According to estimates, a fifth of NHS staff in England are foreign nationals, while top doctors are allowed to work abroad.
Three in 10 nurses and more than a third of doctors are non-UK residents – the first time this milestone has been reached.
Health chiefs have warned that overseas recruitment cannot fill vacancies in the health service forever, adding that the figures reflect how the NHS relies on international staff to prevent it from “caving under pressure”.
It comes as a recent Mail on Sunday investigation revealed that NHS staff at all levels are working remotely in countries including Australia and Japan.
Critics have warned that allowing staff to work abroad puts patients’ lives at risk.
Some 214 nationalities are now represented in the NHS workforce. Pictured: Victoria Atkins, UK Health Secretary.
The record total includes three in ten nurses and more than a third of non-resident doctors in the UK. Pictured: Pat Cullen, General Secretary of the Royal College of Nursing (RCN)
At least 335 staff across 33 trusts have been able to work from a different country over the past two years, including consultants who can earn a basic salary of up to £126,000.
According to the latest available data from NHS Digital, a third of the 335,763 full-time equivalent (FTE) nurses and health visitors working in England in September whose nationality was known are foreign nationals.
The figure is up from two in 10 employees outside the UK three years earlier.
It also marks the highest proportion of foreign nationals working in the health service since current data began in 2009.
The most common foreign nationality is Indian, accounting for 10.1 per cent of all FTE nurses and health visitors, followed by Filipino, Nigerian and Irish.
There has been an equally sharp rise in the proportion of doctors in hospitals and community health services who are not UK nationals, now accounting for more than a third of the total.
Indian was the most common non-British nationality among this group, accounting for 8 per cent of all doctors, followed by Pakistani, Egyptian and Nigerian.
Danny Mortimer, chief executive of NHS Employers, said the analysis “shows how dependent the NHS has become on its talented international workforce.”
He also said that without such staff the health service “could very easily have given in to the pressures it has been put under”, including rising demand, the pandemic and strikes.
Mortimer added: “Teams across the NHS are hugely grateful to their overseas colleagues for their support and contribution. But there is no room for complacency as we will no longer be able to rely on international recruitment to fill NHS vacancies forever.
‘If anything, retention is as important as attracting new staff to the NHS and will be key in the short term to prevent pressures from getting worse and ensure the recruitment base we seek to build is on solid foundations.
“Expanding the number of staff we train here is also important, so it is vital that the continued expansion of training and education, set out in NHS England’s long-term workforce plan, is maintained.”
Not all NHS staff positions have seen an increase in the percentage of the workforce who are foreign nationals.
The number of consultants has remained largely unchanged, while the number of midwives remains at 9 per cent – an increase on last year but a return to levels seen in 2009.
Some 214 different foreign nationalities are now represented in the NHS, with countries ranging from India, Portugal and Ghana – all in the top 10 – to smaller nations such as Tonga, Liechtenstein and the Solomon Islands.
Lucina Rolewicz, a researcher at independent think tank The Nuffield Trust, said the NHS has become “increasingly reliant on overseas recruitment to fill staffing gaps”, and foreign nurses have proven “pivotal” to it. The Government delivers on its 2019 promise to increase the number of nurses in England by 50,000.
He added: ‘This is far from a long-term sustainable solution. The NHS still competes with other health systems for foreign staff and in some cases our working conditions, salaries and career prospects may appear less favorable compared to other countries.
‘Not only this, but of foreign workers joining the UK nursing and midwifery workforce, almost two in five left within five years of joining the professional register in the latest year of data .
“The long-term workforce plan proposes to focus more on expanding national training and increasing the number of home-trained graduates working in the NHS, but these plans will only become a reality if we reduce the number of people leaving training and we attract more graduates to choose jobs in the NHS and then stay longer.”
The workforce plan, published in 2023, sets out steps to recruit thousands more NHS staff in England, which could add 60,000 more doctors and 170,000 nurses by 2036/37.
Alex Baylis, deputy director of policy at health charity The King’s Fund, said: “There are currently more than 120,000 vacant posts in NHS England, including 42,000 nursing posts and almost 9,000 doctor posts.
‘This is largely because, over the past five or more years, workforce planning has failed to keep pace with growing demand. This level of vacancies is rightly a major concern for the public: in last year’s British Social Attitudes Survey on Satisfaction with the NHS, increasing staffing was seen as the top priority.
‘As vocational training takes several years, the NHS will rely heavily on overseas recruitment for at least the next five years, and retaining current staff, if vacancies are to be filled.
‘Overseas staff are – and always have been – absolutely essential to the NHS and must be recognized and valued as such.
“The NHS must ensure that they are well supported as they get used to our system, that they have access to continuing training and career progression and, above all, that they are treated fairly and are not discriminated against.”
A Department of Health and Social Care spokesperson said: “International recruitment has a valuable role in helping the NHS deliver its world-class care, but it is important that we boost the national workforce and reduce our reliance on agency staff and of foreign workers”.
‘The NHS’s first long-term workforce plan was commissioned by the Government to train, retain and reform the workforce, and put the NHS on a sustainable footing for the future.
‘Backed by £2.4bn, the scheme will double the number of medical school places, almost double the number of adult nurse training places and increase the number of GP training places by 50 per cent. cent by 2031.
“Through these expansions of domestic training, we expect about 10 percent of our workforce to be hired internationally within 15 years, compared to almost a quarter today.”