHS staffing crisis has no easy solution. The health system has seen one of its most challenging periods— the aftermath of COVID-19, increased seasonal flu admissions, and industrial action have laid bare the need for staffing. Recent press coverage on the staffing shortage has increased, but what is the answer?
NHS staffing crisis: A growing shortage
Recent press coverage has raised concerns over the increasing use of agency and bank staffing. This is an unsustainable workforce model that cost the NHS over £3bn in 2022. The report also revealed that one doctor was paid £5,200 for a single shift. Costs for agency and bank staff are increasing despite the NHS committing to decrease spending on agency staff.
In 2016, the BMA found acute NHS trusts spend 25 times as much on locums as on permanent doctors. Locum staff are a significant drain on the NHS, which spent upward of £3bn on locums in 2022. In addition, relying on bank staff from a workforce that is already overworked and burned out is not a sustainable model.
The NHS is stuck between filling vacancies with bank or agency staff or cancelling appointments and operations. Neither option is viable, with a waiting list of seven million appointments and a budget that is already stretched. A staffing strategy based on the use of agency locums and relying on existing staff to cover bank shifts is neither financially sustainable nor good for workforce morale.
The current situation
Vacancies in the NHS have risen significantly in the past few years. The need for recruitment is evident, given growing waiting lists, missed targets, and reports of staff burnout. The current number of UK doctors in training is far short of the number required for the NHS workforce, and the problem is set to get worse as increasing numbers of NHS staff plan to leave the profession.
There is a predicted shortfall of 571,000 by 2036 if current trends continue. The long-awaited NHS Workforce Plan, released last year, announced a doubling of medical school places. However, it will take at least ten years for medical students to begin training to qualify. While we support the increase in training for UK medical students, we need a sustainable interim solution. Currently, doctors in the NHS are doing the work of 1.3 FTE doctors. It is this overwork that is driving NHS staff to leave the workforce- only when vacancies are filled via permanent recruitment will retention be improved.
As of 2024, one in six doctors working in the NHS were born and trained overseas. This is likely to increase as demographic changes, an ageing population, and an increased disease burden mean that more NHS staff are needed. Without international recruitment, the NHS would be in an increasingly vulnerable position and would not be able to provide the level and standard of care every citizen in the UK expects. The demand for healthcare is increasing. The early months of 2023 saw growing waiting times for ambulances, missed targets, and reports of staff burnout – the only way to meet this demand is to increase permanent NHS staffing.
How ethical NHS international recruitment can plug the gap
Though recruiting international doctors on permanent contracts is not a silver bullet, it should form a key part of a sustainable workforce plan. International recruitment is also clearly a far more cost-effective solution than the current model of relying on agency and bank staff. One internationally recruited permanent doctor saves on average £100,000 over nine years in agency fees, amassing a saving of over £400mn based on the 4,000 doctors Remedium has placed since 2013.
International recruitment has been proven to work at several trusts. Remedium partnered with Southern Health and Social Care Trust in Northern Ireland in 2023 to fill 70 vacancies across all grades and specialities. Remedium successfully recruited to these vacancies and worked closely with Southern Health to onboard and retain these doctors as they relocated from across the world to Northern Ireland. The project required an investment of £2.3mn from the Trust but resulted in a cost avoidance of £6.1mn and estimated savings of £3.8mn. To round off the pastoral care package, Remedium travelled back out to Northern Ireland in February of 2024 to host a welcome event for the 53 doctors who had arrived at Southern Health by that point. The social event was a resounding success, with all new doctors, as well as many members of staff from the Trust, plus their families, able to get together to socialise after a long and busy induction period. This was a crucial part of the induction process: giving these doctors space to meet each other and mingle outside of a work environment solidified relationships and served to better integrate them into the community.
Shifting to a more permanent staffing strategy also significantly improves patient care. Permanent doctors provide continuity of care that locums and bank staff cannot. Locums and bank staff may be unfamiliar with hospital processes and layouts, which negatively impacts patient care. International recruitment and the building of a permanent workforce will significantly benefit the NHS and its patients.
What is ethical NHS international recruitment?
While the need for NHS staffing is critical, it is also important to recruit ethically from overseas to ensure that recruitment to the NHS does not impact safe staffing levels in other countries. Remedium is committed to the ethical recruitment of international doctors. As such, we adhere to the NHS code of practice, which sets out a series of guidelines with the aim of tackling the ‘brain drain’ and ensuring that the distribution of medical professionals in developing countries remains stable. We are on a mission to solve the healthcare crisis sustainably and ethically.
Towards a sustainable staffing strategy
The need for international recruitment has never been clearer. To address NHS workforce shortages in the short and medium term, NHS organisations must recruit international healthcare professionals to fill the gap nationwide. Remedium has been supporting healthcare organisations across the UK to develop more strategic workforce planning for over ten years. We must urgently recruit more to fill the staffing gap and improve working conditions for existing staff.
We care deeply about the future of the NHS, and we know we are supporting our clients in addressing a complex and multifaceted problem – which is why we are dedicated to solving the healthcare staffing crisis.
This work is licensed under Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International.
