Nearly 900 nurses could be recruited from overseas in just four years by Swansea Bay University Health Board to plug workforce shortages and staff new operating theatres. A report said the health board was on track to employ 350 overseas nurses in 2022-23, having hit a target of 130 the previous year and partially meeting a target of 60 the year before that. Many are from Kerala, in south-west India.
And a further 350 are to be recruited from overseas in the current financial year, subject to approval by chief executive Mark Hackett. The scale of recruitment prompted questions at a board meeting about whether Swansea and Wales were doing enough to train homegrown nurses and whether health services in places like Kerala could suffer due to the nursing exodus.
Gareth Howells, director of nursing and patient experience, said the overseas recruitment provided the health board an "immediacy of really experienced staff". Referring to the situation closer to home, he said: "Do you know, people don't want to be nurses. If we look at the attrition rate within local training, and the fact that for the first time ever there are surplus places, I think generally we have got more to do to extol the virtue of the NHS."
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The meeting heard that efforts were being made by the health board, which covers Swansea and Neath Port Talbot, and by the Welsh Government to train and retain more homegrown staff. But health-related courses were said to be under-subscribed by 27% in Wales.
Board member Professor Keith Lloyd, who is dean of the faculty of medicine at Swansea University, said there was less of a problem in the Swansea area than others in the country. But he said: "For the first time ever we have seen a drop in nursing applications."
Every year homegrown nurses in Wales finish their training and start their career, but Swansea Bay University Health Board still needs more. It employs nearly 4,200 nurses and midwives, more than half of whom are in Band 5 posts. It currently has just over 300 Band 5 vacancies, according to one method of calculation. The health board report added: "We know that we have an ageing workforce profile in nursing, with 1,322 nurses and midwives currently over the age of 51 that could retire very soon or over the next few years."
Agency nurses and the health board's nursing bank help plug shortages, which are as high as 40% in acute care and surgery. Searching overseas recruitment is a cheaper option, despite short-term recruitment costs of around £9,000 per nurse. The report said overseas nurses were offered a Band 5 contract, with a starting salary of £27,055, but initially received a lower Band 4 wage until they completed their UK registration. Some of them stayed in student as well as hospital accommodation.
The report said: "Many of the nurses have left children and husbands/wives behind. The nurses are asked to move out of the hospital-arranged accommodation only when they have settled and commenced in their Band 5 posts. To date all of the nurses have managed to find suitable accommodation to rent with local landlords. Evaluation of their experience demonstrates that overall the nurses feel very welcome and well supported in the health board." It added that only three overseas nurses had left the health board in the past two years.
Prof Lloyd said Kerala had a highly-skilled workforce but wanted to know if there were any concerns about "depleting" it. Mr Howells said the recruitment company the health board used worked closely with health services in Kerala to ensure this didn't happen. Debbie Eyitayo, director of workforce and organisational development, said the Welsh Government had a deal in place with the government in Kerala about the supply of nurses, and that certain countries trained health staff for work overseas.
It would cost around £4.7 million to employ 350 overseas nurses in 2023-24, but this would save £1.5 million in agency and nursing bank costs. The health board told the Local Democracy Reporting Service that it recruited from the Philippines, Africa and the Caribbean as well as India. Asked if the overseas category excluded nurses from the European Union (EU), a spokeswoman said it didn't exclude EU applications but that the health board received "very few of these".
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