NHS over-reliant on overseas staff, health chiefs warn

A fifth of current NHS staff were recruited from overseas, prompting fears about an overreliance on a non-British workforce.

The proportion of overseas NHS England staff has risen from 9% in 2009 to 20% in September last year.

The British Medical Association (BMA) said successive governments had neglected workforce planning.

The government said the NHS was committed to developing homegrown talent.

NHS England statistics show 311,000 employees have a nationality other than British out of a total workforce of 1.5 million.

The current long-term plan aims for between nine and 11% of NHS staff to be overseas recruits.

Dr Latifa Patel, a chief officer at the BMA, said there was “no point” in targets without adequate funding.

She said: “How many doctors do we have at the moment? How many medical school places do we have?

“Without the funding, we will always have a reliance on overseas doctors.”

International recruits have been important to the NHS since its introduction in 1948.

However, the NHS Long-term Workforce Plan warned a growing reliance on overseas staff “leaves the NHS exposed to future global shocks and fluctuations in international workforce supply”.

Patricia Marquis, the executive director of the Royal College of Nursing in England, said investment in recruiting and retaining the UK workforce was “absolutely critical”.

“People from overseas have been the bedrock of the NHS since its inception,” she said.

“The downside is that we are probably at the point of having an over-reliance on people from overseas and not actually investing in our current workforce and systems to encourage people from the UK to become nurses themselves.”

Dr Patel said the NHS was “an incredibly attractive place” for overseas staff to come and work.

This was echoed by Benjamin Andoh, 28, a dietician who specialises in diabetics, who left home in Ghana and moved to Nottingham.

He came to the UK for a higher salary and training opportunities and works at Nottingham University Hospitals Trust (NUH).

“The UK gives a specialist dietician like me greater options,” he said.

“I also want to do certain things like training, which is not available in Ghana.

“In terms of my professional development, it’s really helped me.”

It was a big move for Benjamin, who had not left Ghana before, but he said the hospital’s pastoral team had been very helpful.

“They are my family here.”

Its pastoral care for international staff is award winning and has contributed to an unusually high retention rate, particularly for nursing staff.

Onyinye Enwezor is the international recruitment pastoral lead.

She said moving to the UK can be “quite disorientating” but “with the right support and guidance they can settle in”.

Since she started in the role two years ago, she said no international nurses had left the trust.

“Currently, our retention rate is quite high because of the support that we offer.”

Across the Midlands, 17% of NHS staff had non-British nationalities, but the picture is not consistent across England, both geographically and by speciality.

As of September last year, almost one in three NHS staff in London had a non-British nationality.

About 58% of speciality doctors were non-British compared to only 8% of ambulance staff.

Tracy Pilcher, chief nurse at Nottingham University Hospitals, said there were specific areas where the trust was particularly reliant on international recruitment, such as occupational therapy and paediatric nursing.

“We know we are not able to recruit them either locally in Nottingham or across the UK,” she said.

Despite the importance of international staff, Dr Patel warned there was a “huge retention problem” in the NHS.

The issue applies to both doctors who are UK graduates and international graduates, she said.

“You can put as many doctors as you want in the system,” she said.

“But if you’re flushing doctors out and not retaining them in those jobs, you’re not really going to achieve your end goal.”

Despite the concerns regarding long-term sustainability, Ms Pilcher said overseas recruits can bring skills, knowledge and passion to their roles.

Dr Patel agreed, saying that “having that sort of international knowledge come into the UK is incredibly important”.

“Each doctor is shaped and framed by their experiences, the training they’re receiving, environments and areas they’ve worked in and all doctors will bring that unique experience with them.”

A government spokesman said the NHS had always drawn on international talent.

“The service is stronger for it and millions of patients are grateful for the skilled and compassionate care they have received from staff from overseas,” the spokesman said.

Additional reporting: Miguel Roca-Terry