In the UK, the NHS is known as a leader in providing healthcare to residents through a network of hospital trusts and primary care services. While it one of the world’s most established healthcare organisations, it has faced noticeable obstacles in years past. A growing population that is aging at the same time, along with staff shortages and budget restraints has left NHS searching for new, innovative ways to ensure patient care remains at top levels. Unfortunately, the stress placed on NHS workers has led to tens of thousands of exits over the last decade, leaving no option but to fill vacancies with foreign skilled workers.
Over the last year, the UK government has focused some of its attention on shoring up staff shortages in NHS trusts, specifically among doctors and nurses. However, the reality of outside policies relating to immigration caps has left vacancies in place or filled by temporary workers that present new problems for the healthcare organisation as a whole. The current state of affairs as it relates to foreign workers is bleak, without much change in sight.
Visa Refusals and NHS Staffing
Throughout NHS trusts, doctors from overseas have played an integral role in filling open positions for many years. While the number of foreign workers has ebbed and flowed, operations within NHS rely heavily on outside sources of medical talent. As it stands today, nearly 140,000 employees of NHS are foreign nationals, making up 12.5% of the 1.2 million workers in the healthcare system. A significant portion of these skilled foreign workers are from Asia, amounting to 45,000, with another 21,000 from African countries. Of the doctors comprising the total number of NHS workers, nearly 26% are from a non-EU country, with almost half originating from Asia.
To become a foreign national working in NHS trusts as either a doctor or nurse, individuals are required to submit an application for tier 2 visa. Under this programme, however, there is a total cap of 20,700 allowed per year. Once the cap is reached, no additional skilled foreign workers are granted visa approval, and therefore, no additional doctors or nurses are allowed to become permanent hires of NHS. To put this into perspective, no skilled workers from other countries have received visa approval in the last six months. Over the last four months, more than 1,500 foreign doctors have been denied access. This trend has led to serious concern over the viability of the visa programme in serving its purpose – filling vacancies in NHS with skilled workers to ensure a high level of quality patient care.
The Effect on Patient Care
Throughout NHS, more than 97,000 positions remain unfilled, causing a slew of issues. In the last quarter of 2017, more than 10,000 positions for specialists, including doctors, remained open, but at the same time, 400 tier 2 visa applications for these positions were refused. Although the numbers do not represent official NHS statistics, the information presented by NHS Improvement reports sheds light on the reality of staff shortages in NHS and the immigration cap’s role in the problem. When these open positions are not filled, temporary workers are tapped to plug the gap.
According to a group of medical negligence claims specialists in the UK, filling skilled worker positions in healthcare with temporary employees puts a greater cost pressure on NHS than employing permanent foreign national workers. It is estimated that a temporary doctor costs £3,500 more for a single shift than a permanent worker, representing a 50% increase in this expense. Temporary workers help fill the gap in staffing across many NHS trusts, but the solution lacks efficiency and stability. The added costs of filling positions with temporary skilled workers instead of skilled foreign doctors creates an environment where permanent staff leave to pursue employment elsewhere. Without increasing the number of tier 2 visa application approvals for these positions, patient care has the potential to suffer greatly.
To create more stability in a permanent workforce housed in NHS trusts, many leaders in healthcare have called for a lift on the immigration caps specifically for skilled workers from non-EU countries. Lifting the restrictions on the number of foreign doctors and workers could ultimately lead to improved outcomes in NHS trusts, including reduced wait times and greater access to healthcare services needed by the public. The calls for action surrounding this critical issue are being considered strongly by leaders in the UK, but with no concrete decision yet.
