We need to train more doctors, not raid the poorest countries for theirs

The Code of Practice for International Recruitment, as followed by the NHS, is unambiguous: some developing countries should not be targeted when actively recruiting health or care professionals.

A list of ‘red’ and ‘amber’ countries, published publicly, is based on the World Health Organisation Health Workforce Support and Safeguard List. Those on it have a number of doctors, nurses and midwives below the global median (48.6 per 10,000 population). In plain English, they are impoverished countries where medical staff are in critically short supply and rich countries like the UK shouldn’t be poaching them.

But successive UK governments have long realised that it is cheaper to import doctors than to train our own. And add to that Brexit – a policy sold with a promise of £350m more each work for the health service – and Britain increasingly finds itself pilfering health workers from countries with much lower doctor-to-population ratios than our own, and whose populations suffer with much greater levels of disease.

A report by the Nuffield Trust think tank highlights a move away from national recruitment in the NHS towards individual agencies and trusts, with a “significant increase” in hirings from countries on the “red list”, countries such as Nigeria, Pakistan and some other Asian countries. A loophole in the rules means individuals can apply to work in the UK “of their own accord and without being targeted by a third party, such as a recruitment agency or employer”. Otherwise the report says: “The UK health system is not supposed to actively recruit staff from ‘red list’ lower- and middle-income countries that are identified as experiencing structural workforce shortages.”

The report, Health and Brexit: Six Years On, found the nurse registration from non-EU countries went from about 600 a month before 2020 to close to 1,000 a month in 2021. Since 2012 the number of nurses joining the UK register from outside the bloc rose since 2012 from 800 to 18,000 as more onerous restrictions for EU citizens on working in the UK kicked in. Staff from EU and European free trade area countries rose by more than 20% before Brexit but has since fallen to just 5%.

Taking medical staff from low-income countries where they are desperately needed raises serious moral and ethical questions. During the pandemic Boris Johnson made much of Britain’s generosity in donating surplus vaccines to places where health systems were collapsing, but how much of that is undone by then taking those countries’ brightest and best?

The number of doctors in the UK per capita is one of the lowest in Europe, second only to Poland. The UK has 2.8 doctors for every 1,000 people compared with an average of 3.5 doctors across the Organisation for Economic Cooperation and Development’s member countries.

The answer is not to parasitically take the medical staff of those poor countries who can least afford to lose them. It is to train more doctors here. There is no shortage of people in the UK who want to become doctors and nurses, but governments of all hues have been reluctant to spend the money to train them. Where’s that £350m a week?