The NHS in England is increasingly relying on workers from countries with significant healthcare staffing shortages since EU recruitment became more difficult post-Brexit, instead of training and retaining enough domestic staff. Medicines companies are also warning of drug shortages more often.
By November 2024, around one in eleven (9%) of all NHS doctors in England held nationality from one of the countries listed by the WHO as having such a shortage of staff that other countries should not actively recruit from them (“red list” countries such as Nigeria).1
A new report from the Nuffield Trust think tank and a group of academics,2 funded by the Health Foundation, tracks the impact leaving the EU is continuing to have on the NHS and its workforce. It finds that following Brexit, all UK countries have relied heavily on very high migration of health care staff from outside the EU – rather than training and retaining enough domestic workers to fill staffing gaps. In England, two thirds of the increase in registered nurses since exiting the single market as 2020 ended have come from staff trained outside the UK or EEA.
The report also finds that elevated and troubling levels of medicine shortages are continuing, with no consistent sign of improvement in key indicators. Medicine supply notifications issued to the Department of Health and Social Care by medicines companies to alert the government to shortages were higher across 2024 than during 2022, or 2023. The UK has had the lowest import growth in medicines of any G7 country, driven by a reduction in EU imports.
Keys findings on NHS staffing post-Brexit: include
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Between 2023 and 2024, the number of NHS staff in England from WHO red list countries continued to grow rapidly. Over 20,000 clinical staff from these countries were added to the workforce.
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Red list-trained nurses account for around a fifth of the total increase in NHS England nurses since leaving the single market at the end of 2020 up to September 2024. The number trained in these countries rose by 15,151, out of the total increase in nurses of 70,541.
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The number of registered nurses trained in red list countries also more than doubled in Wales, Scotland, and Northern Ireland respectively between 2021 and 2024.
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Since 2018 the UK workforce has seen a 46% increase in nurses from Nigeria, 21% more from Ghana and 16% more from Zimbabwe - the main contributing red list countries for nurses. The number of Zimbabwean nurses in the UK is now more than one in ten of the number who are practising in Zimbabwe.
The research also takes a detailed look at how Brexit has led to an important change of course for the UK with regards to artificial intelligence (AI) in health care, with some adverse consequences. The UK has taken a fundamentally different approach to regulating AI to that of the EU’s 2024 AI Act. This divergence creates an additional cost from companies needing to comply twice. The costs to business of having to follow two systems will be a disincentive for bringing AI medical devices to the UK. AI in the UK might end up using EU rules by default, and the UK doesn't have an obvious way to regulate large language models being used unofficially for medical purposes.
Nuffield Trust Policy Analyst and Brexit Programme Lead, Mark Dayan said: “Yet again, British failure to train enough healthcare staff has been bailed out by those trained overseas. We should be grateful that they are coming to offer the skills we lack, but the Health and Care Secretary is right to have recently acknowledged that it is unsustainable to continue this way. Recruiting on this scale from countries the World Health Organization believes have troublingly few staff is difficult to justify ethically for a still much wealthier country.
“This strategy for filling staffing gaps is also risky for the UK because changes to immigration policies can cause sudden and unpredictable changes to the flow of staff into the NHS. Outsourcing the training of the most critical NHS staff leads to a boom and bust where staffing numbers swing back and forth based on migration policies and the global labour market, rather than based on any plans for the NHS.
“Sadly, we also see little sign of a recovery in the UK’s relentless struggle with medicine shortages. The rate at which companies feel they should warn civil servants of possible disruption has hit its highest level since 2021, when many panicked over the Northern Ireland protocol. Action is needed both at home and in forthcoming negotiations with the EU.”
Dr. Nick Fahy, director of the health and care research group at RAND Europe, said: “This report highlights that post-Brexit relations between the EU and the UK are still having impacts on the NHS. The UK government also has an opportunity here. As wider events are driving UK-EU co-operation in defence and security, a "reset" for closer and better working with the EU would benefit from an ambition of also delivering concrete benefits for health."
Professor Tamara Hervey, Jean Monnet Professor of EU Law at the City Law School said: “The UK’s approach to health post-Brexit is diverse and contradictory. Our immigration policies don’t offer the consistency needed to build a health and social care workforce. In some areas, we are tracking the EU’s regulations. In others, we have adopted a different approach. The ‘reset’ of relations should prompt an honest and evidence-led public discussion about the pros and cons of divergence."
References
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A list of countries on the WHO’s “red list” is available here.
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The report is a collaboration between authors from the Nuffield Trust, City St George’s University of London, RAND Europe, Queen’s University Belfast, and the University of Michigan. It is part of the Health and International Relations Monitor project supported by the Health Foundation.
