Health services in London could face a staffing crisis in the future according to a study which has found that more than four out of every ten overseas nurses working in the capital are considering taking up posts in other countries. The worrying finding comes from the biggest ever survey of internationally recruited nurses working in London, published today by the King’s Fund and the Royal College of Nursing.One major concern of the survey is that among Filipino nurses, one of the largest groups of overseas recruits to the NHS, two thirds are considering leaving Britain to work in America.

Almost 400 nurses from more than 30 different countries took part in the survey, which was designed to find out why overseas nurses choose to work here, where they are working and how long they are intending to stay.

Many of those taking part, especially those from sub-Saharan Africa, believe they are under graded and under paid given their experience and responsibilities. Others claimed they had been treated unfairly by the recruitment agencies that brought them to the UK. The report says this shows bad practice persists in some organisations, mainly outside the NHS, and that some nurses are still being exploited.

The study also finds that in spite of a government clampdown on the active recruitment of nurses from developing countries, there is clear evidence of ‘back-door recruitment’. Many nurses said they had initially worked here in the private sector before moving quickly into the NHS. Most of those questioned said that although they could earn much more in the UK the main reason for coming here was professional development or the chance to travel.

The Report’s author, Professor James Buchan, said the NHS and the independent health care sector rely heavily on overseas nurses and without them, parts of the health service would collapse. “They perform a crucial and valuable role but our survey shows the NHS is playing a high risk game by relying on these overseas staff to commit long term to the NHS,” he added. Professor Buchan said it was clear the NHS needed to step up efforts to grow its own workforce.

The RCN general secretary, Beverly Malone, said the study gave further compelling evidence of the weakness in the Government’s Code of Practice, with two-thirds of nurses reporting that a recruitment agency has been involved in their move to the UK. “It is imperative the Government takes urgent steps to extend the Code to cover the private and independent sector,” she said.

Following the survey the King’s Fund and the Royal College are calling on the Department of Health to track the number of overseas nurses that the NHS recruits and employs. They also want all UK employers to work with each international nurse they recruit to draw up an individual career plan to ensure they can work effectively and meet their career aspirations. Finally they say that “back door” recruitment via the private sector is undermining the code of practice on international recruitment, so the NHS should make sufficient resources available for the necessary number of adaptation and supervised practice placements within the service rather than leaving nurses to pay for nursing home-based adaptation and then recruiting them soon after they have done so.