If, as Voltaire once wrote, the Kingdom of Prussia was not a state with an army, but an army with a state, then modern Britain is surely not a state with a healthcare system, but a healthcare system with a state. 

Despite the declining quality of care, the National Health Service remains unassailable within the British political establishment. Often, entire policy agendas are justified with vague, almost pagan appeals to “Our NHS” — whether smoking bans, sugar taxes, or poisonous Covid-era lockdowns.

Unfortunately, such appeals are now also a feature of our national debate around immigration. Those of us who seek to reduce overall levels of migration are often told that this simply can’t be done — after all, the impact on Our NHS would simply be too severe. Even Reform UK, supposedly the fearless champions of the restrictionist agenda, promised to maintain visa access for foreign doctors and nurses in their 2024 manifesto. 

Fortunately, we can afford to ignore this argument outright; it simply isn’t true that our healthcare system needs to rely on foreign labour. 

Let’s start with a basic point — most immigrants do not come to the UK to work in the NHS. It’s perfectly possible to reduce our current levels of migration, even dramatically so, without turning away a single nurse or doctor. In fact, less than 3 per cent of the 1.22 million migrants that came to the UK in 2023 came here to work as doctors or nurses. Our current policy of mass migration is not driven, exclusively or even primarily, by a need to support Our NHS.

But perhaps it’s still fair to say that our system is still “dependent” on migration? After all, we simply do not have enough people training to be doctors and nurses here in the UK. It’s inevitable that we have to prop up our system with foreign-trained practitioners — right?

In reality, this is an entirely artificial problem. In consultation with the British Medical Association, the Government caps the number of training places at UK medical schools. Currently, this stands at 9,500 trainees per year, though there are indications that this might be increased over time to 15,000.

When the cap was temporarily lifted in 2020/21, demand for medical places shot up — before the cap was reimposed in 2022. This whole absurd system stems back to 2008, when the BMA voted to cap the number of medical places and ban the opening of new medical schools. At the time, they cited a fear of “overproducing” doctors, which risked “devaluing the profession”. Of course, maintaining the cap suits the BMA and its members just fine — fewer doctors trained here in the UK means less competition for highly-paid consultant roles. 

Truth really is stranger than fiction. We cap the number of medical training places for medical students, which creates gaps in the healthcare service — rather than training more people, we import foreign-trained doctors to fill those gaps. We’re then told that we “need” migration to keep the system going. 

Clearly, this isn’t true. The obstacle to a self-sustaining NHS workforce is the UK Government’s unwillingness to make a long-term investment in the UK’s domestic workforce. Between 2010 and 2021, 348,000 UK-based applicants were refused a place on a nursing course. A House of Lords report from late 2016 found that, in 2016 alone, 770 straight-A students were rejected from all medical courses to which they applied. Without the BMA’s absurd protectionist cap, these students would now be entering the NHS workforce. 

And it’s not as if we’re trading low-quality domestic trainees for high-quality foreign imports, either. Foreign-trained doctors are 2.5 times more likely to be referred to the GMC as unfit to practice than British-trained doctors — and there’s plenty of variation depending on national origin. Bangladeshi doctors, for example, are a staggering 13 times more likely to be referred to the GMC than their British counterparts.

As far as our healthcare system is concerned, then, we absolutely do not need to be reliant on foreign labour

Granted, training takes time. Gaps in the healthcare system would not be filled immediately by new trainees. In the short term, there is an argument to be made for a special, time-limited visa route for medical practitioners from certain approved countries. While we’re in the process of training our own workforce, there is a case for paying a premium to early-career doctors from trusted countries, without provision for dependents, and without an automatic right to settle. That said, a policy of using migrant doctors to fill short-term gaps obviously does not require us to open our borders in perpetuity.

As far as our healthcare system is concerned, then, we absolutely do not need to be reliant on foreign labour. This is, and always was, a political choice. Rather than making long-term investments in our domestic workforce, politicians of both parties have preferred to rely on immigration as a stopgap solution. They have been encouraged to do so by a medical establishment that cares more about protecting doctors’ salaries than about the sustainability of our healthcare system. Any Government, at any time, could simply have chosen to ignore the BMA, and invested in the training and placement positions that we clearly need. 

So the next time somebody says that Our NHS “needs” migration, feel free to dismiss them out of hand. It doesn’t have to be this way — we are here because of the choices that we’ve made. It’s time for our politicians to choose differently.