Recruiting Nurses from outside the EEA


According to the Migration Advisory Committee (MAC), recruiting nurses from outside the EEA may be the only solution to the national nursing shortage, due to a lack of Government foresight.

Since 2009, approximately 15,500 Tier 2 certificates of sponsorship have been issued to healthcare providers in the UK to recruit non-EEA nurses.

A 2015 survey revealed that 56% of NHS employers planned to actively recruit from non-EEA sources in the next 12 months.

Facing domestic labour shortages and an urgent need to fill vacancies and ensure patient safety, many healthcare trusts have no viable alternative.

Background to the MAC report

In October 2015, MAC was commissioned to investigate the causes of the UK’s nursing shortages and consider whether it was sensible to add nurses to the Shortage Occupation List.

Pending the outcome of MAC’s report, the Home Secretary temporarily added nursing to the List.

When an occupation features on the Shortage Occupation List, it receives priority under the Tier 2 visas that are allocated annually.

Before nurses were added, when the maximum allocation of Tier 2 visas had been reached in a year, many visa applications for nurses were refused.

In March 2016, MAC published an initial report, criticising the Department of Health for using immigration as a get-out-of-jail-free card but conceding that, in the present circumstances, visa priority must be given to nurses, at least in the short term.

In July 2016, MAC published a more detailed report on the UK labour market for nurses.

MAC’s conclusions: Why is there a nursing shortage?

Examining the UK labour market for nurses since 1990, MAC concluded that a lack of long-term and strategic planning has meant that nursing supply and demand has rarely been in sync.

Consequently, international recruitment has at times been employed as a ‘policy solution’ during peak times of shortage.

For policy makers, international recruitment enables a rapid and immediate response to labour demand.

Foreign nurses can begin work as soon as their visas have been processed and there is no financial risk; recruits are trained elsewhere, at the expense of another county.

However, in the pursuit of reducing net immigration, the Government is reluctant to rely on international recruitment as an answer to the current nursing shortage.

According to MAC, a number of factors have contributed to the current nursing shortage:

  • a modern emphasis on safe staffing levels;
  • the failure of student nursing commissions to match demand;
  • a growing number of nurses leaving their jobs; and
  • an ageing workforce.

These factors should have been apparent for some time and MAC blames a lack of long-term strategic planning, co-ordination and oversight for the present crisis.

“It is largely this lack of long-term, strategic workforce planning, that offers oversight, coordination and alignment of the different dimensions of the nursing workforce, that has led to the current shortage of nurses and the pattern of varied and differential recruitment of non-EEA nurses among trusts, even those in the same shared region,” MAC reported.

No viable alternatives to international recruitment

Trusts and experts have identified five potential interventions to address the current nursing shortage:

  • improve the retention of nursing staff;
  • increase the number of nurses that are trained;
  • attract ‘returners’ back to the workforce;
  • improve productivity and/or working patterns; and
  • international recruitment.

There are significant difficulties with each of these solutions.

Retaining staff, for example, will not address the challenge of an ageing workforce and the need to expand the current recruitment pool.

“We can do more to improve our retention here but that just makes it harder for the trust down the road to fill their vacancies,” one NHS trust is reported to have said.

According to MAC, some trusts also questioned whether they would have the capacity to improve retention, given their financial position.

Trusts have also commented that the student nursing commissions are not doing enough and that, in any case, roles need to be filled now and it will be 3-4 years before new nurses can be employed.

Experts and trusts were similarly sceptical of the ability of return to practice schemes and increased productivity to meet current and future nursing demands.

International recruitment also has its limitations.

“It takes the pressure off employers to become more effective in planning, recruiting and retaining domestic supply; if not well aligned with other workforce policies it can contribute to boom and bust, and may restrict opportunities for domestic entrants to train as nurses (in recent years applications for nursing education in the UK have far exceeded available funded places)” MAC reported.

In the current labour crisis, however, recruitment from outside of the EEA appears to be the only legitimate short-term solution.

Advantages of international recruitment

An immediate solution

From an NHS trust’s perspective, recruitment within the EEA is preferred as it is cheaper, quicker and easier, but it is not always a possibility.

MAC reported diminishing returns from recruitment within the EEA, with a recent survey of NHS employers revealing that 68% of EEA-targeted recruitment drives were unsuccessful at sourcing the number of applicants sought.

There is a perception that the European market, which has been heavily recruited from in recent years, is now exhausted and countries like the Philippines and India have an oversupply of skilled nurses, eager to accept overseas vacancies.

An affordable solution

Non-EEA recruitment is viewed by trusts as an affordable alternative to the costs of agency nurses.

According to the MAC report, trusts interviewed were critical of agency nurses because of their significant expense, as well as the negative impact on patient care.

Better skills

Trusts and expert interviewees also reported that non-EEA nurses, particularly those from India and the Philippines, often had more experience and better English language skills than their EEA counterparts.

Higher retention

Healthcare trusts interviewed by MAC also reported that non-EEA recruits were frequently motivated to support dependants, either in their home country or in the UK, and that this meant they were more likely to stay with the trust.

EEA nurses, on the other hand, often came to the UK to gain experience or because of temporary economic problems in their home country.

Visa restrictions, tying a non-EEA recruit to an employer for the first years of their stay, also contribute to greater retention.

In the North West of the England, of the 200 Indian nurses recruited between 2001 and 2004, all are still working with the healthcare trusts. Similarly, in 2005 a North East trust recruited 95 Filipino nurses, 92 of which are still employed at the trust.

Given MAC’s conclusions, it seems unlikely that nurses will be removed from the Shortage Occupation List in the near future.

If you are a healthcare provider seeking to recruit from outside of the EEA, contact us for advice on using the Tier 2 visa route.



Founder and Managing Director Anne Morris is a fully qualified solicitor and trusted adviser to large corporates through to SMEs, providing strategic immigration and global mobility advice to support employers with UK operations to meet their workforce needs through corporate immigration.

She is a recognised by Legal 500 and Chambers as a legal expert and delivers Board-level advice on business migration and compliance risk management as well as overseeing the firm’s development of new client propositions and delivery of cost and time efficient processing of applications.

Anne is an active public speaker, immigration commentator, and immigration policy contributor and regularly hosts training sessions for employers and HR professionals

About DavidsonMorris

As employer solutions lawyers, DavidsonMorris offers a complete and cost-effective capability to meet employers’ needs across UK immigration and employment law, HR and global mobility.

Led by Anne Morris, one of the UK’s preeminent immigration lawyers, and with rankings in The Legal 500 and Chambers & Partners, we’re a multi-disciplinary team helping organisations to meet their people objectives, while reducing legal risk and nurturing workforce relations.

Contact DavidsonMorris
Get in touch with DavidsonMorris for general enquiries, feedback and requests for information.
Sign up to our award winning newsletters!
We're trusted