Expert advice

COVID-19: without international nurses, where would the NHS or the prime minister be?

This post-Brexit pandemic has highlighted how heavily we rely on overseas-trained nurses

Illustration showing nurses parachuting into different countries, including the UK
Picture: iStock

A government is elected on a ‘tough on immigration’ pro-Brexit manifesto.

Four months later, its leader is cared for through the worst of his COVID-19 illness by nurses from Portugal and New Zealand.

Irony aside, there’s a serious point to be made on immigration and COVID-19

The scope for some sledgehammer irony is all too clear, but let’s concentrate on the bigger picture.

Before the pandemic, the NHS in England was short of around 40,000 nurses. Employers were lobbying for an easing of immigration rules to allow active international recruitment of nurses to help plug the staffing gaps.

‘UK domestic “self-sufficiency” in nursing is unlikely to happen any time soon’

The UK’s level of reliance on international nurses is highlighted in the Nursing and Midwifery Council’s (NMC) registration data reports.

At September 2019, the NMC reported more than 700,000 nurse, midwife and nursing associate registrants. The majority – around 85% – were trained in the UK, but 32,000 were from EU countries and 77,000 were from non-EU countries, mainly the Philippines and India.

This equates to about 15% reliance on international nurses in the UK – almost three times that of the average for high-income countries in the OECD, or Organisation for Economic Co-operation and Development. 

Reliance on international nurses in high-income OECD countries

Graph taken from Health at a Glance 2019, a report by the OECD

Source: OECD Library: Health at a Glance 2019


Without nurses coming here from overseas, our health service can’t function

This high dependency is not new or temporary; the UK has always exploited its shared language and the attractions of a career in the NHS to recruit from Commonwealth countries and beyond.

One consequence is that the UK trains relatively few new nurses of its own – about half the per capita graduation rate of the US and little more than a third of the rate in Australia.

UK domestic ‘self-sufficiency’ in nursing is unlikely to happen any time soon, even if the funding did exist to ramp up training.

Simply put, without inflows of nurses trained in other countries, the current and future health system in the UK cannot function.

If the prime minister did not appreciate that a few weeks ago, he surely must by now.

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James Buchan, professor in the faculty of health and social sciences at Queen Margaret University, EdinburghJames Buchan is professor in the faculty of health and social sciences at Queen Margaret University, Edinburgh