A record one in five NHS workers in England do not have British nationality, figures show

One in five NHS workers in England are not British nationals, according to figures showing the crucial role foreign workers play in keeping the health service running.

Healthcare workers from 214 countries – from India, Portugal and Ghana to small countries such as Tonga, Liechtenstein and the Solomon Islands – work 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 staff in England in September 2023 whose nationality was known, 20.4% were non-UK nationals. This was an increase from 13% in September 2016 and 11.9% in September 2009, when data series began.

Danny Mortimer, the chief executive of NHS Employers, said the analysis ‘demonstrates how reliant the NHS has become on its talented international workforce’ and that without such staff the health service ‘could very easily have collapsed under the pressure placed on it’. .

He said: “Teams across the NHS are extremely grateful to their overseas colleagues for their support and contribution. But there is no room for complacency as we will not be able to continue using international recruitment to fill NHS vacancies forever.

“Retention is at least as important as attracting new staff into the NHS and will be vital in the short term to prevent pressures from worsening and to ensure that the recruitment base from which we want to build is a solid has a basis. Expanding the number of staff we train here is also important, so it is vital that the continued expansion of training and education set out in NHS England’s Long Term Workforce Plan is maintained.

Three in ten nurses (30%) and more than a third of doctors (36.3%) are non-British nationals, reflecting sharp increases in recent years, according to analysis by news agency PA Media.

The most common nurse and healthcare visitor with a 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 nationality was again the most common non-British 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 not British citizens has also risen recently, from 7.1% in 2020 to 9% in 2023, although this marks a return to 2009 levels of 9.1%. For medical support staff, this figure has increased 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 has become “increasingly reliant on recruitment abroad to fill staff shortages”, with international nurses proving “critical” as the government delivers on its 2019 pledge to to increase the number of NHS nurses in England. with 50,000.

She said this is far from a sustainable, long-term solution. “The NHS still competes with other healthcare systems for overseas staff and in some cases our working conditions, wages and career prospects may look less favorable compared to other countries,” she said.

Alex Baylis, deputy director of policy at the King’s Fund, said: “Staff from abroad are – and always have been – absolutely vital to the NHS and must be recognized and valued as such. The NHS must ensure that they are well supported as they get used to our system, that they have access to ongoing training and career development and, above all, that they are treated fairly and not discriminated against.”

The Department of Health and Social Care recognized the “valuable role” international staff play in helping the NHS deliver world-class care, but said it was important to reduce reliance on foreign workers.

“The NHS long-term workforce plan will double the number of medical training 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. “With these domestic training expansions, we expect that in fifteen years, approximately 10% of our workforce will be recruited internationally, compared to almost a quarter today.”