To deliver a health and care system fit for the 21st century the NHS does and must seek people from overseas. Because of caps on the number of Tier 2 visas hundreds of applications were refused between December 2017 and May 2018 – we were made aware of 400 applications refused from 53 Trusts – and that was just up to March. We expected the true number to be higher and a Freedom of Information Act request exposed that it was more than 1,500 applications for doctors refused over those four months.
Most Trusts re-submitted their applications more than once, and in some cases up to four times. This means time, money and added pressure on staff.
Trusts were left scrabbling and paying extra for locums and agencies to fill posts. One Trust told us of costs of £2,000 per week per doctor to cover the gaps. Gaps in rotas lead to delays in patient discharge, cancelled clinics and longer waiting times.
This wasn’t just an issue for the NHS. Our size and the interest in the NHS focused attention on our sector. But 4,500 applications were also rejected for other employers across the UK.
There was a danger that this well-publicised issue was therefore putting talent off coming to work in the UK and many sectors were starting to report that applicants were withdrawing from recruitment processes. These shared concerns led to important discussions and common cause with representative organisations across the economy.
All employers should therefore welcome relaxation of the Tier 2 visa rules, which come into effect after 5 July 2018, and will see all applications for doctor and nurse posts exempt from the Tier 2 visa cap. Importantly this should create significant extra capacity in the system for other professionals within the wider economy: the Home Office stated that at least 35% of Tier 2 permits were going to healthcare workers.
HR for me has always been about helping organisations (in my case NHS organisations) make the most of the talent available to them. And there are three lessons for us as a profession in light of this experience.
Firstly, we should be hopeful that this step by the government starts to tell us something about the post-Brexit migration policy we will develop as a country. It points to a willingness to recognise that our economy needs to seek out global talent alongside our own population. If our post-Brexit future is about greater domestic control over trade and policy, then its success will require us to develop a reputation as a nation that recognises the global market in talent.
I’m also struck by the risk that we see this in selfish terms; we need to be clear that access to global markets and experience is of mutual benefit. We as patients, for example, benefit from the experience that UK doctors gain elsewhere in the world.
Secondly, there still remains a challenge in making the most of the domestic talent available to us.
In the NHS we are particularly struck by this in the post-Brexit landscape. We have made a large investment in the pay and conditions of our people; we are launching major recruitment campaigns in England this Summer focused on A-Level students and nursing as a career; we are using our 70th birthday as a stimulus to increase engagement with local schools; and we are challenging ourselves to be better, fairer and healthier employers.
Thirdly, this positive step with regards to Tier 2 by the government also tells us something about the need for employers to work effectively together to recognise shared goals and challenges and to set out common potential solutions to government. That’s why we convened the UK-wide Cavendish Coalition of social care and health organisations, private and public, employers and trade unions, to seek alignment in terms of our post-Brexit workforce policy.
To take another example, my members and those of the CBI operate quite different organisations, but I’m struck by the importance of us making common cause on the Tier 2 problem and the way forward. You should ensure your boards expect their representative body to continue that kind of joint work in the next couple of years, just as the CIPD and TUC recognise their roles in convening this kind of dialogue.
Danny Mortimer is CEO of NHS Employers
