Foreign doctors and nurses are increasingly shunning the NHS because anti-migrant rhetoric and rising racism have created “a hostile environment”, the leader of Britain’s medics has warned.
The health service is being put at risk because overseas health professionals increasingly see the UK as an “unwelcoming, racist” country, in part because of the government’s tough approach to immigration, Jeanette Dickson said.
Record numbers of foreign-born doctors are quitting the NHS and the post-Brexit surge in those coming to work in it has stalled. At the same time, the number of nurses and midwives joining the NHS has fallen sharply over the past year.
Dickson is the chair of the Academy of Medical Royal Colleges, which represents the professional interests of the UK and Ireland’s 220,000 doctors, including GPs, surgeons, anaesthetists and A&E specialists.
She said that without the contribution of foreign doctors and nurses the NHS “could quite easily fall over” and find itself without “a critical mass of people there to run the service safely”.
Foreign-born doctors and nurses were being put off by antagonism by 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, she said.
“My feeling is we are creating a culture where the rhetoric is ‘foreigner bad’. If you have never visited Britain and are looking at our media, the social media, press media, print media, what our politicians are reported as saying, I think that it’s not unreasonable to see that as a hostile environment,” Dickson, an NHS consultant clinical oncologist, told the Guardian.
“Because [foreign health staff] see Britain retreating from Europe, ‘we can go it alone’. They see attacks on synagogues, they see anti-Muslim protests. They see the rhetoric that immigration is bad, [that] immigration is a major problem for the country.
“Why would you go somewhere where people are going, ‘we don’t need you, we don’t want you’? For them that makes Britain appear unwelcoming, racist. The prevalence of it [hostility to migrants] is significantly more [than] 10 years ago.”
While the NHS has relied on overseas staff since its creation in 1948, this dependence has reached its greatest extent. For example, 42% of all UK doctors qualified abroad, General Medical Council (GMC) figures show.
The atmosphere in the UK towards migrants is now so unpleasant that some foreign-born NHS staff feel unsafe in their everyday lives, Dickson added.
Selina Douglas, the chief executive of the Whittington health trust in London, told a public meeting last month that hospital and community-based staff were experiencing a rise in racism.
Referring to overseas nurses who have worked here for 25 years, Douglas said: “Those staff are being racially abused in our hospital. I have had staff spat at walking up the hill [from the tube station].”
In a warning to abusive patients, Wes Streeting, the health secretary, said last month that “your right to access free healthcare in this country does not come with the freedom to abuse our staff on any grounds”. However, it is unclear what action NHS trusts or the police take against abuse by patients.
Workforce data collected by the GMC and the Nursing and Midwifery Council show that more and more foreign medical and nursing graduates are “voting with their feet” by either not coming to the UK or leaving to work elsewhere, Dickson said.
She voiced her concerns at the end of a year in which Streeting has said NHS staff are often the targets of an increasingly overt “1970s, 1980s-style racism” and an NHS trust leader expressed alarm that Black and Asian staff visiting patients’ homes had been “deliberately intimidated” by the placing of England flags.
She claimed that the Labour government was partly to blame for doctors deciding not to come to Britain because it was prioritising UK medical graduates over those who qualified overseas in the allocation of places in specialist medical training. This is a key issue alongside pay in the resident doctors dispute in England between ministers and the British Medical Association.
That may prove shortsighted, Dickson suggested, given that there was a global shortage of doctors, who can earn more money and enjoy easier working lives outside the UK.
She added: “You have a population who have retreated from internationalism through Brexit. There is a secretary of state who is also saying ‘we would prioritise UK graduates for jobs’.
“There’s always been a cohort [of doctors] who’ve gone back to their country of origin or another country. More worryingly to me [is] the number of overseas graduates who wanted to enter the country is diminishing as well. And I think that’s partly about the prioritisation argument that’s being pushed forward.
“Doctors have a lot of portable skills, as do nurses. There’s an international shortage [of both]. If the country is not looking as welcoming, or people don’t feel as safe, and Canada, Australia and New Zealand are opening their doors more, then I find it unsurprising that people are leaving.”
Anti-migrant sentiment expressed by unnamed politicians could prompt so many overseas staff to quit that the NHS “could quite easily fall over”, she warned.
“If we have significant outward migration, and continue with the rhetoric nationally that immigration is bad and also ‘we’re prioritising UK graduates’, then I do worry about us coming to a point of not having a critical mass of people there to run the service safely.”
She said Keir Starmer, the prime minister, and Streeting should make clear to the public that foreign-born frontline NHS doctors and nurses were welcome because “they provide an invaluable service to patients but also to the NHS and their colleagues, because without them we’d all be completely snowed under. The ones who are already in the UK, we absolutely need to make them feel welcome and go out of our way to make them feel welcome”.
Responding to Dickson’s remarks, a spokesperson for the Department of Health and Social Care said: “The NHS benefits hugely from its international staff, and we’ll continue to support and attract talented overseas staff who want to dedicate their time, energy and skills to the health service.
“Discrimination against patients and staff alike undermines everything our health service stands for – and the NHS has a zero tolerance for racism.”
They added: “However, a failure to train enough medical professionals has left us reliant on international recruitment to plug the gaps. It’s only right that British taxpayers should see a return on the investment they make in training homegrown medical talent which is why our 10-year health plan commits to prioritising UK medical graduates and others who have worked in the NHS for significant periods for speciality training roles.”
The best public interest journalism relies on first-hand accounts from people in the know.
If you have something to share on this subject, you can contact us confidentially using the following methods.
Secure Messaging in the Guardian app
The Guardian app has a tool to send tips about stories. Messages are end to end encrypted and concealed within the routine activity that every Guardian mobile app performs. This prevents an observer from knowing that you are communicating with us at all, let alone what is being said.
If you don't already have the Guardian app, download it (iOS/Android) and go to the menu. Select ‘Secure Messaging’.
SecureDrop, instant messengers, email, telephone and post
If you can safely use the Tor network without being observed or monitored, you can send messages and documents to the Guardian via our SecureDrop platform.
Finally, our guide at theguardian.com/tips lists several ways to contact us securely, and discusses the pros and cons of each.
In November, in a joint interview with the Guardian alongside the NHS England chief executive, Jim Mackey, Wes Streeting said he had been “shocked” hearing NHS staff, especially those working in A&E, recount growing levels of harassment, aggression and violence when their care gets delayed.
“Even if you’ve got a long wait, which I know is frustrating, or you feel like you’ve been sent from pillar to post, which sadly does happen, there’s no excuse for taking that out on staff,” Streeting said.
“But the thing that has shocked me most of all is that 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 said.
