The health service relies on trained doctors and nurses coming from overseas. Now, a crisis is loomingby Sue Richards / June 21, 2017 / Leave a comment
As we face Brexit negotiations with curtailed and controlled immigration as a key objective, it is worth reflecting on what capping migration—from the EU or from elsewhere—would mean for the NHS. This means not only thinking about immigration targets, but about the wider systems that govern who works in our NHS—and how we ensure that they are prepared for that work.
Health systems are highly dependent on being able to employ people with knowledge developed through experience and not only through classroom learning, and therefore not subject to the quick fix of more courses. In the past, the NHS had a planning function which oversaw the development pipeline for doctors, nurses and other health professionals which ensured that the supply more or less matched the demand—and that mitigating steps were taken if this was not going to be the case.
Two factors placed this system in jeopardy. First, the 2012 Health and Social Care Act turned a planned public service into a market, with the assumption being that competing providers, rather than central planners, would make sure they had the capability to operate successfully. Secondly, much of Whitehall was hollowed out in the name of austerity and “shrinking the state.” Those concerned with ensuring that there was a continuing flow of people with the right skills and experience were despatched to early retirement.
Gaps began to appear in the pipelines. Only five people were trained as district nurses in London in 2013/14, basic nurse training was reduced between 2010 and 2013. There were even cuts in medical training in 2012, on the grounds that we might have too many doctors.
Nurses from overseas
Meanwhile, new immigration laws introduced in 2011 meant migrants were required to earn a minimum income. This was set higher than the salary for a main grade qualified nurse, choking off migration from outside the European Economic Area (EEA).
This had a drastic effect. In 2001-02, there were just over 15,000 new entries on the Nursing and Midwifery Council (NMC) register by people not from the EEA. This fell to under 700 in 2014-5.
Fortunately for the NHS, the Eurozone crisis created a new supply of qualified doctors and nurses from Portugal, Italy, Greece and Spain—so for a while, the problem was solved. New registrations with the by people from within…