Even before the pandemic there were bold ambitions around increasing NHS staff numbers, with the effect of Covid on the health service making this demand for additional staff a matter of life and death. Given recent discussions about our reliance on foreign workers, we chart the contribution of overseas nationals to the supply of NHS staff.
Overall, 21% (around 35,300) joiners to NHS hospital and community services in 2020 were not UK nationals – equivalent to one in five of joiners. This includes people from 162 different nations. These people may have moved to England as qualified health professionals, specifically for health care training or before that. The level over the last year represents an increase on the typical proportion of those with overseas nationalities who had joined between 2010 and 2018, which was between 15 and 19%.
Certain professions within the NHS appear to be more reliant on overseas recruits than others. For some staff groups, the proportion of joiners with overseas nationalities is small, including ambulance staff (12%) and non-clinical staff (13%). However, for hospital doctors in particular the contribution is much higher than average, with non-UK nationals accounting for two in five joiners. For the group with the most joiners overall – represented by the size of the squares – namely those who support clinical staff, the figure is 18%. There is no similar data for the general practice workforce.
Of course, the NHS is not the only sector of the economy that recruits overseas nationals and, in fact, taken as a whole the health service does not appear to have a disproportionately large overseas contingent. NHS hospital services are unusual in disclosing data on the nationality of joiners, so comparisons with other sectors need to be treated with a degree of caution and also capture how long previous joiners have stayed in the NHS. In December 2020, 14% of all NHS hospital and community services staff had non-UK nationalities, although it was double this – at 30% – for hospital doctors. In comparison, 12% of school staff were born outside the UK, 16% of the social care workforce are non-British, as are 28% of the UK research workforce.
There have been some increases in numbers going into nurse and medical training and, in the long term, as we have previously stated, there may be the potential for international recruitment to return to lower levels, encouraging cultural and skills exchange, if desired. However, given the lag between raising training numbers and an increase in available staff – it typically takes at least three years to train a nurse and 14 years for a consultant – overseas recruitment will have to be a major contributor if the various goals on increasing staff numbers are to be met.