One in five NHS staff in England are non-UK nationals, according to figures that show the pivotal role foreign workers play in keeping the health service afloat.
Healthcare workers from 214 countries – from India, Portugal and Ghana to tiny nations such as Tonga, Liechtenstein and Solomon Islands – are employed in the NHS. And the proportion of roles filled by non-UK nationals has risen to a record high, according to analysis of NHS Digital figures.
Of the 1,282,623 full-time equivalent (FTE) hospital and community health service staff in England in September 2023 whose nationality was known, 20.4% were non-UK nationals. This was up from 13% in September 2016 and 11.9% in September 2009, when the data series began.
Danny Mortimer, the chief executive of NHS Employers, 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”.
He said: “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 for ever.
“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.”
Three in 10 nurses (30%) and more than a third of doctors (36.3%) are non-UK nationals, driven by sharp increases in recent years, according to the analysis by the PA Media news agency.
The most common nurse and health visitor non-UK nationality is Indian, accounting for 10.1% of all FTEs, followed by Filipino (7.7%), Nigerian (2.5%) and Irish (1.1%).
Indian was again the most common non-UK nationality among doctors, accounting for 8% of all medics, followed by Pakistani (3.7%), Egyptian (2.9%) and Nigerian (2.0%).
The proportion of midwives who are non-UK nationals has also jumped recently, from 7.1% in 2020 to 9% in 2023, though this represents a return to levels seen in 2009 when it stood at 9.1%. Among medical support staff the figure has risen from 7.2% in 2009 to 10.3% in 2016 and 17.6% in 2023.
Lucina Rolewicz, a researcher at the Nuffield Trust, said the NHS had become “increasingly reliant on overseas recruitment to fill staffing gaps”, with international nurses proving “pivotal” to the government meeting its 2019 pledge to boost the number of NHS nurses in England by 50,000.
She said this was 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,” she said.
Alex Baylis, an assistant director of policy at the King’s Fund, said: “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.”
The Department of Health and Social Care acknowledged the “valuable role” international staff play in helping the NHS deliver world-class care, but said it was important to reduce the reliance on overseas workers.
“The NHS long-term workforce 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,” a spokesperson said. “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.”
