Immigration and the NHS: the evidence

New promises for the NHS are appearing almost daily on the campaign trail: more cash, more doctors and nurses, better hospitals and equipment. Meanwhile – in the real world – NHS performance continues to deteriorate. NHS data out last week paints a grim picture. A&E performance is the worst on record. And 4.6 million people are stuck on waiting lists.

In response, the Conservative Party issued a statement suggesting that international migrants – among other things – will make things worse. It said: ‘the last thing our NHS can afford is Labour’s plans for a four day week and uncontrolled and unlimited immigration, which would could cripple our health service, leaving it understaffed and underfunded.’

This isn’t a new argument. And it plays on public perceptions that international migration can put pressure on public services. Migration policy is about much more than its impact on the NHS or the economy. And political narratives often fail to reflect the different experiences, understandings, and impacts of migration in the UK. But – leaving these issues aside – the idea that migration has a negative impact on the NHS is not backed up by the evidence.

Existing research tells us that international migration is good for the NHS.

This is for several reasons. First, migrants are an essential part of the health care workforce. They are the doctors, nurses, porters, cleaners and other people that look after the nation. The proportion of migrants working in the NHS varies across staff groups and different regions. In June 2019, 13.3% of NHS staff in hospitals and community services in England reported a non-British nationality. Among doctors, the proportion is 28.4%. And many doctors have trained abroad. In March 2019, 20.1% of GPs in England qualified outside the UK, compared with 28.1% in North Central and East London and 7.3% in the South West.

The result is a clear benefit for the NHS – as the Home Office’s own Migration Advisory Committee concluded in their 2018 report on EEA migration in the UK. They found ‘no doubt that EEA migrants contribute more to the health workforce than they consume in health care’.

The NHS needs more staff from overseas, not less. Staffing shortages in the NHS currently stand at around 100,000 – and could grow to 250,000 or more by 2030. Even with other policy action and investment, we estimate that the NHS will need to recruit an additional 5,000 international nurses a year until 2023/24 just to stay afloat.

International recruitment is also needed in social care, where workforce shortages stand at around 122,000. A restrictive immigration policy risks making this harder. More than 90% of care workers earn below the proposed £30,000 salary threshold that could be required to obtain a visa after Brexit. People with non-British nationality account for around 17% of the social care workforce in England – and around 40% of the workforce in London.

Second, migrants are not just health care workers, they are also taxpayers. This means that migrants contribute to the costs of public services, including the NHS, like everyone else. Different researchers have tried to estimate the contribution of migration to public finances – and the answers differ depending on the assumptions used and migrants’ characteristics. The Migration Observatory at the University of Oxford reviewed existing studies and found that, overall, the net fiscal impact of migration – the difference between taxes the government receives from migrants living and working in the UK and the costs of providing services and benefits – is likely to be relatively small compared to the size of the economy. 

And third, although research on how and when migrants use NHS services is limited, data suggests migrants tend to use fewer services than UK-born residents. The most recent comprehensive analysis – based on GP registrations and hospital data in England from 2003 to 2006 – found that, in the years following arrival to the UK, migrants used inpatient hospital services around half as much as UK-born residents of the same age and gender.

This is partly because people who move to the UK tend to be young and healthy. But migrants may also find it harder to access services – for example, because of language barriers or uncertainty about eligibility. So it’s not necessarily good that migrants use fewer services. In either case, the same Migration Advisory Committee report on EEA migration from 2018 found ‘no evidence that migration has reduced the quality of healthcare’.

Immigrants should not be blamed for the pressures in A&E and other parts of the NHS. The reasons behind these pressures – unsurprisingly – are far more complex: a mix of growing and changing population health needs, chronic workforce shortages, a decade of austerity in funding for the NHS and other public services, and many other factors. What is clear, however, is that the health and care system depends on its international staff to help fix the mess it’s in.

Hugh Alderwick (@hughalderwick) is Assistant Director of Policy and Lucinda Allen (@LucindaRAllen) is Research Officer (Policy) at the Health Foundation.