Navigating Ethical International Recruitment: Insights from Dr. Na'eem Ahmed
1 March 2024
Dive into ethical international recruitment in the NHS with Dr. Na'eem Ahmed. Discover insights on talent acquisition and global healthcare equity. A must-read for sustainable healthcare practices.

We need a Sustainable approach to international recruitment, en Route to a ‘self sufficient’ NHS Workforce
A recent King’s Fund analysis reported that international staff make up 19% of the NHS workforce – the service would struggle to function without them. It pointed out that even with these international staff, there are still around 121,000 vacancies across the NHS.
The discussion that these statistics prompt is often focussed on the impact and sustainability of the NHS - how will it cope with changes to immigration policies, how can we work towards a more ‘home-grown’ NHS workforce.
What often gets overlooked is the impact of these statistics on the countries that we are taking talent from. Processes are in place to try to prevent harm being done - for example, in nursing, the NHS can recruit from ‘green list’ countries, but ‘red list’ countries are highlighted as having lower coverage of healthcare workers as deemed by the World Health Organisation.
An ethical approach to recruitment would balance giving people the right opportunities to work in the UK with the needs of their home country, as well as the sustainability of the NHS workforce. This is a complex challenge we are far from cracking.
To achieve this, we need to move to a partnership model with “earn, learn and return” being as a key deliverable for international NHS employees. We make use of their expertise internally and share knowledge, but we need to do better to both equip colleagues for a return to their home countries and to ensure systems where we are actively recruiting are helped with capacity building.
The Medical Training Initiative (MTI) scheme for international medical graduates (IMGs) helps support international doctors to gain experience in the UK and enables hospitals to recruit skilled clinicians that are an alternative to expensive locums. However, it appears much of the international engagement within the NHS remains focussed on recruitment of staff, with limited attention given to preparing IMGs for their potential return at the end of their stay. Capacity building programmes to support global healthcare systems provided for by the UK government continue to be limited in scope and geography and boosting these would foster mutual trust, trade, and facilitate skills and knowledge sharing.
Our diverse workforce are overlooked ambassadors for the NHS. There is little support for diaspora NHS employees to help their countries of origin - harnessing their cultural knowledge and ties something that would help make the benefits of an international NHS reach further globally and have a longer lasting impact.
For me, this took the form of setting up a charity, Selfless, which aims to inspire and support the global health leaders of tomorrow, and directly support high-impact and evidence-based interventions on the ground in Bangladesh, today. Where employees have a passion to support programmes in countries where we have benefited from their talent, the NHS should support and guide them to do so. Supporting NHS diaspora employees to engage in meaningful work overseas will no doubt also boost retention among a significant proportion of NHS staff.
While we are working to strike the right balance of recruiting but not draining talent, we need to ensure the environment international workers come into becomes significantly more welcoming.
A quarter of NHS staff are from an ethnic minority, this rises to 39% of nursing staff. For ethnic minority staff, career progression remains a burning issue. A BMJ column in 2022, highlighted that two Filipino nurses were in senior nursing positions in the NHS despite making up around 10% of the nursing workforce. Ethnic minority staff continue to have differential experience within the workplace including being more likely to experience harassment or face abuse.
On the way to self-sufficiency, and lowering reliance on international staff, is an opportunity for the NHS to strengthen health systems and foster diaspora links and become a net contributor to global health system development. Ensuring equality of opportunity for all within the NHS workforce place will also have a positive effect on recruitment and retention. The cumulative effects of this approach will make the NHS a force for good in healthcare development overseas.