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

Revision of the Scottish code of practice for the international recruitment of health and social care personnel.

9. Annex B – Process for code of practice contraveners

9.1 This section describes an abridged version of the informal and formal escalation stages of investigation when NHS Employers becomes aware of recruitment and/or associated activity that contravenes the Code of Practice. The detailed process is housed securely by NHS Employers and applies to all recruitment organisations, agencies and collaborations. Employing organisations who are reported as being in breach of the code will also be investigated. This will include the informal stage as outlined below, as well as discussions with DHSC, and possible additional investigations if activities were supported by a recruitment organisation, agency or collaboration as outlined below.

9.2 If there are any concerns about potential breaches to the code, please contact

9.3 NHS employing organisations are reminded that NHS England nursing, midwifery and AHP international recruitment funding is currently provided on the condition that they adhere to the code of practice in all international recruitment activity.

Informal stage

9.4 NHS Employers receives information about an organisation, either through random checks or another manner, that indicates a potential breach of the Code of Practice.

9.5 NHS Employers carries out desktop research and other checks including but not limited to conducting a spot check on Companies House, the organisation website and social media presence to determine whether there is any evidence to pursue further investigation. NHS Employers also considers if any other breaches or investigations have been previously recorded as well as their knowledge test as part of their initial application to the code of practice (for those who joined after August 2022).

9.6 If appropriate, the organisation is contacted via email to clarify their business activities, how it may have breached the code of practice and is given ten working days to respond. The reply from the organisation and any supporting evidence will be reviewed and considered against the guiding principles and best practice benchmarks of the code of practice.

9.7 The organisation's response is considered and depending on the response, NHS Employers may consider:

  • to close the informal investigation.
  • if the organisation may be given an opportunity to correct their behaviour or
  • if the formal procedure needs to begin.

Formal stage

9.8 Where a formal investigation is required, any relevant information (including media articles, social media activity, promotional/website material) from the organisation under investigation in relation to alleged wrongdoing or contact from an employer, framework provider, trade union representative or other stakeholder will be collated and saved securely and in accordance with any relevant data protection laws to aid future investigations.

9.9 This information will be shared with the organisation in a formal letter. The formal letter will be addressed to the most senior person listed on the organisation details as provided to NHS Employers and sent to the organisation.

9.10 The formal step in the process is to outline the initial findings from the informal stage, provide them with the evidence that has been gathered and give the organisation concerned a right to reply.

9.11 The organisation will have ten working days to provide a formal written response. NHS Employers may consider a short extension to the ten-day response time frame, in exceptional circumstances, at their discretion.

9.12 The panel receives relevant documentation 5 working days before the panel meeting

9.13 The independent panel will consider all the evidence presented and where appropriate will recommend sanctions to the DHSC, which may include temporary or permanent removal from the ethical recruiters list. Other sanctions may include:

  • The organisation will remain on the ethical recruiters list however will be subject to monthly spot checks for up to one year, and/or additional training imposed.
  • A formal warning that a repeat of the same activity (or other code breaches) will result in removal from the code of practice.
  • Requirement for additional training and a re-sit of the knowledge test.

9.14 Generally a one-year waiting period comes into effect before the recruitment organisation, agency or collaboration can apply to be placed back on the list. However, the sanction may be to permanently remove the organisation from the code of practice.

9.15 It is at the discretion of NHS Employers as to whether this waiting period should be extended or any applications should be immediately refused in future. They will consider:

  • repeated breaches
  • the measures put in place to prevent future breaches
  • the organisation's co-operation in any investigations

To re-apply an organisation will need to provide evidence that it has changed its business practice. The organisation will either be accepted or declined. If declined, the organisation will need to wait an additional 12 months before re-applying

Appeal Stage

9.16 On receiving the formal notification letter from the Independent panel from the formal stage, the organisation can appeal to NHS Employers by providing any further relevant information for consideration within 10 working days.

9.17 The purpose of the appeal procedure is to review the process and reason for the decision to remove an organisation from the list when the organisation believes the process was improperly administered or the decision was unjustified/

9.18 The appeal panel will be independent of any previous decision making in the process. The panel will include:

  • NHS Employers staff member at director level
  • NHS Confederation staff member at assistant director level
  • NHS Employers or other Stakeholder staff member at programme lead or manager level

9.19 The appeals process should be completed within 6 weeks of receiving the written appeal unless there are circumstances that warrant an extension. In these circumstances, the appeals panel should inform the organisation in writing of the reasons and, where possible, the timescale of the delay.

9.20 The panel members will consider the appeal submission and any evidence together with the original papers supplied by the NHS Employers' investigation team.

9.21 Panel members can ask for additional information or clarification from either the organisation or the NHS Employers' investigation team.

9.22 Consideration should be given to the following:

  • whether the primary investigators clearly demonstrated that a breach or breaches of the code of practice has taken place – the evidence should support this – and the decision to remove the organisation from the ethical recruiters list is proportionate
  • whether there is any possibility that the information on which the original decision was based is incorrect
  • whether the organisation has been given an opportunity to respond and provide an explanation of their actions
  • whether the organisation disproved the evidence or raised serious doubt about its validity
  • whether the process has been handled appropriately by NHS Employers

9.23 The panel will make a majority decision whether to uphold or reject the appeal. It may also make other specific recommendations. When the review is completed, the organisation will be notified of the outcome in writing by NHS Employers.

9.24 If the appeal is upheld, the sanction will be removed or adjusted in line with the appeals panel decision and relevant stakeholders will be notified of any sanction applied.

Action by appeals panel

9.25 Panel members do not have to consider the appeal together in a formal face-to-face meeting but should meet if requested by one of the panel members.



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