The NHS in England is increasingly relying on workers from countries with significant health care staffing shortages themselves. This reliance makes health in the UK vulnerable to sudden changes in immigration policy.
Since hiring from the EU became more difficult post-Brexit, instead of training and retaining enough domestic staff, NHS policies have seen workers brought in from countries on the World Health Organisation red list.
Active recruitment is not permitted from countries on the red list because of the shortage of medics within those countries. Recruitment is permitted from those on the amber list but only after agreement between governments, however.
NHS workforce
Scrapping NHS England could affect critical training, warns experts
According to new research by the Nuffield Trust think tank, Health in the UK After Brexit, about one in 11 (9%) of all NHS doctors in England holds nationality from one of the red list countries, among them Pakistan, Nigeria, Ghana and Tanzania.
The report stated that between 2023 and 2024 the number of NHS staff in England from WHO red list countries continued to grow rapidly. More than 20,000 clinical staff from these countries were added to the workforce.
Academics from City St George’s University of London, Rand Europe, Queen’s University Belfast, and the University of Michigan contributed to the Nuffield study, which tracked the impact leaving the EU has had on the NHS and its workforce.
It found that following Brexit, all UK countries have relied heavily on very high migration of health care staff. In England, two-thirds of the increase in registered nurses since exiting the single market at the end of 2020 have come from staff trained outside the UK and EEA.
This strategy for filling staffing gaps is also risky for the UK because changes to immigration policies can cause sudden and unpredictable changes to the flow of staff into the NHS” – Mark Dayan, Nuffield Trust policy analyst
In February last year the NHS reported a record number of international workers.
Among the key findings were that red list-trained nurses accounted for around a fifth of the total increase in NHS England nurses since leaving the single market at the end of 2020 up to September 2024.
The number trained in these countries rose by 15,151, out of the total increase in nurses of 70,541. The number of registered nurses trained in red list countries also more than doubled in Wales, Scotland, and Northern Ireland respectively between 2021 and 2024.
Since 2018, 46% of the increase in red list nurses was from Nigeria, 21% from Ghana and 16% from Zimbabwe – the main contributing red list countries for nurses. The number of Zimbabwean nurses in the UK is now more than one in 10 of the number who are practising in Zimbabwe.
Nuffield Trust policy analyst and Brexit programme lead, Mark Dayan, said the use of workers from red list countries was unethical. He said: “Yet again, British failure to train enough healthcare staff has been bailed out by those trained overseas. We should be grateful that they are coming to offer the skills we lack, but the health and care secretary is right to have recently acknowledged that it is unsustainable to continue this way. Recruiting on this scale from countries the World Health Organisation believes have troublingly few staff is difficult to justify ethically for a still much wealthier country.”
Our immigration policies don’t offer the consistency needed to build a health and social care workforce. In some areas, we are tracking the EU’s regulations. In others, we have adopted a different approach” – Prof Tamara Hervey, City Law School
“This strategy for filling staffing gaps is also risky for the UK because changes to immigration policies can cause sudden and unpredictable changes to the flow of staff into the NHS. Outsourcing the training of the most critical NHS staff leads to a boom and bust where staffing numbers swing back and forth based on migration policies and the global labour market, rather than based on any plans for the NHS.”
Professor Tamara Hervey, Jean Monnet Professor of EU Law at the City Law School said a reset with the EU was needed. She said: “The UK’s approach to health post-Brexit is diverse and contradictory. Our immigration policies don’t offer the consistency needed to build a health and social care workforce. In some areas, we are tracking the EU’s regulations. In others, we have adopted a different approach. The ‘reset’ of relations should prompt an honest and evidence-led public discussion about the pros and cons of divergence.”
The research also examined how Brexit has led to an important change of course for the UK with regards to artificial intelligence in health care. The UK has taken a fundamentally different approach to regulating AI to that of the EU’s 2024 AI Act. This divergence creates an additional cost from companies needing to comply twice. The costs to business of having to follow two systems will be a disincentive for bringing AI medical devices to the UK.
AI in the UK might end up using EU rules by default, and the UK doesn’t have an obvious way to regulate large language models being used unofficially for medical purposes, the study found.
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