Ministers’ plans to cut the international workforce within NHS England appear overambitious, MPs have said, as a report reveals the health service saved more than £14bn by recruiting doctors, nurses and midwives from abroad.
Many of the countries recruited were struggling with staff shortages, and the UK had a moral duty to offer support, rather than simply extracting what it needed, the All-Party Parliamentary Group (APPG) on Global Health and Security concluded.
The group’s research into the benefits and costs of international recruitment of healthcare workers revealed that the scale of the NHS’s reliance on foreign workers meant the government’s plan to reduce international recruitment to around 10% by 2035 was too ambitious.
“The NHS has not operated at that level for decades,” said Andrew Mitchell, a former development minister who chaired the inquiry.
36 per cent of UK doctors and 24 per cent of nurses and midwives received training elsewhere in the world.
The number of visas granted to health professionals has decreased dramatically in recent years. But foreign staff will be needed “for the foreseeable future,” the APPG said.
Mitchell added: “We must grow our own workforce. But in a shrinking world, claiming the health workforce is a purely domestic asset is no longer credible. If we benefit from overseas-trained health workers, we also have a duty to help strengthen the systems from which they come.”
The World Health Organization predicts a global shortage of 11 million health workers by 2030. Today, nearly a quarter of the world’s doctors, nurses and midwives are concentrated in just 10 high-income countries.
There are around 30 doctors per 10,000 people in the UK, compared to nine in India, six in the Philippines and one in Ghana.
As testimony to the investigation, representatives from Kenya and Uganda said they were losing significant numbers of experienced doctors, nurses and clinical educators. That would have detrimental effects on the next generation of health care workers, as well as patient safety and care, they said.
Ben Simms, chief executive of Global Health Partnerships (GHP), said: “The NHS is one of the most internationally connected health systems in the world. But when we recruit in countries that can least afford to lose staff, the consequences can be measured in lives.”
The APPG report is published on Monday at the UK Global Health Summit in London. Conference organizer GHP and the Center for Global Development conducted an analysis of the savings achieved by hiring foreign staff.
They used “conservative estimates” that training a doctor in the UK costs taxpayers around £120,000, including things like subsidized university places and paid clinical training, while training a nurse costs around £23,000.
The UK has signed agreements with many of the countries where it recruits, but these tended to “manage mobility mechanisms only” rather than linking recruitment to sustained investment in training and retention that could offset its impact, the report said.
The APPG investigation recommended a fairer system in which international recruitment was offset by commensurate investment in health workforce development and strengthening health systems in partner countries.
“A model based on partnership rather than extraction offers a path that aligns moral responsibility with the national interest,” the report says.
Last week, The Guardian revealed that the government was scrapping a flagship health project supporting the development and training of health workers in six African countries, as part of aid cuts to boost defense spending.
Dr Beccy Cooper, chair of the APPG, said: “International healthcare workers are part of the DNA of the NHS. In a world where diseases don’t stop at borders, their global expertise strengthens our health system. Supporting local talent and ethical international recruitment are not opposite goals: they are both essential. What we cannot afford is boom-and-bust workforce planning that destabilizes the NHS and weakens global health systems at the same time.”
A Department of Health and Social Care spokesperson said: “The NHS benefits greatly from its international staff and we will continue to support talented overseas healthcare workers who want to dedicate their time, energy and skills to the health service.
“However, this should not come at the expense of countries with already overstretched health systems, and it is only fair that British taxpayers see a return on the investment they make in training our own medical talent. That is why we are making bold decisions to focus on recruiting and retaining local doctors and nurses, prioritizing UK medical graduates for jobs and increasing the salaries of graduate nurses.”
