James Johnson: The debt the NHS owes to workers from overseas

From a speech by the chairman of the British Medical Association at the annual conference in Llandudno
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Whether the next government is Labour or Tory, we face a fundamental shift in the balance between public and private provision. There are some major challenges to overcome. One of these is to help the most vulnerable, the most disadvantaged and the chronically ill to navigate the system and exercise meaningful choice. We must not let "choice" mean choice for some and the devil take the rest.

Choice implies spare capacity, and we are still woefully short of the doctors, nurses and health professionals we need to run a 21st-century service. The medical workforce is expanding - and I give due credit to the Government for investing in new medical schools. But the effect of reduced hours and the rising number of women and part-time doctors in the profession will largely mop up this increase in doctor numbers.

Throughout the history of the NHS, we have relied on other countries to fill our NHS manpower gaps. As the fourth largest economy in the world, we are still doing so - still taking doctors away from countries like South Africa and nurses from the Philippines, who need them more than we do. It's a shameful record of exploitation. We should be producing enough doctors to look after our patients.

Operation Thank you - which starts later this year, is a belated, but sincere, effort to pay tribute to the many thousands of doctors from India, Pakistan and Bangladesh who have been a mainstay of the NHS for the last 40 years and have often received scant acknowledgement or suffered outright discrimination.