Commercialised nursing education fuels migration of nurses to the UK, strains Indian healthcare

The trend of Indian nurses migrating to the UK comes at a significant cost to India's healthcare system, according to a recent study funded by the Economic and Social Research Council (UK). 

The study, published in the latest issue of British Medical Journal (BMJ) titled "Market Making and the Production of Nurses for Export: A Case Study of India–UK Health Worker Migration," indicated that for-profit intermediaries are customising training to meet UK healthcare needs, exacerbating the brain drain.

Earlier this month, the Federation of Indian Chambers of Commerce and Industry (FICCI) and Ernst & Young (EY) had pointed out that to achieve the Healthcare Vision 2047, India needs to increase the number of nurses to approximately 12.5 to 15 million. This target aims to bring India closer to the nursing averages of developed countries. However, the current trend of nurse migration disrupts these national healthcare goals.

As per the government data, India faces a significant shortage of nurses, with a nurse-to-population ratio far below the World Health Organization's (WHO) recommendation of three nurses per 1,000 people. Estimates suggest India has around 1.96 to 2.0 nurses per 1,000 people.

“Despite the impressive number of nurses and midwives our country educates, there's a noticeable gap in their availability, particularly in key centres. This creates challenges, with staff often feeling overburdened. While there are various factors contributing to this, such as insufficient remuneration, long hours, limited career growth opportunities, and sometimes a lack of appreciation for their crucial role, contribute to this issue,” said Twinkle Caroline Vinita, Nurse Manager, KITES Senior Care, a Geriatric Care specialist firm.

Authors Sibille Merz, Benjamin M Hunter, Susan F Murray, and Ramila Bisht explored the networked and commercialised nature of the Indian market for nurse migration to the UK. The study utilised data from 27 expert interviews, revealing how private and public actors, including commercial agencies, nursing colleges, and language schools, are deeply involved in this process. These entities customise curricula and offer language and cultural training tailored to meet the specific shortages in the UK healthcare system, the study said.

One concerning revelation is that several Indian nursing colleges are explicitly preparing students for international markets, particularly the UK and the US. These colleges collaborate with recruitment agencies to facilitate the migration process, sometimes even before students have passed their professional licensing exams. This focus on exporting nurses often leaves domestic healthcare severely understaffed.

The migration industry's commercialised nature has substantial negative repercussions on India's healthcare system. Highly skilled nurses, whose training has been subsidised by the Indian state, are leaving in large numbers, worsening the nurse-to-patient ratio in hospitals. This exodus exacerbates the already uneven distribution of healthcare workers across the country, particularly affecting rural and underprivileged areas, the study said.

“Nurses abroad are offered attractive packages, including competitive salaries, comprehensive healthcare coverage, supportive family visa programs, and other incentives that make working abroad appealing. However, if India understands the challenges and comes up with more and better solutions, we can encourage more nurses to stay and work in their homeland,” she said.

The study highlighted the urgent need for Indian health policymakers to address this growing crisis. There must be a balanced approach to nurse training and migration to ensure that while international opportunities are provided, domestic healthcare needs are also met. Investing in better working conditions, pay scales, and career opportunities for nurses within India may serve as a deterrent to this outward migration.