In the 12 months to March this year, 48 per cent of the 48,436 new nurses and midwives who registered to work in the UK came from abroad, a record high, according to figures from the Nursing and Midwifery Council (NMC). An overwhelming majority of the overseas recruits came from outside the European Economic Area (EEA).
Echoing the picture in nursing, almost two-thirds of doctors who signed up to the General Medical Register in 2021 came from outside the UK. The proportion of international medical graduates (those trained outside the EEA ) was particularly high at 50 per cent and outstripped the number of UK-trained doctors (37 per cent) for the first time.
While non-UK trained staff play an essential role in the NHS, the UK’s increasing reliance on personnel from low-income countries has led to concerns that the health service is resorting to an unethical practice to plug its own staff shortage. One in seven nurses and over one in five doctors come from outside the UK or EU with Indians, Filipinos and Nigerians accounting for particularly large numbers.
The World Health Organisation specifies recommended ratios of doctors and nurses to patients. It has identified 47 "red list" countries where the number of doctors, nurses and midwives is below the global median, from which the UK has promised to not actively recruit. Doctors and nurses from these countries are not prevented from applying themselves to the NHS.
Analysis from the Royal College of Nursing this month found that there has been a ten-fold increase in new sign-ups to the UK nursing workforce from 14 countries on this list since 2019. The International Council of Nurses, a federation of more than 130 national nursing associations, put this increase down to post-Covid demand for extra nursing staff in wealthy countries, including the UK. While the RCN underlined that it supported the rights of those from overseas to work in the UK, it said that “Ministers are overly reliant on nurses from countries with critical workforce shortages. Meanwhile, their lack of investment in UK nursing staff – both today’s and those of the future – is deeply concerning.”
Other countries such as India, while not on the WHO list, still face medical personnel shortages. In 2020, India was 600,000 doctors short based on WHO recommendations.
Recruiting from abroad also makes the UK vulnerable to global events. In the year to March 2021, fewer nurses and midwives signed up to the NMC, driven by a fall in numbers of recruits from outside the UK.
The government has promised to recruit 50,000 extra nurses by 2024. In 2016, the then health secretary, Jeremy Hunt pledged that the NHS would no longer rely on doctors from overseas. While medical school places have increased in the UK, the data suggests reliance on staff trained abroad is unlikely to diminish.