Written evidence submitted by RCN Scotland (COR0023)
Scottish Affairs Committee Inquiry: Coronavirus and Scotland
Additional information from RCN Scotland
Immigration and health and care workers
- International nursing staff have always played a vital part in sustaining our health and care services. There are currently 84,316 non-EEA internationally educated nurses working in health and care across the UK.[i] The pandemic has brought to the fore the expertise and value that all nursing staff make; they are all key workers.
- While international recruitment cannot be used as a substitute for appropriate domestic training and supply, given that it takes at least three years for new nurses to qualify, it is clear that international recruitment must continue, and increase in the short to medium term, so that patients can receive safe and effective care.
Freedom of movement
- Freedom of movement and the Mutual Recognition of Professional Qualifications (MRPQ) has enabled the mobility of health and care workers across Europe and played a key part in bolstering the UK’s nursing workforce. The end of freedom of movement will exacerbate current workforce shortages with significant implications for the provision of care. We already know that since the Brexit referendum over 12,000 EU nurses left the UK workforce.
- The MRPQ has enabled the free movement of nurses and other health professionals by converging the standards of competency required to practice. It includes language checks on EU nurses and a duty on all EU member states to inform one another about suspended or banned professionals, both of which are important for patient safety. Clarity is required on how the MRPQ will be retained and used following the end of free movement. We expect assurances that the UK will continue to align professional standards with the Directive should it no longer apply.
Future immigration system
- The government’s plans for the UK’s future immigration system fall short of what is required to meet the workforce needs of the health and social care sectors, now and in the future. The current proposals will exclude many health and care workers from entering the UK, primarily social care staff, which will have a devastating impact on the health and social care sector. The Home Office must urgently review the current proposals, which provide no migratory route for care workers.
- By expanding the Tier 2 visa route to include medium skilled jobs (occupations of RQF3+), the current salary threshold of £30,000 to enter the UK will be lowered to £25,600. Individuals may also be able to enter the UK on a lower salary (no less than £20,480) should their occupation be listed on the Shortage Occupation List (SOL). Whilst we acknowledge that these measures provide a necessary level of flexibility, these changes do not go far enough. The lower salary threshold will still be unrealistic and unattainable for many health and social care assistants, who would likely be ineligible due to the qualification specification.
- The current emergency has highlighted that low wage is in no way synonymous to the skill or value of a professional. For example, a healthcare support worker working with a registered nurse to provide end of life care in a care home, is carrying out a skilled and fundamentally important role which must be better valued. The future immigration system must not use arbitrary salary levels as the primary determinant of a person’s ability to work in the UK.
- Introduction of the new Health and Care Visa was a prime opportunity for government to acknowledge the value and contribution of all international health and care staff. The exclusion of social care staff is wrong. We expect the visa to be inclusive and apply to all health and care staff, regardless of pay or qualification level.
- The pandemic has revealed how reliant the NHS is on good social care and vice versa – they cannot be viewed as separate services. The care system has been heavily reliant on international staff, and the proposals continue to ignore the significant risk to this sector, and therefore the entire health and care system across the UK.
Immigration Health Surcharge (IHS)
- The RCN had been calling for the government to exempt heath and care workers from this charge immediately and on a permanent basis for over two years. We welcomed the announcement to exempt health and care workers from the IHS; an unjust additional financial burden placed on staff and their dependents, as they already contribute through their taxes and by virtue of their work.
- Following the RCN’s open letter to the Prime Minister calling for the exemption to be fair and inclusive for all staff, the government announced that the exemption will automatically apply to Tier 2 registered nurses as well as their spouses and dependants. However, we are concerned that health and care workers not eligible for the Tier 2 route will be required to pay the fee upfront. This will disproportionately affect lower-paid staff, particularly in the social care sector and plans to reimburse staff in six-month increments simply do not go far enough to compensate for the initial unjust financial burden faced. We expect that all health and care workers and their dependents will be exempt, not just those working in our NHS and that families who have already paid the IHS be appropriately refunded in full.
Shortage occupation list
- We expect the UK government to ensure that internationally educated nurses are supported to work in the UK and therefore call for nurses to continue to be exempt from the salary threshold and to be included on any shortage or priority occupation list.
- We have submitted evidence to the Migratory Advisory Committee calling for Nursing Support Workers within the RQF3-5 bracket to be included on the shortage occupation list. There are significant workforce shortages for nursing support roles across the health and care sector. While shortages are more acute in certain sectors and staff groups, due to the significant limitations and gaps in the available data, we believe there is a strong reason for all nursing and care support roles to be listed on the SOL.
RCN members share their experiences of nursing during the pandemic
In August, we published the results from our UK-wide Building a Better Future for Nursing, member survey which captured nearly 42,000 nursing staff’s experiences of working during the pandemic.
Over 3,800 nursing staff in Scotland responded to this survey and their responses reflect the picture across the UK. Some of the key findings from Scotland are highlighted below.
- Just over three quarters (77%) reported an increase in their own stress levels
- 90% agreed with the statement that they were concerned about the wellbeing of those in the nursing profession generally
- Around a third (32%) said they were working at higher level of responsibility, with 93% of those saying they were not being paid extra for it
- A third (34%) said staffing levels had worsened during the pandemic
- A third (34%) were putting in longer hours.
The survey also revealed a sharp rise in the proportion of nursing staff considering quitting the profession. Across the UK more than a third of respondents (36%) are thinking of leaving nursing, compared to 27% in 2019.
When asked what they would like to see done to make them feel more valued, respondents were clear that pay and staffing levels were top of their agenda:
- Nearly three quarters (73%) said improved pay would make them feel more valued
- Half (49%) said better staffing levels would make them feel more valued
Nursing staff across the country have stepped forward to meet the challenges brought by the COVID-19 pandemic. Their work is fundamental to caring for patients and protecting our health and care services, but this commitment to excellence in clinical practice has taken its toll. We know that staffing levels and the lack of recognition of nursing staff’s contribution were already issues before the pandemic. We are looking for the governments of the UK to help our existing workforce and ensure that nursing is attractive, well-paid and meaningfully supported.
The pandemic it not over, but unless nursing is attractive, well-paid and meaningfully supported, we risk many of our members leaving the profession – at a time when the country needs them more than ever.