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How reliant is the NHS on foreign doctors?

Theresa May under pressure to lift cap that stops skilled workers coming to the UK - but what difference would it make?

Benjamin Kentish

Political Correspondent

Monday 04 June 2018 17:04 BST

More than one in four NHS doctors are foreign nationals (Getty)

Theresa May is on the verge of lifting an immigration cap that prevents doctors and nurses coming to Britain to work in the NHS, according to reports.

The prime minister has faced pressure from within her Cabinet to act, amid concerns that strict immigration quotas are stopping vacancies in the health service being filled.

Currently, doctors wanting to come to the UK from non-EU countries are affected by a cap on the number of tier 2 visas that can be given out. This type of visa is given to skilled workers, but under government regulations only 20,700 are allowed to be granted each year.

If the quota for each month is met then skilled workers seeking to come to the UK are refused. This has been the case for each of the past six months, leading NHS bosses to warn about a crippling lack of skilled staff, and pressure on the government to lift the cap.

But how many NHS workers come from abroad, and how big a difference would raising the cap make?

1,518 applications for visas by foreign doctors were turned down in the four months to March 2018. This suggests that, if the cap were raised, around 4,500 more doctors could come to the UK each year.

The health service is heavily reliant on staff from overseas.

In total, around 139,000 of the 1.2 million NHS employees are foreign nationals – equating to one in eight (12.5 per cent).

Of these, around 62,000 – or 5.6 per cent of all employees - come from EU countries. 45,000 come from Asia, and 21,000 are from African countries.

The most common nationalities are Indian (18,300), Filipino (15,400), Irish (13,000) and Polish (8,500).

Everyone the Government blames for the NHS crisis – except themselves

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1/6Everyone the Government blames for the NHS crisis – except themselves

Everyone the Government blames for the NHS crisis – except themselves

The elderly

“We acknowledge that there are pressures on the health service, there are always extra pressures on the NHS in the winter, but we have the added pressures of the ageing population and the growing complex needs of the population,” Theresa May has said. Waits of over 12 hours in A&E among elderly people have more than doubled in two years, according to figures from NHS Digital.

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Everyone the Government blames for the NHS crisis – except themselves

Patients going to A&E instead of seeing their GPs

Jeremy Hunt has called for a “honest discussion with the public about the purpose of A&E departments”, saying that around a third of A&E patients were in hospital unnecessarily. Mr Hunt told Radio 4’s Today programme the NHS now had more doctors, nurses and funding than ever, but explained what he called “very serious problems at some hospitals” by suggesting pressures were increasing in part because people are going to A&Es when they should not. He urged patients to visit their GP for non-emergency illnesses, outlined plans to release time for family doctors to support urgent care work, and said the NHS will soon be able to deliver seven-day access to a GP from 8am to 8pm. But doctors struggling amid a GP recruitment crisis said Mr Hunt’s plans were unrealistic and demanded the Government commit to investing in all areas of the overstretched health service.

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Everyone the Government blames for the NHS crisis – except themselves

Simon Stevens, head of NHS England

Reports that “key members” of Ms May’s team used internal meetings to accuse Simon Stevens, head of NHS England, of being unenthusiastic and unresponsive have been rejected by Downing Street. Mr Stevens had allegedly rejected claims made by Ms May that the NHS had been given more funding than required.

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Everyone the Government blames for the NHS crisis – except themselves

Previous health policy, not funding

In an interview with Sky News’s Sophy Ridge, Ms May acknowledged the NHS faced pressures but said it was a problem that had been “ducked by government over the years”. She refuted the claim that hospitals were tackling a “humanitarian crisis” and said health funding was at record levels. “We asked the NHS a while back to set out what it needed over the next five years in terms of its plan for the future and the funding that it would need,” said the Prime Minister. “They did that, we gave them that funding, in fact we gave them more funding than they required… Funding is now at record levels for the NHS, more money has been going in.” But doctors accused Ms May of being “in denial” about how the lack of additional funding provided for health and social care were behind a spiralling crisis in NHS hospitals.

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Everyone the Government blames for the NHS crisis – except themselves

Target to treat all A&E patients within four hours

Mr Hunt was accused of watering down the flagship target to treat all A&E patients within four hours. The Health Secretary told MPs the promise – introduced by Tony Blair’s government in 2000 – should only be for “those who actually need it”. Amid jeers in the Commons, Mr Hunt said only four other countries pledged to treat all patients within a similar timeframe and all had “less stringent” rules. But Ms May has now said the Government will stand by the four-hour target for A&E, which says 95 per cent of patients must be dealt with within that time frame.

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Everyone the Government blames for the NHS crisis – except themselves

No one

Mr Hunt was accused of “hiding” from the public eye following news of the Red Cross’s comments and didn’t make an official statement for two days. He was also filmed refusing to answer questions from journalists who pursued him down the street yesterday to ask whether he planned to scrap the four-hour A&E waiting time target. Sky News reporter Beth Rigby pressed the Health Secretary on his position on the matter, saying “the public will want to know, Mr Hunt”. “Sorry Beth, I’ve answered questions about this already,” replied Mr Hunt. “But you didn’t answer questions on this. You said it was over-interpreted in the House of Commons and you didn’t want to water it down. Is that what you’re saying?” said Ms Rigby. “It’s very difficult, because how are we going to explain to the public what your intention is, when you change your position and then won’t answer the question, Mr Hunt”. But the Health Secretary maintained his silence until he reached his car and got in.

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These figures are for all NHS staff, but the changes the government is considering making would relate only to specialist workers - namely doctors.

Among doctors, the proportion of non-British NHS staff is much higher: 26 per cent are foreign nationals.

12 per cent of NHS doctors come from Asia, with two-thirds of this group being either Indian or Pakistani. 10 per cent are from EU countries – most commonly Ireland. A further 3 per cent come from African nations.

The proportion of foreign doctors in the NHS has fallen in recent years amid a tightening of immigration rules. In 2009, 30 per cent of NHS doctors were non-British, but by 2017 that figure had dropped to 26 per cent.

Among nurses – who Jeremy Hunt, the health secretary, also wants exempted from the immigration cap – the proportion of non-British staff is lower.

Only 16 per cent of nurses and health visitors in the NHS are non-British. 7 per cent (21,200) come from EU countries – mostly Ireland, Spain and Portugal. A further 6 per cent are from Asia – the vast majority from India or The Philippines - and another two 2 per cent come from African countries.

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