To what extent does the English healthcare system depend on nurses educated in Scotland, Wales and Northern Ireland? Evidence from analysis of linked registration and census data

Abstract

Background
A recently published 10 Year Plan for the National Health Service in England has an ambitious aim to reduce dependence on nurses recruited internationally. Reliance on home educated nurses will inevitably have to increase. However, many nurses employed in the English system were educated elsewhere in the UK, in Scotland, Wales or Northern Ireland, though the extent is unknown.

Objective
To quantify the degree to which England’s nursing workforce is reliant on recruitment of nurses educated in the other devolved UK nations.

Methods
We analyse a linked dataset combining the Nursing and Midwifery Council (NMC) register of 600,000 nurses with the 2021 Census for England. Descriptive statistics are generated using NMC training-location and census migration data. Statistical models are developed to assess geographical variation in England’s reliance on nurses educated elsewhere in the UK.

Results
Findings are presented by field of nursing practice (i.e., whether educated in adult, mental health, children's, or learning disability nursing), and UK country of education. Socio-demographic characteristics of nurses educated elsewhere in the UK, along with time since initial registration, are described. Models provide insights into reliance on the rest of the UK for the English regions.

Conclusion
Nurse migration after education is a key factor driving regional workforce sustainability. Evidence from this study informs robust data-driven workforce planning by illuminating the degree of England’s dependence on nurses educated elsewhere in the UK. Implications for workforce policy, regional employers, devolved administrations, and the importance of coordinated, UK-wide policy will be considered.