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NHS’s immigrant workforce is no cause for celebration


Due to a technical problem, the first few paragraphs of this article were missing when it was published on Tuesday.

THE reliance of the NHS on immigrant labour is often cited as a symbol of Britain’s diversity and progressivism and thus a cause for celebration. The NHS is already a symbol of a certain communitarian self-image, so the combination of our much-loved health service with the supposed ideals of openness and multiculturalism proves an irresistible cocktail for the pro-immigration lobby and the politically correct-thinking, liberal establishment.

Historian David Olusoga’s forthcoming BBC documentary Our International NHS (not what Nye Bevan or William Beveridge had in mind) picks up on this entrenched cultural motif and promises to celebrate ‘the immigrant workforce that has been the backbone of the NHS, from its inception 70 years ago to the current pandemic’.

Olusoga’s documentary will at once focus on the essential work done in the health service by foreign workers over the years, while emphasising the racial tensions and the feelings of being unwanted among some migrant staff members. Once again, a cocktail of symbols will perform its role in driving home a political message. The irresistible blend of self-congratulation about the NHS and self-hatred about the UK’s past will work its beguiling magic.

It is important, however, to establish some facts about the NHS’s reliance on immigrant labour. A parliamentary research briefing notes that as of January 2020, 169,000 NHS staff in England report a non-British nationality. This is 13.8 per cent of all staff for whom a nationality is known. Only 9.1 per cent of doctors and 6 per cent of nurses are EU nationals. Out of every 1,000 NHS staff, 52 are Asian and 22 are from Africa. Other nationalities amount to only nine in every 1,000 members of staff. These averages hide very considerable regional differences. In many parts of the country the overwhelming majority of medical staff are British, but in areas with high costs of living such as London and the South East, an increasing proportion are immigrant workers.

Nurses are currently on the Shortage Occupation List, a directory of workers whom employers can fast-track into UK jobs because of an alleged lack of domestic workers willing to do them. However, a report by the independent Migration Advisory Committee in 2016 said that there is no inherent reason that nurses should be on this list, nor is there any reason to believe that nursing roles could not be filled by home-grown workers. The MAC said: ‘There is no good reason why the supply of nurses cannot be sourced domestically. There seems to be an automatic presumption that non-EEA skilled migration provides the health and care sector with a “Get out of Jail Free” card.’ 

The think tank Migration Watch UK has previously noted that our medical schools attract tens of thousands of applications every year for fewer than ten thousand places. UCAS figures showed that a majority (55 per cent, or 325,000 out of a total 590,000) of UK-domiciled applicants to nursing courses (2010-19) were rejected even as we brought in huge numbers from abroad on the basis of a supposed ‘shortage’. The government did away with bursaries which help applicants such as these pay for their own training, and there has been no improvement in working conditions that would help to retain talented British staff. In 2018, Migration Watch UK noted in a blog that immigration is too often being used by our politicians and employers as a sticking plaster for the problems of training and retention. 

In a recent article in the Telegraph, Allister Heath showed that too often the NHS is used as a weapon by certain political interests, which like to conflate the undoubted dedication and skill of health care staff, and the bloated, monolithic institution of the NHS itself. 

This cheap trick allows any criticism of the inefficiencies and costs of the NHS to be dismissed as an attack on the workers themselves. I would suggest that this the underlying driver of the reluctance by many to speak up, while the NHS’s reliance on immigrant labour is a consequence of the general failure of British leaders to reform a costly, wasteful and inefficient system that does not meet the needs of our society in the 21st century. It is also a monument to the ongoing abysmal failure to invest in homegrown talent. Dressing up the NHS as a symbol of diversity and presenting our country as endemically racist is a handy narrative for those who enjoy the fruits of cheaper labour while burnishing an image of civil rights activism.

The extent to which our health service depends on immigrant labour is no cause for celebration. It is the result of political decisions based on cutting costs and a failure of successive governments over many years to put their money where their mouth is and help British people who would dearly love a career in the NHS helping others. 

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James Black
James Black
James Black is a Bournbrook columnist.

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