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 overseas.
Many of the countries recruited from 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 found.
The group’s inquiry into the benefits and costs of international health worker recruitment heard that the scale of NHS reliance on overseas workers meant the government’s plan to reduce international recruitment to around 10% by 2035 was overambitious.
“The NHS has not operated at that level for decades,” said Andrew Mitchell, the former development minister who chaired the inquiry.
Thirty-six per cent of UK doctors and 24% of nurses and midwives were trained elsewhere in the world.
The number of visas granted to healthcare professionals has fallen sharply in recent years. But overseas staff would be needed “for the foreseeable future”, the APPG said.
Mitchell added: “We must grow our own workforce. But in a shrinking world, pretending health workforces are purely national assets, is no longer credible. If we benefit from health workers trained overseas, we also have a duty to help strengthen the systems they come from.”
The World Health Organization forecasts a global shortage of 11 million health workers by 2030. Today, almost a quarter of the world’s doctors, nurses and midwives are concentrated in just 10 high-income countries.
There are around 30 doctors for every 10,000 people in the UK, compared with nine in India, six in the Philippines and one in Ghana.
Giving evidence to the inquiry, 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 workers as well as patient safety and care, they said.
Ben Simms, the 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 from 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. Analysis of the savings made by recruiting staff from overseas was conducted by the conference organiser GHP and the Center for Global Development.
They used “conservative estimates” that training a doctor in the UK costs taxpayers about £120,000, including elements such as subsidised university places and paid clinical training, while training a nurse costs about £23,000.
The UK has signed agreements with many of the countries it recruits from, but these tended to “solely manage the mechanics of mobility” rather than linking recruitment to sustained investment in training and retention that could offset its impact, the report found.
The APPG inquiry recommended a fairer system where international recruitment was offset by proportionate investment in health workforce development and health system strengthening in partner countries.
“A model based on partnership rather than extraction offers a path that aligns moral responsibility with national interest,” the report says.
Last week, the Guardian revealed that the government was axing a flagship health project that supported development and training for healthcare staff in six African countries, as part of aid cuts in order to boost defence spending.
Dr Beccy Cooper, the APPG’s chair, said: “International health workers are part of the NHS’s DNA. In a world where diseases don’t stop at borders, their global expertise strengthens our health system. Supporting homegrown talent and ethical international recruitment are not competing goals – they are both essential. What we cannot afford is boom-and-bust workforce planning that destabilises the NHS and weakens global health systems at the same time.”
A Department of Health and Social Care spokesperson said: “The NHS benefits hugely from its international staff, and we’ll continue to support talented overseas health workers who want to dedicate their time, energy and skills to the health service.
“However, this shouldn’t be at the expense of countries with already stretched health systems, and it’s only right that British taxpayers should see a return on the investment they make in training our own medical talent. That’s why we’re making bold choices to focus on the recruitment and retention of homegrown doctors and nurses, prioritising UK medical graduates for jobs, and boosting graduate nurse pay.”
