GUEST COLUMN: Care home providers looking overseas to reduce mounting agency costs

Anne Morris

Immigration solicitor Anne Morris looks at how care home providers are nursing their staffing budgets back to health by recruiting from overseas. 

With patient safety and care standards non-negotiable, care homes have become reliant on UK agencies to meet shortages in nursing staff.

But a recent report by NatWest has highlighted care home staffing costs, at 55% of turnover, have hit an all-time high.

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As the cost of agencies become unsustainable, many care homes are turning to foreign nurses as an alternative, longer-term solution for healthcare recruitment.

The process of hiring nurses that were trained outside the EEA can, however, raise a number of concerns for employers:

Before a care home can recruit foreign nurses, they must first apply to the Home Office for a Tier 2 sponsor licence, and then meet ongoing HR compliance duties. The process can seem daunting.

All applicant nurses wishing to come to work in the UK must first pass the stringent Nursing & Midwifery Council (NMC) registration process. Pass rates are low.

The relative cost of hiring from overseas versus continued spend on agency recruitment differs substantially between organisations. We know of care home groups outlaying hundreds of thousands pounds per quarter on agency workers.

But with the right HR infrastructure in place, overseas recruitment can quickly become a manageable, sustainable and cost-effective way for care homes to meet their healthcare staffing needs.

What should care homes do to prepare to hire from overseas?

Care home management can overcome the HR challenges of recruiting foreign nurses by looking at these key areas with the support of professional advisers:

HR compliance healthcheck. To secure a sponsor licence, you must meet certain Home Office criteria. Ensure your care home is ‘match fit’ for your sponsor licence application by undertaking a review of your internal HR policies, processes and skills. The review should identify weaknesses and recommendations to take you to the required standards.

Apply for your sponsor licence. Following the HR review, you should be in a position to approach the application process with confidence. Care homes already pay salaries that meet minimum salary requirements, so it becomes a matter of evidencing your capability to meet your duties as a ‘sponsor’.

Applicant nurse programme. In addition to getting your HR house in order, supporting applicant nurses in their home country through the NMC process is shown to improve registration success rates, such as providing access to English language learning programmes.

Manage your ongoing compliance. Sponsor licence holders are under ongoing compliance duties, such as record keeping. Non-compliance results in Home Office penalties. An effective sponsor licence management process will ensure continued compliance with minimal impact on your resources.

Changes to registration process for nurses trained outside EEA

The NMC registration process in its current form continues to cause difficulties for employers bringing foreign nurses to the UK.

But following pressure from the industry, change is on the horizon. The NMC is expected to make concessions to the process, notably relating to the International English language test system (IELTS).

A more flexible regime will make the overseas recruitment process considerably easier both for the applicant nurse and the care provider.

In anticipation, we are seeing care homes taking stock of their HR compliance and gearing up to apply for a sponsor licence.

Cue a dash to the airports on both sides – as care homes take advantage of the relaxed rules and shift their recruitment focus overseas.

Anne Morris is managing director of immigration solicitors, DavidsonMorris. Anne can be contacted on, 020 7494 0118

Tags : Legal AdviceRecruitment

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