Case study
PrimeReach Care is a government funded, acute health care service to around 500,000 people in its local region. Located across multiple, geographically dispersed sites, it employs over 15,000 people in a wide variety of professional and ancillary roles and maintains a variety of important partnerships with dozens of other organisations.
PrimeReach Care has faced very substantial challenges in recent years. Some, like the covid pandemic were exceptional, but thankfully quite short-lived. Others, such as a fast-aging population and the emergence of some chronic skills shortages in key areas, are longer term in nature, but equally concerning in terms of their potential impact on PrimeReach Care’s capacity to provide the highest standards of healthcare. Skills shortages in some specialist areas are becoming increasingly
severe. PrimeReach Care has plugged gaps by recruiting overseas but is finding it hard to retain these recruits for longer periods of time.
During 2024, employee voice activities highlighted that groups of staff were dissatisfied about pay and conditions within the organisation. This has now abated due to significant government-funded pay rises, but discontent among staff in respect of terms and conditions continues to simmer. Staff retention is a particular current challenge, as is absence. A higher percentage of PrimeReach Care’s employees are currently taking extended periods of sick leave than has ever been the case before, and in over 50% of these cases poor mental health comprises at least one of the causes. Senior managers at PrimeReach Care have recently attended a briefing given by ministers and officials, at which some very clear messages were communicated regarding the next five years. The most important concerned funding. Put simply, health care services like PrimeReach Care should plan for very tight, ongoing financial settlements in the next five years. They should not expect above- inflation increases in their regular operating budgets, which include pay for staff. Any additional funds that become available will be focused specifically on priorities such as bringing waiting lists and waiting times down. Capital budgets will also be very constrained, reducing the availability of funds for new buildings and equipment. Repair bills will have to be met out of current expenditure. Substantial efficiency improvements and increased productivity are both needed and expected.
Senior Managers have asked the People Department to provide recommendations about appropriate future actions at PrimeReach Care in some key areas. You work in a generalist, mid-level People management role on PrimeReach Care’s main site but are considered to be someone who is appropriate for promotion into a more senior role on completion of your studies. The People Director has asked you to provide answers to the following questions that will provide insight into some of the major challenges facing PrimeReach Care and help to inform the recommendations.
Globalization has had a massive impact on the operations of companies globally. It has emerged due to a combination of factors that include low cost of sea transport, emergence of new technologies, and expansion of international trade. Therefore, it has transformed how the organizations operate, trade, and interact across boundaries. In the healthcare sector, the impact of globalisation has been massive and largely positive. For a company such as PrimeReach Care, which is a government funded acute healthcare provider that is serving more than half a million customers, globalisation has affected the supply of its workforce, partnerships, and service delivery to customers. The most significant impact of globalisation on the operations of the company is sourcing and managing medical talents overseas for roles that are hard to recruit.
Nature and Drivers of Globalisation
Globalisation is the interconnection of national economies, society and workforce due to a convergence of factors named earlier. Again, those factors are advances in communication technology, free movement of labour and capital, and policy changes that support international trade between economies. In the healthcare sectors, these factors have made it easier for doctors and other workers in the healthcare sector to move freely. Today, many national health systems, including UK’s National Health Service (NHS), relies on the international market for healthcare professionals to fill certain cadres in the healthcare sector specially nurses. For PrimeReach Care, the implication is that labour market for healthcare professionals is not national but global. The company must complete in the global market for nurses and people with skills in nursing, midwifery, radiography, and specialist medical fields (Chartered Institute of Personnel and Development, 2023). Thus, the company has the advantage of drawing professionals from a wide pool of international qualifications but it also comes with the risks that include competing in the global market place for people with medical skills, retention risks, and ethical considerations when recruiting.
Globalisation and the UK Health Workforce Context
The UK health system is reliant on global workforce to fill in gaps in the sectors where skills are required. According to NHS Digital (2023), nearly 18% of NHS staff in England were non-UK nationals, up from 13% in 2018. Furthermore, according to additional data from the Nursing and Midwifery Council (NMC) reports that more than 50% of new nurse registrants in 2023 were trained overseas, mainly in India, the Philippines, and Nigeria. These statistics show that the UK healthcare sector is heavily reliant on the global workforce.
For PrimeReach Care, it benefits from this large talent force of cheap labour for high end skills in the market. In the case of this specific organization, the major benefit is tapping into it to get skills in emergency medicine, anaesthetics, and intensive care. The demand for these skills is high and tapping into it allows the organization to benefit and acquire cheap labour. The only downside is that by relying too heavily on international labour markets, it is exposed to risks arising from changes in immigration, fluctuations in the exchange rates, and global economic shifts. For instance, as the global south becomes more prosperous, it is keen in retaining skills such as nurses and doctors and this means less supply in the international labour markets for those skills. PrimeReach Care is exposed to those shifts.
Benefits of Globalisation for Workforce Sourcing
Access to a Global Talent Pool
With globalisation, PrimeReach Care can require training professionals in various medical fields especially in areas with shortfalls in the domestic market. Therefore, the company can maintain adequate staffing levels and continue to offer high quality healthcare to its customers.
Faster Skills Acquisition
PrimeReach Care can gain access to workers with advanced training and skills without investing much time in training and talent pipelines. Therefore, the company can reduce the time and effort that is require to training employees in the domestic industry.
Knowledge and Practice Exchange
The benefits of international workforce are that it brings new perspectives and practices. This happens because the workers have been trained under different health systems so this international workforce brings new perspectives and innovations in different areas such as clinical procedures, care models, and technology adoption. For the company, having an international workforce is a benefit.
Enhanced Resilience
The covid pandemic demonstrated the need to have an international workforce and networkers for sharing knowledge, resources and expertise. During these trying times, it is important to have those networks to ensure that the care continued without interruption (Chartered Institute of Personnel and Development, 2023).
Challenges of Globalisation in Recruitment and Retention
High Turnover of International Staff
PrimeReach Care struggles to retain staff because the employees view UK as a transition destination as they seek for better opportunities in other high-income countries. This challenge means that for the organization, it retains high cost of recruitment, selection, and training due to high attrition. In the longer terms, these costs could be significant and dent the overall operations of the company.
Integration and Cultural Adjustment
Most of the migrant health workers in the UK comes from Nigeria, Pakistan, and India who are from different cultures and this means problems with adjusting to the local culture and language. Without proper intercultural training and competence.
Ethical and Reputational Risks
Hiring employees from low to medium income countries raises ethical issues. These counties invest their scarce resources in healthcare training only to see the same resources flee the countries to high income countries with better resources for training. Therefore, for PrimeReach Care, it must comply with UK’s Code of Practice for International Recruitment (Department of Health and Social Care, 2023) to avoid reputational harm.
Dependency on Global Labour Markets
By depending too much on global labour markets, there is little incentives to develop domestic talent pipelines. Therefore, with little incentives tot develop local talent pipelines, there is unhealthy imbalance making the workforce less sustable in the longer term. A good policy needs to balance the short term and long-term recruitment and staff need to build a sustainable balance.
Globalisation as a Lever to Enhance Overseas Sourcing Processes
PrimeReach Care can formalise partnerships with accredited overseas training institutions and health ministries in countries with surplus healthcare professionals. Such partnerships create predictable, ethical recruitment pipelines. Memoranda of understanding (MOUs) can ensure mutual benefit, aligning with WHO guidelines. Examples include NHS trusts that have established long-term collaborations with nursing colleges in India and the Philippines.
Leveraging Digital Recruitment Platforms
Globalisation and digitalisation intersect to simplify international recruitment. PrimeReach Care can adopt global online recruitment platforms, virtual interviews, and pre-arrival onboarding systems to speed up hiring and reduce administrative costs. Artificial intelligence can be used to screen qualifications and match candidates to suitable roles more efficiently.
