Publication - Advice and guidance

Health and social care personnel - international recruitment: code of practice

This Code of Practice sets out the principles and practices for the ethical international recruitment and appointment of all international health and social care personnel in Scotland. This demonstrates Scotland’s commitment to ethical recruitment and protecting the healthcare systems of developing.

Health and social care personnel - international recruitment: code of practice
4. Best Practice Benchmarks

4. Best Practice Benchmarks

4.1 It is expected that all health and social care sector organisations that comply with the Code of Practice will apply the best practice benchmarks set out in this section.

4.2 These best practice benchmarks should be read in conjunction with NHS Employers' International Recruitment Toolkit. The toolkit is designed to encourage and enable supportive practices and processes for the recruitment of international staff across a wide range of professions.

4.3 Although the toolkit was developed for employers in England, the general principles within the toolkit are applicable in all the nations of the UK.

There is no active recruitment of health and social care personnel from countries on the list.

4.4 No active recruitment will be undertaken from countries on the list by Scottish or UK-wide recruitment agencies, or by any international agency sub-contracted to that agency, or any health and care organisation in Scotland, unless there exists a UK government-to-government agreement that health and care personnel from that country may be targeted for employment under the terms of that agreement.

4.5 The list is available at Annex A and on the NHS Employers website. The list will be updated, alongside scheduled progress reports on WHO Global Code implementation, by the World Health Assembly every three years.

4.6 Health and social care organisations may consider applications from an individual in a country on the list if that individual is making an application directly and on their own behalf and not using a third party, such as a recruitment agency or a health or social care employer on a commercial basis.

All international recruitment by health and social care employers will follow good recruitment practice and demonstrate a sound ethical approach.

4.7 Health and social care employers, when using a recruitment agency, should only contract with agencies that comply with the Code of Practice. A list of those agencies can be found on the NHS Employers website

4.8 Using approved agency frameworks ensures compliance with NHS pre-employment standards and grants access to a wide range of experienced international recruitment organisations that all operate at a high standard of quality. NHS National Services Scotland can provide further information about frameworks in Scotland.

4.9 All international recruitment will be sensitive to local health and care needs so that international recruitment from any country should not weaken local health and care provision.

4.10 A recruitment agency will be removed from the list of agencies if, following a thorough investigation, it is found to be breaching the principles of the Code of Practice. This process is set out in Annex B.

International health and social care personnel will not be charged fees for recruitment services in relation to gaining employment in Scotland

4.11 Applicants will not be required to pay any fees to any recruitment agency, or other body, to gain employment.

4.12 Any costs incurred by a recruitment agency will be incorporated into the negotiated fee charged to employers. At the employer's discretion, Visa costs to exit their home country/enter UK and/or any professional registration fees would normally be met by the health or social care candidate if applying independently, and by the employer if through active recruitment.

4.13 Employers will not contract agencies that charge fees to candidates for them to be considered for recruitment in Scotland. Agencies that sub-contract to agencies outside the UK, should also not be used if that agency from outside of the UK charges fees.

All international health and social care personnel will have the appropriate level of English language to enable them them to undertake their role effectively and to meet registration requirements of the appropriate regulatory body.

4.14 All potential employees will be able to communicate effectively to practice safely and to enable them to communicate appropriately with patients, clients, carers, family and colleagues.

4.15 It is lawful for employers to apply conditions relating to a candidate's linguistic ability if this is required because of the nature of the post to be filled.

4.16 If a regulatory body requires an assessed competency in English language to be eligible for registration, this should be achieved where possible and if appropriate, prior to selection interview.

All appointed international health and social care personnel must be registered with the appropriate UK regulatory body

4.17 Candidates should be advised of the requirements to practice in the UK and how to obtain relevant professional registration and be signposted to the relevant regulatory organisation. It is the responsibility of the recruit to progress the registration process, with support from the relevant regulatory body. Employers should continue to communicate with their recruit and make sure they are clear about the process to avoid unnecessary delays.

4.18 Candidates should be strongly advised to commence the registration process in good time and if possible before applying for a post. If a candidate does not have registration at the time of appointment, employers and contracting bodies should factor this in when agreeing contracts and start dates. Employers should consider approaching the appropriate regulatory body early in the recruitment process to provide early insight on upcoming registration demand and support the professional regulator to manage capacity.

4.19 Employers must ensure that confirmation of professional registration, or notification of any stipulated period of supervised practice, is received prior to the candidate taking up the post where this is stipulated by the regulatory body.

4.20 Candidates should be advised of the importance of professional support and representation from membership representative bodies and where appropriate medical defence, should they be engaged in any process, including supervised practice, with their regulator.

All international health and social care personnel required to undertake supervised practice, if required to do so by a regulatory body, should be fully supported in this process.

4.21 To enable the health or social care personnel to provide safe and effective care they will be appropriately supervised and the employer will take active steps to ensure the workplace environment is one in which all staff can demonstrate their competence.

4.22 The health or social care personnel will not be charged for any part of supervised practice and will be employed on the same terms and conditions of employment as other trained employees. Employers are encouraged to recognise previous experience where applicable.

4.23 The health or social care personnel will have appropriate opportunities to reach the required standard for UK registration and will be objectively and fairly assessed.

All international health and social care personnel will undergo the normal health assessment prior to commencing employment.

4.24 All employment offers will be made subject to occupational health clearance.

4.25 Occupational health assessment information is confidential and will only be divulged to the relevant occupational health bodies, or as permitted and/or required by law.

4.26 Employers will ensure thorough, sensitive, individual risk assessments are conducted for all new international migrants before they are exposed to work in a clinical environment.

All international health and social care personnel will have appropriate checks undertaken for any criminal convictions as required by legislation.

4.27 Applicants will be informed that any individual who has made a false declaration may be dismissed from their post.

4.28 All appointments should provide references from current and previous employers and/or education provider.

4.29 All personnel will be required to complete a statement informing the employer of any criminal conviction. Employers should undertake the necessary checks for criminal convictions as required under Scottish law.

4.30 Employers and contracting bodies must carry out pre-employment checks seeking to verify that an individual meets the preconditions of the role they are applying for.

4.31 In Scotland, personnel working with children and protected adults will be required to join the "Protecting Vulnerable Groups" (PVG) scheme which is managed by Disclosure Scotland. The application process involves gathering criminal record and other relevant information.

All international health and social care personnel offered a post will have a valid visa or appropriate permit before entry to the UK.

4.32 Personnel offered a post in Scotland must have an appropriate UK visa or appropriate permit that allows them to undertake employment/training.

4.33 The cost of any visa may be met by the employer at their discretion.

4.34 All personnel employed in the UK are employed on the same terms and conditions as domestically recruited employees.

Appropriate information about the role applied for will be available to all international health and social care personnel

4.35 Health and social care personnel will have access to all the relevant information about the post they have applied for. This will include a job description, person specification, grading structure, salary, location, information on the professional regulatory context and relevant staff-side organisations.

4.36 All parties involved in recruitment will have explicit equal opportunities policies and procedures.

4.37 On making the job offer, health and social care employers and contracting bodies should provide candidates with the exact terms of the contract under which they will be working. Any element which may differ pre- and post-professional registration such as salary, and any incentives and reclaim of advances must be clearly explained in writing. This applies regardless of when the formal contract is issued.

All newly appointed international health and social care personnel will be offered appropriate support and induction. As part of this, employers should undertake pre-employment/placement preparation activity to ensure a respectful working environment for all.

4.38 Employers and potential education providers should ensure they understand the culture, context and system within which the individuals work in their home country before the international health and social care personnel arrives.

4.39 Other staff working in the host organisation should be made aware of the requirement to recruit internationally and of the support expected of them to encourage a culture in which diversity is valued and respected.

4.40 Induction should include aspects of cultural awareness, equal opportunities and diversity. Ongoing support should be culturally sensitive and offer career development and opportunities for progression.

4.41 Feedback is sought from currently employed staff and internationally recruited individuals as the employment/placement progresses and any issues are identified and resolved in a timely manner.

4.42 Each international recruit must be made aware of how to find help and assistance in all aspects of their appointment. They should undergo a comprehensive programme of induction to ensure that they are clinically and personally prepared to work safely and effectively within the Scottish health and care system. The provision of a mentor can be helpful. NHS Employers International Recruitment toolkit provides advice and good practice guidance on the support required.

4.43 Induction programmes should encompass wider pastoral support to settle into working and living in Scotland It should include such matters as: initial welcoming of staff (and family where appropriate), accommodation, pay, registering with a GP and dentist, school information (if required,) information relating to professional organisations, union representation, national embassies, high commissions and introduction to social networks.

4.44 The potential financial position of health and social care personnel should be considered, and employers and contracting bodies should be aware that additional support may be required at varying levels depending on each individual situation.

Health and social care employers should respond appropriately to applications from international health and care personnel who are making an individual application.

4.45 Individuals making enquiries from outside of the UK should be directed to the appropriate regulatory body in the first instance.

4.46 Individuals applying to vacant posts should be dealt with equitably and fairly. Where appropriate, employers will have determined whether they accept applications from individuals requiring a visa or permit for that post.

Health and social care employers and contracting bodies should record international recruitment activities. This will support Scotland and the UK to monitor and measure the impact of international recruitment flows on the health and social care sector in both the country of origin and Scotland and the UK.

4.47 It is important to have a national perspective on international recruitment supply and demand to inform policy development, workforce planning, recruitment processes and attrition rates. This also helps to identify best practice in maximising benefits to the UK, to the country of origin health and social care systems, and to health and social care personnel.

4.48 Health and care organisations should ensure they record information about their recruitment activity such as countries targeted, planned recruitment numbers, headcount and nationality of international recruits in employment and the length of the recruitment process.

4.49 DHSC has a UK designated national authority to contribute to exchange on health worker migration on a global level, including regular progress reports to the World Health Organisation, for ongoing monitoring, analysis and policy formulation.

4.50 Health and social care employers are encouraged to share information on any known breaches of the Code of Practice.

Illustrative case studies

4.51 A guiding principle of the Code of Practice is that there must be no active recruitment from countries on the list, unless there is an explicit government-to-government agreement with the UK to support managed recruitment activities on the terms of the agreement. Active recruitment is defined at paragraph 2.5.

4.52 The scenarios below set out how the definition of active recruitment is applied in practice. These scenarios are not an exhaustive list of the types of conduct which constitute active recruitment, any conduct which falls within the definition at paragraph 2.5 will constitute active recruitment.

Recruitment activity in breach of the Code of Practice

Scenario 1

An agency advertises within a country on the list and actively supports a number of candidates from that country with their applications, appointments and travel to Scotland. This would be deemed active recruitment and contravenes the guiding principles within the Code of Practice.

Scenario 2

An agency runs a recruitment fair in Lebanon highlighting opportunities in Scotland. Lebanon is on the list and should not be actively targeted for recruitment. The agency does not actually hire anyone. This would still be deemed active recruitment and contravenes the guiding principles within the Code of Practice.

Scenario 3

An agency/organisation with multinational contracts advertises in Uganda. They highlight that they are recruiting to a different country (i.e. not Scotland or the UK), however they also have contracts in Scotland. It later transpires that the agency facilitated a candidate's arrival to work in Scotland. This would still be deemed active recruitment and contravenes the guiding principles within the Code of Practice.

Scenario 4

An agency based in a country on the list, does not advertise in that country but is approached by a group of individuals looking to work in the NHS. The agency interviews and appoints a number of these candidates and then organises the travel logistics and visa to bring them to Scotland. This would be deemed active recruitment and contravenes the guiding principles within the Code of Practice.

Scenario 5

A recruitment agency based in a country on the list is approached by several individuals requesting they are matched to vacant posts in the social care sector. The recruitment agency approaches a number of social care employers with details of the candidates wishing to apply and the employer takes it from there. This would be deemed active recruitment as the individuals did not approach the social care employer individually.

Acceptable recruitment activity under the Code of Practice

Scenario 6

A nurse from Zimbabwe applies to work in the NHS unassisted. They are interviewed by the NHS Board and deemed successful for the post, subsequently travelling to Scotland on receipt of their visa. This activity did not include any active recruitment therefore does not contravene the Code of Practice.

Scenario 7

A doctor from Syria is working in Canada having relocated there five years ago. An agency advertises in Canada and the doctor is picked up in the cohort and wishes to come to Scotland. This activity is not in breach of the Code of Practice; ethical recruitment is determined by the country from which the individual is being recruited, rather than the nationality of the individual.

Scenario 8

A nurse from Peru applies directly to a social care employer in Scotland and is successfully appointed. The social care employer requires the support of a recruitment agency to facilitate the nurse through the remaining part of the recruitment process. This activity is not in breach of the Code of Practice as the nurse approached the social care employer directly and it was only after the individual was appointed that the recruitment agency was brought in to support the remaining part of the process.