Boom and Bust: Where do migrant health professionals fit into the reforming NHS?

Helen McCarthy

Migration and the NHS

NHS logo drip feedIt seems that in recent months the NHS has barely been out of the news. Whether it’s the privatisation of services, the impending funding crisis, or the length of waiting times the NHS is regularly in the headlines.  This is in part to do with the fact that the NHS is undergoing a period of substantial change; the whole structure has been fundamentally re-ordered and despite the budget being ring-fenced, hospitals are being asked to find savings as money is reallocated to provide care in the community. Nevertheless, despite the often alarming headlines, surveys consistently show public support for and pride in the NHS , attitudes which were recently corroborated by a study that ranked the NHS as number one of 11 OECD health care systems.

One feature of the NHS that is often overlooked in these discussions is the fact that the NHS continues to rely heavily on migrant workers to fill vacancies. In 2013, 39% of doctors on the specialist register (such as paediatricians etc.) had received their training abroad (either in EEA countries or in so called ‘third countries). That figure is even higher, at 66%, for doctors who were neither on the GP nor specialist register such as those working as locum doctors (substitute doctors) or in mid-level positions. Although recent data about the situation of nurses and midwives is hard to come by, the evidence suggests a significant proportion of nursing staff are individuals who have trained abroad and migrated to Britain. In 2008, 16% of new registrations to the Nursing and Midwifery Council were to nurses trained abroad (EEA and third countries). And this phenomenon is not just occurring in Britain but across the EU to differing extents.

Migrant health professionals: ‘the brightest and the best’ versus ‘the dangerous foreign doctor’
Positions on this reliance on migrant staff tend to fall into two opposing camps. On the one hand, it is argued that labour migration to the NHS is a positive example of the benefits that migrants can bring to a country. This position highlights the hospitals up and down the country that would be left under-staffed without migrant health professionals, and cite it as an example of positive integration and Britain attracting the ‘brightest and the best’ from abroad.

The other camp sees an over-reliance on professionals trained abroad as representing a failure in Britain’s training of doctors and nurses. Commentators have questioned the quality of international medical training, as well as the standards that migrants are expected to demonstrate when applying to come and work in Britain. Whilst so called international medical graduates (IMGs) must take a language test as well as a professional exam, until recently EEA medical graduates benefitted from automatic recognition of qualifications and were not required to take any assessments.  A recent change to an EU directive that will mean that EEA medical graduates must first pass an English test before being allowed to work is the result of previous disquiet about the language skills of EEA doctors and nurses.  Despite the regulatory framework in place, these fears continue to be raised when cases of medical malpractice involving migrant doctors or nurses hit the headlines, and the figure of the ‘dangerous foreign doctor’ continues to make for good tabloid fodder.

Boom and bust: The need for research
NHS stethoscope and paper
These two opposing positions, along with various political currents at play at different moments help to explain the slightly ‘boom and bust’ nature of recruitment abroad. Under New Labour, the NHS expanded rapidly, and there was a huge drive to recruit abroad. However, current restrictions on entry for work as well as a legacy of increased medical training positions has meant that active recruitment beyond the EU appears to be reducing. Nevertheless, there are still positions to be filled – particularly in nursing – and recruitment from within the EEA appears to be on the increase.

This makes it an opportune moment to look again at migrant health professionals in the UK. Much of the existing research on this topic is based in an era when there was far more active recruitment of migrant health professionals from lower income countries, especially in the global south.  But in the context of major restructuring of the health care system in England, as well as a substantial tightening of entry routes for migrant workers, the question arises: how effective is the NHS at integrating and retaining its migrant workers in the workplace?

The Work> Int: Assessing and enhancing integration in workplaces project will set out to explore this question. Funded by the European Commission, five country teams in the UK, Ireland, Italy, Germany and Spain will compare the methods and models of integration in health sector workplaces in each country. In depth qualitative research will explore the different dynamics at play from the perspectives of migrant health professionals, UK-born managers and colleagues. The project will also seek to understand the strategies adopted and barriers faced by migrant health professionals. More broadly, the project aims to provide a comparative of integration approaches which could be used in other workplace contexts. As the qualitative fieldwork has just kicked off in the UK, stay tuned for more updates later in the year.

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Health