What’s the truth about the nurse exodus in NHS Scotland?

Are record numbers of nurses deserting the NHS for jobs abroad?

That was the claim at the weekend after the Royal College of Nursing obtained new figures showing the number of nurses seeking to work overseas.

Existing statistics already show that the number of nurses and midwives leaving the NHS has reached an all-time high. So where are they going, and what does this mean for staffing, vacancies and patient care?

Leaving on a jet plane?

According to figures obtained by the RCN under freedom of information, a total of 370 applications for a "certificate of professional status" were made between April and September last year by nurses registered as living in Scotland.

The data was obtained from the Nursing and Midwifery Council, the regulator responsible for issuing the certificates that allow nurses and midwives to work outside of the UK.

Back in 2018/19, the number of applications from Scotland-based nurses was 237 during the full year. On this basis, the RCN extrapolates that the number of nurses leaving the NHS for jobs abroad has tripled.

They also note that between 2018 and September 2023, the most popular destination by far was Australia – accounting for 1,031 of all the 1,768 certificates obtained (58%). This was followed by New Zealand (288), the Republic of Ireland (234), the USA (115), and Canada (100).

A separate certificate is required for each country, so some applicants may have obtained more than one.

However, supposing the 740 certificates that the RCN projects will be sought during 2023/24 equated to 740 individual nurses, that would represent 1.1% of NHS Scotland's total nursing and midwifery workforce upping sticks.

Read more:

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Of course, not everyone who applies for the certificate necessarily leaves. But the trend hints at a growing dissatisfaction with working conditions in the NHS.

Pay is undoubtedly part of it – the starting salary for a staff nurse in NHS Scotland is £30,229 compared to around Aus$76,000 (£39,000) Down Under – but the lure of a sun, sea and sand lifestyle cannot be discounted, nor the appeal of working in a health service comparatively less burdened by Covid-related backlogs.

Just leaving

The idea of the "overseas exodus" tends to be a distraction to the more mundane reasons for workforce problems, however.

According to the latest statistics – published on March 5 – there were 66,884 nurses and midwives employed within NHS Scotland by the end of 2023 – a record number. Nonetheless, more than one in 20 posts were unfilled – a shortfall of 4,097 nursing and midwifery staff.

In some regions – Highland, Orkney, Lanarkshire – one in 10 of these posts is empty.

In the year to March 2023, a record number of nurses and midwives – just over 6,800 – left the NHS in Scotland. That compares to an average of 4,185 per annum in the five years prior to the pandemic.

This goes some way to explaining why the most recent report by Audit Scotland, published in February, noted that spending on agency nurses by NHS Scotland had increased by a massive 79% year-on-year, to £169.7 million in 2022/23.

The vast majority of nurses are not leaving for jobs abroad, then. Retirement is the biggest single factor behind departures. Between 2014 and 2022, the proportion of registered nurses in NHS Scotland aged 55 or older increased from around 12.5% to nearly 19%.

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Staff surveys have also found that many nurses towards the end of their careers tend to retire earlier than planned in order to return to the NHS as agency or bank nurses because it is the only way to make their hours more flexible.

Others are quitting within the first few years of qualification, however. Workload pressures linked to staff shortages tend to be the main reason blamed, which of course creates a domino effect: as more nurses leave, more of those left behind want to leave too.

The end result is patients on wards that are either under-staffed or over-reliant on temporary staff, both of which are associated with a higher risk of adverse outcomes for patients.