Staffing is the issue keeping NHS leaders awake at night — and which consumes two-thirds of trusts’ spending. The fortnightly The Ward Round newsletter, by HSJ workforce correspondent Annabelle Collins, will make sure you are tuned in to the daily pressures on staff, and the wider trends and policies shaping the workforce. Contact me in confidence

Next week is significant for the NHS. No, the people plan isn’t finally about to be released but instead the Migration Advisory Committee is expected to publish its report on how a refined points-based immigration system would work. This, according to The Times, is expected to be followed by the government’s white paper in March.

It was also reported that, according to sources, Boris Johnson is looking to scrap the existing £30,000 salary cap, but is unclear whether new proposals would make it any easier for overseas staff — both from the European Economic Area and beyond — to come and work in the NHS.

The last white paper, published by the government at the end of 2018, stoked alarm among NHS leaders and experts. In particular, the NHS Confederation said it was extremely concerned about the proposed £30,000 salary cap for workers with “intermediate skills”, and warned the government needed to fund wage increases or make special provisions for health and social care, so as to avert a social care crisis, which would have “enormous” knock-on effects on the population and wider economy.

Overseas staff currently wanting a tier 2 visa to work in the UK must earn £30,000, but some healthcare professions are on the shortage occupation list, so this cap does not apply. Last year, the MAC added all doctors and nurses to the SOL and removed the cap on numbers, symptomatic of the desperate need to boost the NHS workforce in the short term.

However, the NHS isn’t just made up of doctors and nurses. Many other key professions are not on the SOL, for example physiotherapists. The Chartered Society of Physiotherapy has been clear for many years the goverment needs to boost salaries to ensure a steady supply of international staff. 

The SOL certainly isn’t set in stone and the government also asked the MAC to review it, alongside the visa points system. The “NHS visa” announced by Boris Johnson is yet to be expanded on and there is no clarity on how it would interact with the SOL.

The post-Brexit rhetoric of bringing down levels of immigration is at odds with both the numbers briefed out by the Tories before the election and leaked people plan modelling published by HSJ at the end of last year. Both set out that immigration needs to be the biggest lever of recruitment into the NHS.

Furthermore, NHS Employers has this week produced guidance for trusts looking to recruit from abroad, which encourages them to work within integrated care systems and learn from trusts already running successful programmes.

The guidance has a strong emphasis on ethical recruitment and ensuring overseas staff are treated properly and welcomed — the benefits of boosting international recruitment will be completely wasted if staff are lost through poor retention.

The “toolkit” gives best practice examples of trusts that pay for the first month of a new staff member’s accommodation, provide them with a UK SIM card and offer loans for various other things to make them feel at home.

The NHS has been crying out for clarity on the government’s immigration policy, and now it appears to be on the horizon. The NHS must hope its warnings about an empathetic policy did not fall on deaf ears. Otherwise, with the best will in the world, the ambitious international recruitment targets will be unreachable.