International recruitment of health and social care personnel: code of practice - March 2023 (revised)

3. Guiding Principles

3.1 There are five guiding principles that underpin the Code of Practice and these are set out in this section.

1. International migration of health and social care personnel can contribute to the development and strengthening of health and social care systems, if recruitment is managed properly.

2. Opportunities exist for individuals, organisations and health and care systems in relation to training and education and the enhancement of clinical practice.

3. There must be no active international recruitment from Countries on the red list, unless there is an explicit government-to-government agreement with the UK to support managed recruitment activities that are undertaken strictly in compliance with the terms of that agreement.

4. Recruitment of international health and social care personnel is monitored and reported on to the Cross Whitehall International Recruitment Steering Group.

5. International health and social care personnel will have the same legal rights and responsibilities as domestically trained staff in all terms of employment and conditions of work. They will also have the same access to further education and training and continuing professional development.

International migration of health and social care personnel can make a contribute to the development and strengthening of health and social care systems in both source and destination countries if recruitment is managed properly.

See the WHO Global Code of Practice on the International Recruitment of Health Personnel.

3.2 International recruitment (migrant workers, moving temporarily or permanently for employment) has made a substantial contribution to the delivery of health and social care services across the world and will continue to play a vital role in the future. With its focus on workforce planning to ensure the NHS and Social Services Sector has a sustainable health and care workforce, alongside increasing the supply of "homegrown" health and care staff through training more, retaining more and encouraging staff who have left to return. The NHS and Social Services has a long history of developing the knowledge and skills of health and care staff coming to Scotland at some time in their careers.

3.3 Well managed migration ensures that the health systems of both the source and destination country derive benefits.

3.4 Good practice, ethical standards, respect for rights, and value for money should underpin all international recruitment activities.

3.5 Compliance with this Code of Practice ensures that the international recruitment of health and social care personnel minimises harm to the health and care systems of source countries, whilst safeguarding the rights of health personnel to migrate, and ensures fair and just recruitment and employment practices.

Opportunities exist for individuals, organisations and the health and care systems in relation to training and education and the enhancement of clinical practice

3.6 International recruits gain from opportunities to develop their skills, and in turn, advance their own careers and economic opportunities. International health and social care personnel bring new and valuable perspectives and learning that enables the transfer of experience and the sharing of ideas.

3.7 Collaborative partnerships for training and continuous learning can bring benefits for individuals, organisations and health and care systems of the UK and the source country.

There must be no active international recruitment from countries on the red list, unless there is an explicit government-to-government agreement with the UK to support managed recruitment activities that are undertaken strictly in compliance with the terms of that agreement.

3.8 Skilled and experienced health and social care personnel are a valuable resource to any country. For some low and lower middle-income countries, increasing the scale of health and care worker migration threatens the achievement of national health and care goals.

3.9 Countries on the red list must not be targeted for international recruitment, unless there is a government-to-government agreement negotiated and signed by the Department of Health and Social Care on behalf of the UK Government and recruitment is consistent with the provision of the agreement. Where recruitment is restricted solely to the terms of the government-to-government agreement, the country will appear on the amber list. Such agreements can be designed to help regulate or mitigate against any negative impacts of health or care migrant flows to the UK. All agreements will take WHO guidance on the development of bilateral agreements into account.

3.10 Government-to-government agreements must take steps to ensure that migration to the UK does not exacerbate existing health and social care workforce shortages in the country of origin, and the country of origin derives proportional benefits as set out in the 'health workforce development and health systems sustainability' section below.

3.11 Consideration of evidence will form part of decision making on agreements, and will inclue a health labour market analysis from red listed countries, engagement with health sector stakeholders and consultation with the WHO. Notification to the WHO will be made through the global WHO Code of Practice monitoring processes. Further details on government-to-government agreements and case studies are available in section 6.

3.12 Scotland recognises the importance of providing support for health and care systems support to countries facing severe health workforce vulnerabilities. Our health systems partnerships increase the capacity of the health and care workforce and support health systems improvements, examples are provided in section 6. Where special recruitment arrangements have been agreed, a government-to-government agreement sets out the specific parameters of support that have been mutually agreed upon.

3.13 This does not prevent individual health and social care personnel resident in countries on the red and amber country list, from making a direct application on their own behalf to a health and social care employer without using a third party, such as a recruitment organisation, agency or collaboration.

Recruitment of international health and social care personnel is monitored and reported on to the Cross Whitehall International Recruitment Steering Group and the WHO.

3.14 DHSC will continue to monitor data on health and social care personnel international workforce flows and report to the Cross Whitehall International Recruitment Steering Group as appropriate. Information will be analysed to understand where recruits have come from, with a particular focus on low and lower middle-income countries and fragile and conflict-affected states.

3.15 Through the steering group, relevant information will be shared with the UK's FCDO diplomacy network. DHSC also shares reports with the WHO as part of the UK's global commitment to uphold the principles of the WHO global code of practice. This information directly strengthens understanding of and cooperation on global mobility patterns.

3.16 Where trends indicate increases in recruitment from low and lower middle-income countries or fragile and conflict-affected states, further work may take place, in partnership with the FCDO to understand the cause(s) and impact of this activity.

International health and social care personnel will have the same legal rights and responsibilities as domestically trained staff in all terms of employment and conditions of work. They will have the same access to further education and training and continuing professional development.

3.17 All staff, regardless of country of origin and/or training, have the same legal protections within the workplace.

3.18 Relevant employment legislation applies as long as the employee holds a valid permit or appropriate visa.

3.19 All health and social care employees will be employed on the same terms and conditions of employment as other domestically trained employees.

3.20 Health and social care employees must meet and maintain requirements for continued professional regulation.

3.21 The opportunity to enhance skills and experience are important features that underpin international health and social care mobility.

3.22 International workers employed within the NHS, social care sector and other health and care organisations that comply with the Code of Practice, will receive high standards of induction and support in their new career equal to other employees.