By John Puntis, Co-chair Keep Our NHS Public
The NHS and care services would collapse without overseas workers
Why do we have workers from abroad?
The NHS and the wider UK economy have been dependent on migrant labour to fill job shortages for decades. Pay freezes, rising workloads, and inadequate training places have meant producing and retaining domestic staff has fallen short of what is needed. This has led to a continued reliance on migrant labour and agency staff. Across many countries and professions, migrants are not a random sample of the population they come from. On average, they tend to have higher levels of education or skills, better language ability and greater ambition, resilience, and willingness to take risks.
Even back in 1971, 31% of all doctors working for the English NHS were born and qualified overseas. Recruiting trained staff from abroad is much cheaper upfront than training them in the UK. Fewer employment protections, less regulation, and more low-wage jobs have also created the demand for more flexible migrant labour. The NHS has generally opted to train a conservative estimate of numbers of staff needed and use migrant labour to temporarily (or permanently) fill any shortages.
How many workers from overseas are there?
Around 325,000 of the 1.5 million NHS staff have a non-British nationality. In England, 9.9% are Asian, 5.2% EU nationals and 4.2% African. Since 2015, the proportion of Asian and African staff has doubled while there has been a slight fall in EU staff. Regions vary, with London having the highest proportion of overseas staff (32%) and Yorkshire and the North East the lowest (13%). As a proportion of particular groups, staff from overseas account for 36% of doctors and 30% of nurses. No data is collected on the nationality of GPs, but their place of initial training is recorded. For England as a whole, 34% of GPs qualified outside the UK. Around 25% of the adult social care workforce in England have a non-British nationality.
Government policy drives the NHS approach to staff recruitment
Between 1999 and 2005 the NHS’s workforce grew by 24% to achieve the government’s objective of improving services and access to care, meaning that significant inflows of migrant labour were needed. The NHS’s position as the largest, and sometimes only, employer has allowed it to suppress wage growth for healthcare staff (sometimes below international rates), which has pushed domestic staff to emigrate or leave the NHS. While the current underfunding of the NHS is driving job losses, the hostile environment means retaining staff and filling gaps is becoming even more difficult. The likely outcome is that the quality of both medical and social care for the UK population will deteriorate.
Racist politics and ‘the hostile environment’
Prof Nicola Ranger, general secretary of the Royal College of Nursing (RCN) recently observed that: “A sustained campaign of anti-migrant rhetoric is fuelling a growing cesspool of racism, including against international and ethnic minority nursing staff, without whom our health and care system would simply cease to function.” The RCN said the fear created by the recent display of Union and St. George flags was part of an alarming wider picture. Because of the flags, some NHS staff who care for patients in their own homes fear that some areas have become no-go zones for them.
Reform UK has said it would be prepared to deport 600,000 migrants over five years if it won power at the next election. Prime Minister Keir Starmer was criticised by many for his speech stating that we risk becoming an “island of strangers” without tough new policies on immigration. The hostile environment is both making overseas NHS staff leave to work elsewhere, and inhibiting new applicants.
Racism at work in the NHS
The NHS Workforce Race Equality Standard analysing data from NHS Trusts noted that in March 2023, 26.4% (380,108) of the workforce across NHS trusts in England were of a black and minority ethnic (BME) background. This is an increase of 13% (43,070) from 2022. In 2022, the percentage of staff experiencing harassment, bullying or abuse from other staff in the last 12 months was higher for BME staff (27.7%) than for white staff (22.0%). A higher percentage of BME staff (16.6%) than white staff (6.7%) experienced discrimination from other staff; a pattern that has been evident since at least 2015. A lower percentage of BME staff (46.4%) than white staff (59.1%) felt that their trust provides equal opportunities for career progression or promotion.
Consequences of racism for the NHS workforce
According to Jeanette Dixon, chair of the Academy of Medical Royal Colleges, the NHS is being put at risk because overseas health professionals increasingly see the UK as an “unwelcoming, racist” country. The bar for gaining permanent settlement is now being raised and is likely to make the UK even less attractive. It is proposed that there will be a 10-year qualifying period with reductions for, among other considerations, high taxpayers and those who have volunteered extensively in their local communities. Legislation is being introduced to prioritise UK graduates for medical training posts but without due consideration for international medical graduates already working in the NHS.
Nearly 5,000 doctors who qualified overseas left the NHS in 2024, a 26% increase over the previous year. Growth in the nursing and midwifery register has slowed, with a sharp fall in international recruitment over six months of nearly 50%. Dixon warned that without doctors and nurses from abroad the NHS “could quite easily fall over” and find itself without “a critical mass of people there to run the service safely”. Overseas-born doctors and nurses were being put off by antagonism from politicians towards migrants, media coverage of immigration, the racist abuse of international medical graduates by NHS colleagues and racist aggression by patients toward minority ethnic NHS staff.
Secretary of State for Health and Social Care, Wes Streeting, expressed shock at “the rising tide of racism and the way in which kind of 1970s, 1980s-style racism has apparently become permissible again in this country. I’m really shocked at the way this is now impacting on NHS staff”. He also criticised unnamed politicians who condone racism, adding: “I’m disgusted that a level of racism last seen when Britain was a very different country, 50 years ago, has made an ugly comeback and I’m frankly shocked by those in parliament who’ve leaned into it.”
Violence towards staff
Nearly 300,000 violent and sexual assaults were recorded by NHS Trusts over three years (equivalent to 285/day). This has been described by the RCN as a national emergency for staff safety and is almost certainly an underestimate of the true figures. The British Medical Association (BMA) attributes the increase in violence and aggression by patients to a combination of anger about long waits for treatment, growing distrust of medicine fuelled by conspiracy theories about Covid, and a sharp rise in racism against staff of colour. Staff have provided harrowing accounts of what it is like to be on the receiving end of violence from patients.
Dealing with the rise in patient hostility has been hampered by staff shortages, budget cuts and police inaction. Other factors including a lack of beds for mentally ill adults and people with dementia have contributed to the increase in violent incidents. Between 2018 and 2022, the Health and Safety Executive found 60% of 60 NHS Trusts it inspected to assess their compliance with legislation were not doing enough to prevent workplace violence and aggression. There must be similar problems in social care where 1 in 5 staff are from overseas, but social care providers (e.g. residential care, domiciliary care) do not feed into a unified national incident reporting system specific to violence and abuse.
Some Trade Unions collect limited information about their members experiences. A recent report by the RCN based on a survey of 20,000 nurses found that more than 27% said they were physically assaulted by patients, their relatives or other members of the public in the past 12 months, with more than 10% reporting sexual harassment. Black respondents and those of a mixed ethnic background were most likely (around one third) to state they had experienced physical abuse in the previous 12 months. A high number of respondents (60.3%) also felt that when they had endured verbal abuse it was because patients/service users or relatives were dissatisfied with the service
provided. In particular, many cited long waiting times and delays as common flashpoints. Four in ten nurses were considering or actively planning to give up their jobs. The main reasons for this included feeling undervalued (73%), low pay (61%), excessive pressure (60%) and emotional exhaustion (59%).
Government in action
The government has recently declared that “antisemitism is a scourge in the NHS” and set up a rapid review headed by Lord John Mann to investigate how healthcare regulators tackle antisemitism and “other racism”. Mann was first appointed as government’s independent adviser on antisemitism by Theresa May. A fierce critic of Jeremy Corbyn, Mann appeared reluctant to call out antisemitism among Conservative politicians. The government is also asking NHS England to adopt the International Holocaust Remembrance Alliance (IHRA) definition of antisemitism and set clear expectations that every trust, integrated care board and arm’s length body does the same. The government press release quoted an unevidenced statement by the CEO of the Jewish Leadership Council that “Antisemitism in the NHS has been out of control.”
Doctor members of the trade union Unite commented that rather than tackling racism in all its forms ministers were choosing to weaponise antisemitism in order to silence healthcare professionals from speaking out against the genocide in Gaza. In a letter sent to the Department of Health and Social Care, Doctors in Unite said that government plans to tackle racism and antisemitism in the NHS are “racist and dangerous” and should be abandoned. The letter was backed by 23 organisations, including Jewish Voice for Liberation and Health Workers and Allies for Palestine. Signatories were worried that antisemitism was being elevated above other forms of racism in the NHS, while entrenching “pro-Israel political bias into mandatory training for all 1.5 million NHS workers.”
Concerns were also expressed over the call for the adoption of the IHRA definition of antisemitism. Critics of this definition and its accompanying examples include experts on antisemitism and Jewish studies as well as international human rights groups such as Amnesty International, who say it has been used to stop criticism of the actions of the Israeli government. At the BMA’s annual representative meeting in 2025, four motions relating to the genocide in Gaza were passed, including one stating that “criticism of the actions of the state of Israel is not per se antisemitic.”
Bullying and harassment
In November 2025, the NHS Race and Health Observatory announced a new scheme to tackle “rampant levels of bullying and harassment” experienced by ethnic minority staff in the health service. The initial plan, however, is simply to “pinpoint problem areas where interventions can be best targeted and work to identify potential solutions that can be implemented across NHS trusts.” This came after an open letter to The BMJ from doctors and healthcare staff warning that a rising “wave of racism” and far right groups in the UK is affecting patients and staff with some ethnic minority doctors trying to relocate because far right activity is making them fear for the safety of their families. The letter pointed out that the divisions opening up in our communities have the potential to blight all our lives, especially those of the young people who are our future.
Concluding thoughts
International competition for medical staff is increasing. This means that we need to become less reliant on the generosity of migrants and the countries and health systems which pay to train them. Government wants to cut annual intake of non-UK doctors from 34% to under 10% as part of 10-year plan. This will require the state to take on a larger role in terms of workforce planning and regulation, and more serious investment by the NHS in training and retaining staff.
KONP acknowledges the vital role of overseas workers in contributing positively to the health and care of people in the UK, stands with migrants, is opposed to all forms of racism (including antisemitism), and supports the rights of health and care staff to express support for Palestine. Violence against staff is being fuelled by ceding the narrative on migration to right wing groups, but also results from under resourcing and under staffing of services and a failure by those in power to value, respect and support health and care staff.
This must change if we are to promote the highest standards of care for patients. NHS and care staff together with health campaigners should help to build a broad movement to oppose the influence of racism and fascism. The march against the far right in London on 28th March is a good starting point.
John Puntis
(see also video of KONP ‘NHS in crisis – migrants not to blame’ meeting: https://www.youtube.com/watch?v=cLvaoEtG-sk)
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