Sharp jump in proportion of non-UK nationals in NHS workforce
Some 214 different foreign nationalities are now represented in the NHS.
The proportion of NHS roles in England filled by non-UK nationals has jumped sharply and now stands at an estimated one in five of the workforce, the first time this milestone has been reached, new analysis shows.
Three in 10 nurses and more than a third of doctors are now non-UK nationals, driven by steep increases in recent years.
Health chiefs said the figures reflected how the NHS depends on its “talented international workforce” to stop it “buckling under pressures” such as rising demand and strike action, but warned overseas recruitment could not fill vacancies forever.
Of the 335,763 full-time equivalent (FTE) nurses and health visitors in England in September 2023 whose nationality was known, three in 10 (30.0%, or 100,776) were non-UK nationals, according to analysis by the PA news agency.
This is up from around two in 10 (19.7%) three years earlier, in September 2020, and is the highest proportion since current data began in 2009.
The most common non-UK nationality is Indian, accounting for 10.1% of all FTE nurses and health visitors, followed by Filipino (7.7%), Nigerian (2.5%) and Irish (1.1%).
There has been a similarly sharp rise in the proportion of hospital and community health service doctors who are non-UK nationals, which now stands at more than a third of the total (36.3% of 136,265 staff), up from around three in 10 (30.1%) in 2020 and just over a quarter (26.6%) in 2016.
Indian was again the most common non-UK nationality among this group, accounting for 8.0% of all doctors, followed by Pakistani (3.7%), Egyptian (2.9%) and Nigerian (2.0%).
Of the total 1,282,623 FTE hospital and community health service staff in England in September 2023 whose nationality was known, 20.4% – around one in five – were non-UK nationals, the PA analysis found.
This is up from 13.0% in September 2016 and 11.9% in September 2009, when the data series began.
Danny Mortimer, chief executive of the NHS Employers organisation, said the analysis “shows how reliant the NHS has become on its talented international workforce”, and that without such staff the health service “could have very easily buckled under the pressures it has been put under”, including rising demand, the pandemic and strike action.
He added: “Teams across the NHS are hugely appreciative to their overseas colleagues for their support and contribution. But there is no room for complacency, as we will not be able to continue to draw on international recruitment to fill NHS vacancies forever.
“If anything, retention is just as important as attracting new staff into the NHS and will be key in the short term to preventing pressures from worsening and ensuring the recruitment base we are looking to build from has solid foundations.
“Expanding the number of staff we train here is also important, so it is vital the continued expansion of training and education, set out in the NHS England long-term workforce plan, is maintained.”
Not all NHS staff groups have seen a rise in the percentage of the workforce who are non-UK nationals.
The figure for consultants has remained broadly unchanged, standing at 22.2% in September 2023, compared with 21.6% in September 2020 and 23.2% in September 2009.
The proportion has jumped recently for midwives, from 7.1% in 2020 to 9.0% in 2023, though this represents a return to levels seen in 2009, when it stood at 9.1%.
However medical support staff have steadily seen an increase in non-UK nationals over time, from 7.2% in 2009 to 10.3% in 2016 and 17.6% in 2023.
Some 214 different foreign nationalities are now represented in the NHS, with countries ranging from India, Portugal and Ghana – all in the top 10 – to tiny nations such as Tonga, Liechtenstein and the Solomon Islands.
All figures are based on the latest available data from NHS Digital.
Lucina Rolewicz, researcher at the independent think tank The Nuffield Trust, told PA that the NHS has become “increasingly reliant on overseas recruitment to fill staffing gaps”, with international nurses proving “pivotal” to the Government meeting its 2019 pledge to increase the number of NHS nurses in England by 50,000.
She added: “This is far from a sustainable, long-term solution. The NHS is still competing with other health systems for overseas staff and in some cases our working conditions, pay and career prospects may look less favourable compared to other countries.
“Not only this, but of those overseas workers that do join the UK’s nursing and midwifery workforce, nearly two in five (38%) left within five years of joining the professional register in the latest year of data.
“The long-term workforce plan proposes focusing more on expanding domestic training and increasing the number of home-trained graduates working in the NHS – but these plans will only come to fruition if we reduce the number of people quitting training and attract more graduates to choose NHS jobs and then to stay longer.”
The workforce plan, published in 2023, set out steps to recruit thousands more staff for the NHS in England over 15 years, with potentially an extra 60,000 doctors and 170,000 more nurses in place by 2036/37.
Alex Baylis, assistant director of policy at health charity The King’s Fund, said: “There are currently over 120,000 posts that are vacant in the NHS in England, including 42,000 nursing posts and nearly 9,000 medical posts.
“This is largely because, over the last five years or more, workforce planning has failed to keep pace with increasing demand. This level of vacancies is rightly a big worry to the public – in last year’s British Social Attitudes survey of satisfaction with the NHS, increasing staffing was seen as the top priority.
“Since professional training takes several years, the NHS will be highly dependent on recruiting from overseas for at least the next five years, and retaining current staff, if vacancies are to be filled.
“Staff from overseas are – and always have been – absolutely essential to the NHS and must be recognised and valued as such. The NHS needs to make sure they are well supported as they get used to our system, they have access to ongoing training and career progression and, above all, they are treated fairly and not discriminated against.”
A Department of Health and Social Care spokesperson said: “International recruitment has a valuable role in helping the NHS deliver its world-class care, but it is important we boost the domestic workforce and decrease our reliance on agency staff and overseas workers.
“The first ever NHS long-term workforce plan was commissioned by the Government to train, retain and reform the workforce, and put the NHS on a sustainable footing into the future.
“Backed by £2.4 billion, the plan will double the number of medical school places, almost double the number of adult nurse training places, and increase the number of GP training places by 50% by 2031.
“Through these domestic training expansions, we expect around 10% of our workforce to be recruited internationally in 15 years’ time, compared to nearly a quarter today.”