People of non-UK nationality make up a third of doctors and a quarter of nurses in the NHS workforce in England, the first time both of these milestones have been reached, new analysis shows.
Some 209 different foreign nationalities are now represented in the NHS, with countries ranging from India and Pakistan – who together account for nearly one in nine doctors – to the likes of Andorra, Micronesia and Puerto Rico.
Health chiefs warned that the figures highlight how much a “severely understaffed NHS” relies on “dedicated people from all over the world”, adding that the UK needs to avoid becoming over-reliant on overseas staff who would otherwise help fill shortages in their countries of origin.
Of the 125,741 full-time equivalent (FTE) hospital and community health service doctors in England in June 2022 whose nationality was known, just over a third (33.8%, or 42,531) were non-UK nationals, according to analysis by the PA news agency.
This is up from around a quarter (26.7%) six years earlier, in June 2016, and is the highest proportion since current data began in 2009.
The most common non-UK nationality is Indian, accounting for 7.3% of all FTE doctors, followed by Pakistani (3.3%), Egyptian (2.7%) and Nigerian (2.0%).
Health experts warn figures show a 'severely understaffed' NHS.
Lynne Cameron
There has been a similarly sharp jump in the proportion of nurses and health visitors who are non-UK nationals, which now stands at a quarter of the total (25.4% of 313,679 staff), up from around one in six (17.1%) in June 2016.
Indian was again the most common non-UK nationality among this group, accounting for 7.3% of the total, followed by Filipino (6.9%), Nigerian (1.7%) and Irish (1.3%).
Saffron Cordery, interim chief executive of NHS Providers, the membership organisation for NHS trusts, said the analysis shows “just how much our severely understaffed NHS relies on dedicated people from all over the world to deliver high-quality care to patients”, whose contribution is “invaluable”.
She continued: “The stark reality is that the NHS just doesn’t have enough staff, putting patients’ safety at risk by affecting the care that overstretched staff can provide.
“With vacancies at an all-time high across health and care services – 132,000 in trusts in England alone – we desperately need a long-term, fully-funded workforce plan for the NHS from the Government to invest in growing the staff we recruit from within the UK alongside valued recruits from abroad.”
Caroline Waterfield, of the workforce organisation NHS Employers, said: “The NHS benefits greatly from hugely talented workers from around the world.
“The recent focus on additional recruitment of international nurses has resulted in a significant change in the profile of the NHS nursing workforce – we have also seen an increase in the numbers of individuals undertaking the nurse degree apprenticeship and undergraduate nursing programmes.
“It is critical we retain a multi-stranded recruitment approach for the years ahead, with investment going into the UK training routes to support more people from our communities and our current workforce to become nurses and allied health professionals.”
Not all NHS staff groups have seen a rise in the percentage of workforce who are non-UK nationals.
Peter Byrne
Of the total 1,196,477 FTE hospital and community health service staff in England in June 2022 whose nationality was known, 17.6% were non-UK nationals, the PA analysis found.
This compares with 13.0% in June 2016 and 11.9% in September 2009, when the data series began.
Not all NHS staff groups have seen a rise in the percentage of workforce who are non-UK nationals.
The figure for consultants has remained broadly unchanged from June 2016 (22.2%) to June 2022 (21.9%), while midwives have seen a drop from 8.5% to 6.8%.
But other groups have experienced a similar trend to that for doctors and nurses, with ambulance staff seeing an increase in non-UK nationals over this period from 4.8% to 7.4%, and medical support staff from 10.4% to 14.5%.
All figures are based on the latest available data from NHS Digital.
Billy Palmer, senior fellow at the independent think tank The Nuffield Trust, said PA’s analysis shows the health service “clearly relies on these overseas nationals to deliver care”.
He added: “The NHS needs to avoid becoming over-reliant on overseas staff as our recruitment practices could start to negatively impact on the countries of origin which have their own staff shortages.
“Another risk of over-reliance on overseas staff is that a sudden change of circumstances, such as Covid-19 travel restrictions or increased competition from other countries, could mean we become unable to recruit as many through this route as hoped.”
Alex Baylis, assistant director of policy at health charity The King’s Fund, said the absence of a plan to ensure the UK has sufficient domestic supply of healthcare staff means it is “inevitable” that services have “turned to overseas recruitment to plug staff shortages”.
He continued: “We expect this trend to continue for at least the next five years. In the long term, given the World Health Organisation’s predictions for global shortages of healthcare professionals, the UK should aim to ensure it trains and retains enough staff to meet the NHS’s needs.”
A Department of Health and Social Care spokesman said: “International recruitment is only one part of our plans to grow the NHS workforce, and the supply of homegrown staff is increasing.
“There are over 29,000 more nurses working in the NHS now compared to September 2019, and we are on track with our commitment for 50,000 more nurses by 2024.
“Acceptances to nursing and midwifery courses in England have risen since 2019 and we have increased medical school places by 25% alongside creating five new medical schools.
“NHS England have also been commissioned to develop a long-term workforce plan to help recruit and retain more NHS staff.”
Separate research from the Royal College of Nursing (RCN) published on Friday suggests the use of an agency or an internationally recruited nurse costs the NHS up to three times more than giving an experienced nurse a 5%-above-inflation pay rise.
Among the costs incurred in recruiting staff from abroad are recruitment agency fees, visa applications, travel, accommodation and examination fees, while a premium is charged for agency staff because they come through a recruitment firm.
Pat Cullen, RCN general secretary and chief executive, said: “Our NHS is built on the shoulders of our international colleagues and agency nurses play a vital role in patient care, but the UK government must strengthen the domestic workforce and ensure we have long-term, sustainable solutions for the health and care crisis.”
