This requires an expanded and trained workforce. In 2013, the World Health Organization (WHO) projected that by 2030, low- and middle-income countries will have a deficit of 14.5 million healthcare professionals.
Every healthcare professional who emigrates from those countries undermines the global ambition for universal health coverage and thus, while the UK is on the one hand overtly supportive of achieving this, its proposed increased reliance on immigration to bolster the NHS undermines that commitment.
OECD countries will also need more healthcare workers as their populations age, and increases in conditions such as obesity place more demands on the system.
How much does the NHS rely on the EU?
More than 52,000 NHS workers come from a country in the European Union. This is 5 per cent of the total staff, which is in line with their share of the UK population.
It’s also interesting that when the figures are broken down by what they role they fulfill, a higher share of non-Brits are in the higher qualified and better paid positions.
For example, two in three EU-workers in the NHS are professionally trained, while just half of the UK workforce are.
One in 12 NHS Brits are doctors, but it’s one in six Europeans and a quarter of those from elsewhere in the world.
These staff are less likely to be affected by the points-based immigration system favoured by the Leave campaign, but the raw number of unskilled NHS staff from the EU is also high.
The NHS depends on tens of thousands of EU staff
- All staff
- 52,841
- Non-medical staff
- 44,323
- Doctors
- 8,524
The WHO estimates that by 2030, the 31 OECD countries will have a shortage of 750,000 physicians, 1.1 million nurses and 70,000 midwives. The US earlier this year produced estimates of its projected deficit by 2030, which includes a shortage of up to 104,900 physicians.
This worldwide shortage is resulting in a global marketplace, to which the UK is turning. However, so are other OECD countries, and there is no guarantee that the UK will continue to attract healthcare professionals. It may even become a net exporter.
Already countries such as Australia
seek to recruit from the UK, citing better working conditions, and there is evidence from surveys of medical students and young doctors that UK graduates are increasingly looking to move to the US, Australia, New Zealand and Canada.
Many intend to return to the UK in due course, but the reality is that once settled, in practice return is unlikely. Furthermore, competition will not just come from the OECD countries. Some estimate that 88 per cent of the next billion people to join the middle classes will be in Asia.
Asian countries and their middle classes will demand healthcare and be able – and undoubtedly willing – to pay for it. India has recently announced the extension of free healthcare to 500,000 Indians not previously covered.
Not only will the supply of healthcare professionals from Asia reduce, but it is likely that Asian countries will seek to attract back those already working here.
Relying on stop-gap measures such as immigration or increased supply from medical schools will not be sufficient to address the current shortfall
Thus, reliance on immigration to underpin the NHS both undermines the UK’s commitment to universal health coverage, is likely to be short-lived and may well be followed by Britain exporting healthcare professionals – reminiscent of the ‘brain drain’ of the 1950s and 1960s.
Furthermore, it reduces the pressure to undertake a radical review of how the UK, and indeed the world, delivers health services.
At the global level the UN secretary-general appointed a Commission on Health Employment and Economic Growth to “stimulate and guide the creation of at least 40 million new jobs in the health and social sectors”.
The commission has made 10 recommendations, but none of these challenge the current models of care. NHS England’s draft workforce strategy addresses productivity and efficiency.
While it does refer to “new models”, it does not appear to recognise the need for a radical examination of the current structures, which continue to be based on a largely hierarchical doctor-led model.
There are examples both within the UK and globally of alternative models, such as a practice in north Wales that has developed multi-professional teams with operations being led by people who are not healthcare professionals; online primary care services such as Babylon; greater use of advanced practitioners who can work independently of doctors; and support from artificial intelligence and other digital systems.
These are, however, isolated and piecemeal developments and what is needed is a radical review to identify and scale up those which are most appropriate to the health services of individual countries. Relying on stop-gap measures such as immigration or increased supply from medical schools will not, on their own, be sufficient to address the current shortfall.
