Brexit has left the NHS increasingly dependent on doctors and nurses from poor “red list” countries, from which the World Health Organization says it is wrong to recruit.
The health service in England has hired tens of thousands of health staff from countries such as Nigeria, Ghana and Zimbabwe since the UK left the EU single market at the end of 2020.
A post-Brexit surge in the number of health professionals from red list countries working in England has sparked criticism that hiring so many is “unethical” and “immoral”, and will damage those countries’ health systems.
The big jump means the NHS now employs 65,610 clinicians and support staff from the 53 red list countries in its 1.5 million-strong workforce. It has taken on 32,935 of those since the start of 2021, including 20,665 who joined in the 20 months between March 2023 and November 2024 alone, according to NHS figures obtained by the Nuffield Trust health thinktank.
The growth in red list-origin staff has been so dramatic that one in 11 (9%) of all medics in England are now from red list states, and two-thirds (46,890) of all the nurses who began working in the UK between January 2021 and September 2024 were trained outside the UK or Economic Area.
Since 2018, 46% of additional UK nurses from red list countries have come from Nigeria, 21% from Ghana and 16% from Zimbabwe.
Mark Dayan, a policy analyst at the thinktank and Brexit programme lead, said: “Recruiting on this scale, from countries the World Health Organization believe have troublingly few staff, is difficult to justify ethically for a still much wealthier country.
“Yet again, British failure to train enough healthcare staff has been bailed out by those trained overseas.”
The ending of the free movement of labour into the UK by EU nationals from the start of 2021 had created a dangerous “over-reliance” by the NHS on clinicians from red-list countries in Africa, Asia and the Pacific, the thinktank’s report on health in the UK after Brexit says.
“Particularly since the end of free movement of labour at the start of 2021, a remarkably steep and sustained increase in staff trained or holding nationalities outside the UK and EU has occurred,” says the report, published on Friday.
NHS England figures, which the thinktank obtained under freedom of information laws, show the number of red-list nurses working in England rose 36% to 21,500 between March 2023 and November 2024. The number of doctors increased over the same period by 24% to 13,675, while the number of staff who support doctors and nurses soared by 74% to 21,600.
The findings raise questions about whether the NHS is adhering to the WHO’s edict not to “actively recruit” health professionals from the 55 countries, which has been endorsed by the Department of Health and Social Care on behalf of the UK government. The WHO advises against recruitment from these countries because they “face the most pressing health workforce challenges related to universal health coverage” and have too few personnel to care properly for their own populations.
The figures prompted Wes Streeting to accuse the NHS of acting in an “immoral” way by depriving needy countries of homegrown health professionals.
“The NHS has been left in the immoral position of pinching doctors and nurses from countries which desperately need them, because the Conservatives couldn’t be bothered to train enough medics,” the health secretary said.
“At the same time, straight-A students in this country have been locked out of medical school, and we are failing to bring enough young people into the nursing and caring professions.”
He said he was “determined to reduce the NHS’s reliance on recruitment from red-list countries by investing in training the next generation of NHS staff through our plan for change”. Officials are drawing up a revised version of the NHS long-term workforce plan published by the previous Conservative government in 2023, which included a major expansion of UK-trained staff.
Ageing populations worldwide have created a global race to hire doctors, nurses, healthcare assistants and other specialist staff, with rich nations increasingly turning to staff trained in Asia and Africa. Ten high-income countries – including the UK, US, Australia and Saudi Arabia – account for 70% of the global migration of health professionals.
Sebastian Rees, the head of health at the IPPR thinktank, said: “While the NHS benefits hugely from the experience and skills of staff trained overseas, its over-reliance on recruitment from red-list countries is both unethical and unsustainable.
“Recruiting from these countries risks damaging fragile healthcare systems and undermines longstanding efforts to extend medical care to those who need it most – the world’s poorest.”
However Jim Campbell, the WHO’s director of workforce, said many of the red-list staff had applied directly for jobs in the UK and therefore “unethical” recruitment by the NHS was much less common than the Nuffield Trust’s overall numbers suggested.
“This is startling data and raises ethical questions. But behind the headline data there’s a lot of discussions going on between [the UK and other] governments about graduates seeking career opportunities by joining the NHS and doing jobs that they wouldn’t be able to do in their own countries. There’s a lot of people in that category,” he said.
