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The Long History of Migrant Workers in the NHS

If there is one thing that we have learnt from the Covid-19 pandemic, it’s that migrant workers are absolutely essential to the operation of the NHS.

Just last week, the UK government announced that the visas of all migrant nurses, doctors, paramedics and healthcare professionals would be automatically extended for another year. As a result, approximately 2,800 healthcare workers will be able to remain in the UK without going through the visa application process.

Whilst the current crisis has highlighted the crucial contribution migrant workers make to the NHS, we mustn’t forget that the NHS has always relied on the contribution of migrant workers for its function.

Indeed, migrants helped make the NHS what it is today.

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    The Early NHS

    Interestingly, the British health service was no stranger to migrant workers even before the formation of the NHS. Immigrant Irish nurses were well established in UK hospitals for many years preceding the Second World War and came in larger numbers after the formation of the NHS.

    The National Health Service has relied on international workforce since its inception. Considering we are continuously reminded of the staff shortages in the NHS, one might assume that it wasn’t always this way; it was.

    The National Health Service has relied on international workforce since its inception.

    There were acute staff shortages virtually from the moment the NHS began operating. Many of the nurses during the NHS’ infancy years were Irish-born and within a few years, the workforce become much more ethnically diverse, particularly in the cities.

    In 1949, just one year after the NHS launched, recruitment campaigns were launched to source medical workers and, primarily, nurses.

    During the early years of the NHS, nurses were recruited from across the empire to take up nursing positions in the UK. Thousands came from the Caribbean alone – the largest source of NHS recruitment during the post-war years.

    By 1955, there were official nursing recruitment programmes across 16 British colonies and former colonies.

    Many early migrant NHS workers applied their skills in the so-called ‘Cinderella’ specialities, a rather controversial UK term used in the medical field for any under-funded or under-discussed speciality such as mental health, geriatric care and chronic disease.

    Recognition

    It is safe to say that the UK of the 1950s was a very different place to the UK of today, with widespread hostility towards immigration.

    In spite of such sentiments, immigration was becoming an accepted part of the very fabric of the NHS. Black and Asian nurses were represented across all Britain’s national papers in either a positive light, or as an expected part of the NHS context. Even notoriously anti-immigrant newspapers, such as the Daily Mail, spoke positively of NHS migrant workers.

    Migrant workers were indeed an accepted and expected facet of the NHS, and considered to be key in the operation of the NHS. Regardless of British society’s view of immigration and attitudes towards race at the time, the contribution migrants made to the NHS was widely understood.

    Over the next two decades, British colonies and former colonies provided a significant supply of cheap labour to meet staffing shortages in the NHS. By the mid-1960s, there were 3,000-5,000 nurses from Jamaica alone who were working in British hospitals, mainly in the Midlands and London.

    Regardless of British society’s view of immigration and attitudes towards race at the time, the contribution migrants made to the NHS was widely understood.

    It is estimated that by 1972, 10,566 nursing students had been recruited from abroad. In 1977, 12% of the student nurse and midwife population of Britain were from overseas, with 66% of those from the Caribbean.

    The Recruitment of Overseas Doctors

    In the early 1960s, huge numbers of doctors from India, Pakistan, Bangladesh and Sri Lanka came to the UK in response to an appeal from the health minister of the time, a certain Enoch Powell.

    More than 18,000 answered Powell’s appeal, taking up positions across the United Kingdom. It is estimated that between 30 and 40 per cent of junior doctors in the UK were from the aforementioned countries in the early 1960s.

    Colonialism played a part in the recruitment from the Indian subcontinent, and particularly India. By the time of India’s independence in 1947, Indian medical schools and hospital administration ran along the same lines as the British model, enabling a smooth transition for Indian doctors (and other Indian healthcare professionals) in the UK.

    The dependence of the NHS on Indian and Pakistani doctors was not lost on Lord Cohen of Birkenhead, who told the House of Lords in 1961 that “the Health Service would have collapsed if it had not been for the enormous influx from junior doctors from such countries as India and Pakistan”.

    Enoch Powel said that Indian and Pakistani doctors are “a useful and substantial reinforcement of the staffing of our hospitals and who are an advertisement to the world of British medicine and British hospitals.”

    By 1971, the numbers of migrant doctors in the NHS was growing significantly. In England, 31% of all doctors working in the NHS were born and qualified overseas.

    “The Health Service would have collapsed if it had not been for the enormous influx from junior doctors from such countries as India and Pakistan”. (Lord Cohen of Birkenhead, 1961)

    Over the proceeding decades, overseas doctors continued to deliver massive contributions to the NHS, filling vacancies in specialities and locations which were unpopular with doctors trained in the UK.

    Figures show that in 1997, 44 per cent of newly registered doctors had received their original medical education and training overseas.

    The NHS’ Everlasting Reliance on Overseas Workers

    A report recently published by Nuttfield Trust showed the extent of the NHS’ dependence on migrant workers.

    Key findings of this report included:

    • 19% of all workers in health and social care workforce were born abroad (818,000)
    • 23% of all workers in UK hospitals were born outside of the UK (324,000)
    • 50% of the rise in the health and social care workforce over the past decade came from people born overseas

    It is also estimated that 25% of doctors employed by the NHS today are foreign national doctors.

    And a report by the House of Commons library found that 13.1% of all NHS staff say that their nationality is not British.

    It all points to a familiar picture, the NHS is heavily reliant on overseas workers, as it always has been.

    It is clear to see that overseas workers have always played a key role in the NHS, and that their contributions have been crucial to the operation of the NHS.

    Simply put, the NHS would not have survived without migrant workers and the skills they bring. This is something which none of us should forget.

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