Two of UK’s top three sources of international nurses are ‘red list’ countries

Nigeria and Ghana have become two of the three biggest sources of internationally educated nurses and midwives joining the UK workforce, despite both countries being on the government’s recruitment ‘red list’.

The code of practice for international recruitment – published by NHS Employers and based upon the World Health Organization workforce support and safeguard list – states that countries on the red list should not be targeted when actively recruiting health or care professionals.

However, the list does not prevent individual health and social care personnel from independently applying to health and social care employers for employment in the UK of their own accord and without being targeted by a third party, such as a recruitment agency or employer.

According to annual data from the Nursing and Midwifery Council (NMC) register, red-listed Nigeria ranked as the second largest source of international joiners in the year to March 2026 with 1,614 joiners, while fellow red-listed nation Ghana moved into third place with 1,391.

India – on the green list, meaning international recruitment is permitted – remained the largest source of international joiners, with 4,215 new registrants. However, this represented a 54.4% fall compared with the previous year’s 9,249.

Meanwhile, fellow green-listed nation the Philippines fell out of the top three for the first time since 2015-16.

Highlighting the prominent position of the red-listed nations in the rankings, the NMC reminded employers and recruitment agencies to follow the code of practice to ‘help maintain ethical standards in international recruitment and support global health equity’.

The latest NMC annual registration report also found that international recruitment into nursing and midwifery has slowed sharply.

A total of 10,961 internationally educated professionals joined the NMC register for the first time during 2025-26, down 47% from 20,669 the previous year.

Internationally educated professionals accounted for 26.4% of new joiners, compared with 39.1% a year earlier and a peak of 49.4% in 2023-24.

Despite fewer internationally educated professionals joining the register, the NMC said its register had reached a record 867,935 registrants and that the workforce is more diverse than ever.

For the first time, more than a third (33.8%) of registered professionals are from Black, Asian and ethnic minority backgrounds, up from 32.5% a year earlier.

The regulator said this was partly because UK-educated professionals joining the register are becoming more ethnically diverse, with 35% of UK-educated new joiners now from Black, Asian and ethnic minority backgrounds, compared with 22.3% in the 12 months to March 2021.

Emma Westcott, executive director of strategy and insight at the NMC, said: ‘Together, these findings show a workforce that is larger and more diverse than ever, but one where growth is slowing and future supply cannot be taken for granted.’

She added: ‘We also call on employers to continue adhering to the government’s ethical code of recruitment, since two of the top three countries of education outside the UK are on the ‘red list’. While professionals from across the world want to come and work in UK health and care, and we welcome their contribution, we don’t want to undermine health systems in countries with the biggest workforce challenges.’

The NMC also highlighted ‘unacceptable levels of racism and discrimination’ experienced by nurses, midwives and nursing associates while delivering care.

The regulator’s 2025 Spotlight insight report found that 40% of professionals responding to its annual survey had experienced discrimination in the previous year, most commonly on the grounds of ethnicity or age.

Meanwhile, the fall in overseas recruitment contributed to a slowdown in overall register growth.

Although the register reached a record 867,935 nurses, midwives and nursing associates by the end of March 2026, annual growth almost halved to 1.7%, compared with 3.3% the previous year.

The number of UK-educated professionals joining the register also fell for the first time in five years, by 4.9%.

According to Professor Lynn Woolsey, chief nursing officer for the Royal College of Nursing (RCN), the figures will make ‘difficult reading’ for new Prime Minister Andy Burnham given the government’s ambitions to rebuild the NHS and reform social care.

‘We’re seeing domestic nurse numbers fall for the first time in several years at a time when international recruitment has continued to evaporate,’ she said.

‘As demand for services increases and care needs become more complex, the trajectory for the nursing workforce is deeply worrying.’

Professor Woolsey urged the government to deliver new investment to boost domestic nurse growth and provide measures to improve retention.

She also noted that the figures on diversity reflect ‘one of nursing’s biggest strengths’.

However, she added: ‘Amidst this pride is a sense of anger at just how often nursing staff have been failed by their employers who have allowed racism against frontline staff to flourish.

‘Rooting out this despicable behaviour isn’t just a moral duty for employers, but also imperative to the safe running of services.’

In January 2025, RCN research found that between 2020 and 2023, direct UK aid for health projects in recruitment ‘red list’ countries fell by almost 63%, from £484m to £181m.

However, the analysis also showed that between September 2020 and September 2024, the number of UK registered nurses trained in red list countries, including Nigeria and Ghana, had almost tripled – from 11,386 to 32,543.

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