March 10 2025 - 5:15pm
One claim frequently made about Britain’s immigration system is that current levels must continue because the NHS, or the care system, would otherwise cease functioning. Last month, John Harris wrote in the Guardian: “Without hundreds of thousands of people who have come to the UK from abroad, the most basic aspects of how we look after old, infirm and ill people would simply collapse.” This argument, however, ignores both current policy and history, and is usually presented without taking into account the record levels of immigration in recent years. As an argument, it is also highly parochial: those who make it never think to compare Britain with our closest neighbors and ask why we are so much more reliant on this form of immigration than they are.
The NHS is indeed highly dependent on immigration. As of September 2024, 36% of its 156,000 hospital doctors and 30% of its 400,000 nurses were non-UK nationals. The UK’s high rate of foreign medical staff is hardly a new trend, but neither is it a constant law of nature divorced from political decisions. The figures from recent years have been unprecedented, with a slower level of change until 2020 before an accelerated rise once the Conservative government introduced the Health and Care visa in August 2020. This is when the “Boriswave” really came into effect.
The change in adult social care is even more marked. The balance between British, EU and non-EU staff had been relatively static until 2022/23, at which point it started to shift strongly towards non-EU workers due to the addition of care workers and home carers to the Health and Care visa in February 2022. Importing foreign healthcare workers is a growing trend globally, but why is Britain so much more extreme than other European countries?
| The proportion of adult social care workers with non-EU nationality doubled from 2021/2 to 2023/4 |
| !function(){“use strict”;window.addEventListener(“message”,(function(a){if(void 0!==a.data[“datawrapper-height”]){var e=document.querySelectorAll(“iframe”);for(var t in a.data[“datawrapper-height”])for(var r=0;r<e.length;r++)if(e[r].contentWindow===a.source){var i=a.data["datawrapper-height"][t]+"px";e[r].style.height=i}}}))}(); |
 |
OECD statistics for 2024 show that Britain, along with Ireland, is a massive outlier in the percentage of foreign-trained doctors and nurses. Norway, Sweden and Switzerland appear to be outliers too, but their situation is not really comparable. In Norway and Sweden, large numbers of foreign-trained medical staff are native students who studied for their medical qualifications abroad before returning home, while in Switzerland nearly all the foreign-trained doctors and nurses come from neighboring countries. Other European countries range from having half the British rate of foreign doctors and nurses (e.g. Germany) or down to a third or less (e.g. France, Italy and Denmark).
What’s behind this disparity? We often hear of the large numbers of British and Irish doctors moving abroad, requiring replacements from other countries, but the numbers are not as great as are often suggested. Britain trains around 9,500 graduate doctors per year, of which in 2022 1,403 left to practice abroad (around 15%), while data from 2012-17 indicates that 43% of those who do work abroad later return, generally within three years. This indicates that less than 10% of British graduate doctors are lost to other countries over the long term.
Doctors leaving for abroad therefore cannot fully explain the high rates of foreign-trained doctors in Britain and Ireland. Given that comparable European countries like France can run a superior health service with far lower rates of foreign workers, the way we do things is evidently not the only choice available. Neither is it the case that Britain gets its healthcare on the cheap by importing lower-paid medical staff. Looking at the percentage of GDP that different countries spend on healthcare, Britain — though paying slightly less than Germany or France — spends more than most comparable European countries.
International comparisons for care workers are harder to find, though even in the pre-Boriswave days of 2019, Britain was one of the few European countries — along with Luxembourg, Malta, Ireland and Austria — where the share of migrants among care workers exceeded 10%.
Given these international comparisons, it seems likely that Britain simply can recruit from abroad due to the international availability of English-speaking workers, not that it must to the extent it does presently. Policy changes can still make a difference, though. Last spring, the Conservative government belatedly restricted the ability of Health and Care visa holders to bring dependents. This change, coupled with increased Home Office scrutiny, led to an 81% decrease in visas granted to main applicants in 2024 compared to the previous year. While the NHS and the care system aren’t functioning well, neither are they “collapsing” any more than they were in 2023.
These are not easy issues to solve: increasing reliance on foreign workers for health and care work is rooted in aging populations, as well as resulting workforce and financial constraints. It is an increasing trend worldwide; but as with many aspects of immigration, Britain is an extreme case and has handled it especially poorly in recent years. In this context, lazy claims of inevitable collapse simply don’t stand up to scrutiny.
Will Solfiac is a London-based writer focusing on subjects including the politics and history of immigration. He can be found on Substack.
willsolfiac