NHS Seeks Solution to UK Nursing Shortage


While uncertainty dominates post-referendum Britain, for the NHS it has to be ‘business as usual’. Critical challenges such as the severe UK nursing shortage continue to demand immediate resolution, to minimise any impact on quality of care and patient safety.

The Government has reluctantly agreed that the only viable solution to the UK’s nursing shortage is to recruit workers from abroad.

Caught between the pressures of immigration and an understaffed NHS, the Government’s compromise has been to grant foreign nurses temporary relief from visa restrictions.

The UK Nursing Shortage

In the UK, the staffing difficulties that NHS employers face have become notorious.

The nursing shortage has driven a demand for agency staff and premium nursing wages to a level that is unsustainable.

Last year, the NHS spent an unprecedented £3.3 billion on agency workers to plug recruitment gaps.

Notwithstanding these concerns, the Government has been reluctant to offer Tier 2 (General) Visas as the remedy.

Tier 2 (General) Visas

Tier 2 (General) Visas permit licensed employers to sponsor workers from outside the EEA in medium and high skilled roles.

Typically, Tier 2 (General) Visas will only be approved where:

  • the vacancy is of the necessary skill and salary level set out in the Codes of Practice;
  • a resident labour market test has been completed (or the occupation features on the Shortage Occupation List); and
  • the employer has not exceeded the allocated number of sponsorships permitted by its licence.

In most cases, “restricted” sponsorships are also capped at an annual limit, currently set at £20,700.

In 2014/2015, over a quarter of the annual limit was allocated to healthcare occupations.

As part of the Government’s pledge to reduce net immigration, recent legislation has increased the eligibility thresholds for Tier 2 (General) Visas.

From April 2017, the minimum salary required for Tier 2 Sponsorship will be increased from £20,800 to £30,000.

From April 2016, any Tier 2 (General) Visa holders seeking permanent residence must be earning at least £35,000.

NHS employers, who have struggled with the UK’s nursing shortage, even without these new restrictions, have argued that the changes will make staffing impossible.

The average wage for a registered nurse in the UK is approximately £23,000.

Responding to the £35,000 salary requirement for permanent residence, the Royal College of Nursing warned that the rule would cause chaos to the NHS.

According to RCN research, if this rule were applied to all foreign nurses currently working in the UK, by 2020 6,620 nurses may have been forced to leave, wasting almost £40 million in recruitment costs.

In the past, even where nurses meet the criteria for a Tier 2 (General) Visa, applications have been refused because the annual cap has already been reached in that period.

According to the Migration Advisory Committee’s (“MAC’s”) review of nursing, published in March 2016, more than 2,700 nursing applications have been refused because of the annual limit on applications.

Last year, the Newcastle upon Tyne Hospital NHS Foundation Trust reported that its attempts to recruit and sponsor 85 nurses from the Philippines had been rejected.

The Recommendations

Occupations that feature on the Shortage Occupation List receive priority on the annual limit and are not subject to the £35,000 salary requirement when making permanent resident applications.

Employers filling these roles are also not required to advertise positions locally under the resident labour market test prior to recruiting outside of the EEA.

Before October last year, nurses did not appear on the list. At that time, they were temporarily added, pending further investigation by MAC.

MAC’s March report was critical of the Department of Health for using immigration as a “get-out-of-jail-free card”.

MAC determined that the Department should have taken steps to train more domestic nurses long before now.

Despite this criticism, MAC conceded that, in light of the current situation, visa priority should be given to employers seeking to fill nursing vacancies – at least as a short-term measure.

The Relief

The Government ultimately accepted the pleas of NHS employers and the recommendations of MAC.

Nurses remain on the Shortage Occupation List – for the time being.

As a result, nurses receive priority in the annual restricted visa cap and are not subject to the £35,000 salary requirement that apply to permanent residence applications.

However, unlike most occupations on that list, they will still be required to carry out a resident labour market test before recruiting outside of the EEA.

Nurses have also been granted a temporary relief from the new minimum salary thresholds for sponsorship.

Nurses, medical radiographers and paramedics will be exempt from the new minimum salary thresholds, until July 2019. For these occupations, the minimum salary threshold remains at £20,800.

Walsall Healthcare NHS Trust for example recently announced that it was taking advantage of the temporary reprieve. The Board has just approved an international recruitment campaign aimed at “guaranteeing safe staffing levels”.

Securing Staff Post-Referendum 

Given the referendum result, future immigration policy has never been so uncertain. All NHS employers should consider taking advantage of the Tier 2 (General) Visa system to fill vacancies and address the UK nursing shortage, while they are able to.

We are highly experienced in advising organisations on visa options for healthcare professionals such as nurses. To discuss the opportunities that presently exist for obtaining sponsorship licences, recruiting from outside the EU and securing Tier 2 (General) visas for nurses, please contact us.


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 500and 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.

Legal Disclaimer

The matters contained in this article are intended to be for general information purposes only. This article does not constitute legal advice, nor is it a complete or authoritative statement of the law, and should not be treated as such. Whilst every effort is made to ensure that the information is correct at the time of writing, no warranty, express or implied, is given as to its accuracy and no liability is accepted for any error or omission. Before acting on any of the information contained herein, expert legal advice should be sought.

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