First phase
The first phase of the project ran from 2018-2020 and set out to understand why nurses migrate from the Philippines; the factors shaping their choice of destination; what perception and ‘social imageries’ of the UK had they held prior to departure; and how these shaped their choices to come to the UK to work in the NHS. This involved discussions and interviews with nurse educators, medical professionals and academics in the Philippines.
One focus group was held with nurses prior to their departure to the UK, and between 2018 and 2019, focus groups and interviews were held in South-East England with 24 Filipino nurses who had been in the UK working for the NHS for two years or less.
Findings indicated that, despite the nurses being aware of their higher earning potential elsewhere, the UK was favoured primarily because of the relative ease and low financial outlay in the process of coming to the UK to work as a nurse, and the perception that the UK was a relatively stable and meritocratic society whereby one’s position would be determined through effort and ability rather than nepotism, and they would be able to access training and professional development that would enable career progression.
Although the UK was the first-choice destination for most of the nurses in this study, they remained open to moving elsewhere in the future, stating concerns over the cost of living, high levels of taxation, and poor working conditions, with many indicating they would ‘wait and see’ whether the UK lives up to their expectations.
Second phase
The second phase of the project ran during 2023-2024, and involved Dr Smith undertaking a field trip to the Philippines in February 2024, and Dr Smith and Dr Gillin visiting Japan in October 2024. In return, Professor Ela Atienza (University of the Philippines) and Professor Ruth Reina Carlos (Ryukoku University) visited the UK in March 2024 to undertake data collection and workshops.
Subsequent developments
Findings from the first phase indicated that for NHS Trusts, a key advantage of recruiting nurses from India and the Philippines was that they tended to remain working in the NHS for longer, and had lower attrition rates than EEA nurses. More recently, however, this pattern of international recruitment into stable, long-term careers in the NHS is changing markedly, with rising outflows of these nurses from both the NHS and UK.
Firstly, the NHS is experiencing an increasing outflow to other destinations, with over 70% of the 12,000 nurses who applied to work outside the UK being international nurses, largely from India and the Philippines. Secondly, a disproportionately high number of Asian/British-Asian nurses are leaving nursing, with 78% leaving between 2017-2022, compared to an overall rise of 33% rise, with a growing proportion of these nurses being aged 45+.
These trends have significant implications for a workforce strategy that has been heavily reliant on overseas recruitment from developing nations, although there is no research into their intentions surrounding work and retirement or the factors shaping their decision-making.
Next steps
A mixed-methods study is currently in progress, investigating the retirement intentions and expectations of Filipino nurses aged over 50 working in the NHS and whether, and in which ways, they have been influenced by recent events (e.g., Covid-19, the ‘crisis’ in the NHS, cost-of living factors; better opportunities elsewhere etc).
This pilot study will allow us to develop the approach to this research and refine the methodological tools for a larger project. Findings from interviews in the UK concerning the determinants of early retirement and retirement planning, and in the Philippines concerning the potential of ‘reintegration’ (e.g., domestic nurse training) programmes and skills partnerships between overseas and domestic Filipino nurses, will underpin development of this grant application by identifying areas and issues that warrant further research.
