With the NHS facing rapidly depleting staff numbers, can disaster be avoided? Olivia Bridge explains what is causing this problem and whether the government’s actions so far – in particular the decision to exclude doctors and nurses from Tier 2 Visa caps – are enough to address it.

With the NHS nearing its 70th birthday, many healthcare professionals raised awareness to its latest crisis: rapidly depleting staff numbers. A crisis, they say, that has only been worsened by the government’s ‘hostile environment’ and overtly stringent immigration rules.

The Royal College of General Practitioners (RCGP) appealed to the Home Secretary, Sajid David, to demand a change in immigration laws that were responsible for turning away fully-qualified doctors and nurses. The RCGP told the BBC that the ‘hostile environment’ is straining the NHS by making it increasingly difficult to recruit much-needed healthcare professionals from overseas.

The demand for change came just as 1,500 visa applications by international doctors and medical professionals – who had already received their job offers and completed their sponsorship licence application – were denied due to monthly visa caps. In an effort to reduce net migration, the Home Office had refused entry to doctors, nurses, paramedics, and general practitioners at a time when the NHS is doing everything it can to fill staff shortages. NHS officials claimed the visa caps on non-EU doctors were contributing to rota gaps and created delays for patients receiving the care they need.

The concerns were eventually heard. In June 2018, the Home Office announced that they will be exempting doctors and nurses from Tier 2 Visa caps that sit at 20,700 per year. The move looks promising: by excluding doctors and nurses from the cap there will be more visas available for engineers, IT professionals, and those in highly skilled positions. Yet many industry experts remain concerned that the visa cap lift is just a drop in the ocean when addressing staff shortages. Only doctors and nurses are exempt, meaning the NHS still face a skills shortage in its vast array of other medical professions.

Alarming staff shortages too high to be filled

The change is still promising for nurses as up to 3,000 nurses left the NHS than those who joined in 2017, according to the Royal College of Nursing. But the RCGP warn that irrespective of the cap removal, there are ‘significant barriers’ when hiring GPs from overseas. The move is not wholly revolutionary either as the NHS had already permitted to recruit an additional 100 international GPs by the end of March, yet only 85 GPs were in post two years after the scheme was launched. The RCGP argue that lifting the cap will not resolve the staff crisis GPs face overnight, but it is a step in the right direction. Instead, they are urging the Home Office to add GPs to the UK’s Shortage Occupation List which is a resource that advertises jobs that haven’t been filled by UK talent to international and EU workers.

Critics further argue that the visa cap lift is overdue since the NHS currently face a record number of 40,000 vacancies. The government plans to recruit an additional 5,500 healthcare professionals just from Jamaica, and artificial intelligence known as a “bedside robot” has been created to tackle the staff strain in hospital wards. Yet even with the help of an artificial hand, expected applicants still won’t compensate for a lacking medical workforce. The NHS won’t suddenly be flooded with the full support and help it desperate needs.

The impact of Brexit

The UK owes a great debt to its international and European workforce in the NHS. Launched in 1948, the NHS encouraged many nurses and doctors from international waters to come to the UK after the Second World War in order to rebuild the economy. Decades later, these migrants known as the ‘Windrush generation’ have wrongly been subject to threats of deportation as well as losing their homes, jobs, and right to rent due to a Home Office hiccup. Many of these migrants dedicated their whole lives to both the UK and the NHS.

As Brexit has less than a year until the deadline, many European workers are concerned about their immigration status. The UK’s decision to leave the EU has clobbered the industry in one foul swoop: there has been an 89% drop in the number of nurses and midwives coming to work in the UK from Europe, The Guardian reported. In 2016, 9,389 European nurses migrated to the UK. However, only 800 EU nurses came to the UK last year, nowhere near fulfilling the 20,700-visa cap limit. Industry experts are therefore concerned that the vacancy gap could extend beyond repair if EU nurses and doctors feel unwelcome.

Avoiding a ‘cliff edge’

Despite government intervention, the Royal College of Nursing fears that the number of nurses expected to join the NHS – either from graduating in the UK or being recruited from overseas – still won’t account for the number of those leaving. At the same time, prospective British students are disheartened from studying a medical course at university since NHS bursaries were abolished in 2017. Future doctors and nurses now have to pay for their course at the same rate as any other student; instead, they are opting for a degree that incurs less debt, takes less time and effort to complete, as well as guaranteeing a much more rewarding salary for a lot less stress.

Hiring foreign workers is therefore vital to the survival of the NHS. In order to avoid a skills shortage that is disastrous to both the public and private healthcare sectors – the UK needs to encourage international and European talent to apply to positions within the NHS.

Fortunately, the latest information is that there will be a revised immigration system put in place for EU citizens, not dissimilar to free movement. During the implementation period, EU nationals can apply for temporary documentation which allows them to stay in the UK for five years. After five years, they can apply for Settled Status or Indefinite Leave to Remain, allowing nurses and doctors to fulfil a life-long rewarding medical career in the UK.

The Shortage Occupation List

The Shortage Occupation list has always been beneficial to the NHS. It actively advertises to international and European workers, permitting them entry to the UK even if visa caps had already been reached.

Jobs in the UK are normally subject to the Resident Labour Market Test which is a process whereby jobs are advertised to local UK communities for 28 days. Only after the test has run its course can international and overseas candidates apply, so expert professionals that are unwilling to wait for a month are finding another job elsewhere. However, jobs advertised on the shortage occupation list escape this process altogether, making them immediately accessible.

Currently on the list, the UK is in need of:

Medical practitioners

Medical radiographers

Health professionals (such as neurophysiology practitioners and nuclear medicine scientists)

Nurses

Paramedics

The visa cap lift provides some comfort in the short term, yet the NHS’ future depends upon its international workforce – a workforce that, due to a ‘hostile environment’, are dissuaded from a working life in the UK. In order to recuperate from a scarce medical workforce and avoid a skills shortage in the industry, employers, the Home Office, and even employees working in the healthcare sector should sincerely encourage candidates from abroad to apply.

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About the Author

Olivia Bridge is a specialist content writer and political correspondent for the Immigration Advice Service and leading Immigration Lawyers UK.

All articles posted on this blog give the views of the author(s), and not the position of LSE British Politics and Policy, nor of the London School of Economics and Political Science. Featured image credit: Pixabay (Public Domain).