Up to 3,000 doctors have been hired from overseas by the NHS in the past year, as the service battles to tackle staff shortages that medical professionals say are serious and growing.
They came from at least 27 countries, including India, Poland, Australia and Greece – but also even Iraq, Syria and Sudan – according to 32 of the 160 hospital trusts in England who responded to requests from the Guardian for details of their recruitment.
Dr David Rosser, medical director of University hospitals Birmingham, one of England’s biggest trusts, said: “The NHS doesn’t have the number of doctors it needs. The shortage is real. We aren’t training enough doctors in this country, and so we are dependent on foreign-trained doctors. Doctors in more and more branches of medicine report shortages, especially in specialities such as A&E, where it’s tough work.”
Painting a picture of how wide the NHS is having to cast its net for doctors and other clinical staff, the research shows that:
• University hospitals NHS foundation trust in Southampton recruited the highest number of foreign doctors – 113 in the last year.
• The service is struggling to find enough doctors to work in particular medical specialities, including A&E, radiology, ophthalmology and general medicine.
• The 23 foreign medics hired by the University hospitals Bristol trust included six Greeks, three Pakistanis, two Hungarians, two Romanians, two Sri Lankans and one born in Sudan with British nationality.
• Five of England’s 10 regional NHS ambulance services are also pursuing new recruits abroad. More than 100 of the 200 paramedics the London Ambulance Service is hiring before the end of March will be from Australia and New Zealand.
• NHS trusts in England said they had hired just over 1,000 nurses from overseas, with experts warning that hospitals were competing with each other for overseas talent.
Overall figures from the General Medical Council show that the number of foreign-trained doctors on its register rose by 2,957 between 31 December 2013 and 6 January 2015. They made up two-fifths – 39.4% – of the 7,500 year-on-year increase in the overall number of doctors, which rose to 267,150. Of the 267,150 doctors of all types registered with the GMC on 6 January, 97,915 (36.6%) were foreign-trained, including 34,120 (41.2%) specialists.
The GMC said that some of the foreign-trained doctors on the register may not be actively working in the NHS, while others could be working in private hospitals, and some may be British nationals who gained their qualifications abroad.
Rosser blamed the shortages of doctors on two things. NHS central workforce planning, which is supposed to ensure the service has enough staff to meet future medical need, “has never worked and has been a shambles forever”, he said. And the tightening of visa rules under the coalition, which has made it harder for junior doctors from the Indian sub-continent to stay in Britain long enough to complete their training, has prompted some of the doctors who have traditionally made up a key part of the NHS workforce to go instead to places like Canada, where they are allowed to stay until they become senior doctors.
“The NHS is the loser because of that, because we get the offer of high-class trainees subsidised by their countries’ governments and so come at a much lower cost than employing our own trainees, but the number who come over is getting smaller because they want to come here for five, six or seven years but the visa rules can mean they only get two years, which is too short for them”, added Rosser.
A UK-wide lack of radiologists, who interpret scans and x-rays, could harm patients who have a CT or MRI scan or x-ray, warned Dr Giles Maskell, president of the Royal College of Radiologists (RCR). “We are very short of radiologists. The main implications for patient safety are delays in scan interpretation and the risks of people getting the wrong treatment, or no treatment, due to not getting the right tests or expert interpretation,” he said.
The RCR is holding its first job fair at the European congress of radiology in Vienna in March, at which it will help medical directors of hospital trusts find radiologists to come and work for them. Growing numbers have been coming to work in the NHS from Hungary, Latvia, Greece and the Balkans in recent years, said Maskell.
Northern Lincolnshire and Goole hospital trust said it is seeking as many as 83 extra doctors. “We have doctor vacancies in a number of specialities including general surgery, urology, trauma and orthopaedics, emergency medicine, gastroenterology, respiratory [medicine], rheumatology, haematology/oncology, and radiology,” said a trust spokeswoman. “The trust plans to head to Poland, Hungary and India to recruit doctors.”
The growing global recruitment also saw Poole hospital trust take on 13 doctors from Pakistan, Bulgaria, Sudan, Greece, Spain, Italy and Ireland. Similarly, the 21 at Milton Keynes hospital included an Iraqi, Chinese, Pole, Romanian, Nigerian and two Indian medics.
The 32 trusts that responded to a Guardian request for information between them have hired 321 doctors and 1,075 nurses from abroad since the start of last year. But, as they represent only a fifth of the 160 acute trusts, the overall figures will be much higher.
Hospitals and ambulance services are also having to use employment agencies abroad and send staff to recruitment fairs in Europe and the far east in an effort to find thousands of nurses and paramedics.
Of the five ambulance trusts hiring from abroad, the South-East Coast Ambulance Service said it had recently brought staff from Poland and Australia and is seeking 20-40 international graduates during 2015.
South Central Ambulance Service, which covers Berkshire, Buckinghamshire, Hampshire and Oxfordshire, has 220 vacancies – 20% of its workforce. It is actively recruiting in Poland for “qualified paramedics where their qualifications, skills and experience are very similar to our own and meet our own high standards for staff,” said a spokesman.
The NHS is also increasingly short of nurses, prompting concern from medical leaders. “Here we are wholly reliant on our overseas staff. About a third of our nurses are from overseas. This situation isn’t ideal,” said Keith McNeil, chief executive of Addenbrooke’s hospital in Cambridge.
“There’s a fairly major shortage of homegrown nurses. Every week we are right down to the wire in terms of finding nurses to fill the rotas effectively. It really is a challenge.”
Overseas staff cost the NHS more than UK-trained personnel because they take longer to familiarise themselves with the service and receive clearance to work, he added.
Addenbrooke’s has hired more nurses since the start of 2014 than any of the other 31 trusts who supplied information – 185. Of 110 joining the hospital this month, 76 are from the Philippines, 32 from EU countries and one each from Canada and Australia.
Shortages are so severe that hospitals are competing with each other for staff, notably nurses.
“There are fewer nurses entering the profession as a result of reduced training places within universities, which came into effect a few years ago. Given that all NHS trusts are facing similar issues, we are finding that the labour market is very competitive, hence the need to also look overseas,” said Angela Wilkinson, director of human resources at the Mid Yorkshire hospitals NHS trust. The trust has hired 50 nurses from Spain and is seeking 70 more in India next month.
The lack of staff is so acute that NHS trusts in England are spending £2.6bn a year on agency and temporary staff, official figures show. Monitor, which regulates foundation trusts, has warned that trusts are having difficulty recruiting and retaining permanent staff and that this was contributing to unprecedented financial pressure on them.
Richard Murray, director of policy at the King’s Fund, said GP practices and NHS community services trusts, which deliver care outside hospitals, were also reporting difficulty in finding staff as a key concern.
He added: “Trusts clearly do want more permanent staff, both to ensure quality of care for patients but also for good financial reasons. The problem is finding permanent staff to recruit. Some hospital finance directors are asking, ‘are there any people to recruit?’”
The proportion of British staff working in the NHS has risen slightly from 88.9% to 89.1% over the last five years as 9,500 more doctors and 7,800 extra nurses have joined the NHS, the Department of Health said.
“Foreign health workers make a valuable contribution to the NHS, but we have introduced language checks to ensure they can properly communicate with their patients,” a spokeswoman said.
NHS England said that NHS trusts are individually responsible for recruiting and planning their own workforce. “But is it of course vital that we are able to attract the right of numbers of staff to the healthcare system,” said a spokesman.
The organisation is working with Health Education England (HEE) on “robust training and recruitment plans that will lead to more permanent doctors, nursing and paramedics in the NHS”, he added.
HEE said its responsibility is to ensure the NHS has a big enough workforce in the future, and also to help employers relieve current shortages. It is boosting the number of trainee nurses and, with the College of Emergency Medicine, has organised the arrival of the 50 foreign A&E doctors.
But Rosser warned that the NHS’s lack of doctors is here to stay. “A solution involving providing [more] British-trained doctors in significant numbers is a decade away at least, because that’s how long it takes to train a doctor. In the medium-term, the solution is to get more doctors in from other countries. The NHS’s increasing reliance on foreign doctors will continue for a decade at least.”
Dr Rensy Mathew
One of 50 emergency doctors hired to cope with demand, Mathew left a hospital in Qatar to work in Durham. The 39-year-old, from India, says he can’t imagine staying in the UK forever, but better training opportunities closed the deal
“Qatar being so dry and hot, we see a lot of heat-related illnesses; in Durham we see cold-related illnesses such as hypothermia,” says Dr Rensy Mathew, who was thrust into work at University hospital of North Durham’s A&E unit a week after entering the country.
Speaking excellent English, the primary language during his school education in Kerala and his means of interaction with expats in Qatar, Mathew says that he answered the call from the NHS because it offered speciality training limited in the Gulf state.
“The biggest difference [from Qatar] I would say I noticed is, things are more streamlined,” he says. “Everyone follows a system, everything goes in a flowchart way.”
He has also seen first hand the particular pressures facing the NHS. “In Durham, if 1,000 people were to come in on a day, I would say around 85 would be from the geriatric population. The older age group is quite high here and most come in with multiple chronic illnesses.
“The four-hour limit [for being treated, admitted or discharged] is good, but people who come in in an emergency, it requires a lot of care and commitment for staff. When you have a large number of people, there is definitely going to be longer waiting times.”
Having worked for nine years in emergency medicine in Qatar, where sale of alcohol is restricted, another difference has become apparent to Mathew. “In Qatar we do have people with alcohol-related causes but I would say the number of cases definitely is more [in Durham], especially on weekends.”
Mathew attended a recruitment round in India – a second one was held in UAE – which involved four days of interviews and role play. He says he has been welcomed by patients in Durham with open arms. “People are very eager to know where I have come from and what’s my background, they are very courteous, very welcoming and quite keen to know what I have to say and what advice I have to give,” he says.
The weather was more of a challenge. “When I came in, definitely your body needs a week or two to get used to the cold weather,” he says. “I must have got used to it as I’m wearing less clothes.”
Mathew, who has visited the capital, is also already showing a keen appreciation of the north-south divide. “I like Durham more [than London], it’s more relaxed,” he says. “People look like they’re happy, smiling enjoying themselves, it gives you a boost as well.”
Like the other doctors, mainly from India and UAE, Mathew will remain here for four years during which Health Education England, which carried out the recruitment, and the College of Emergency Medicine will help them work to achieve membership or fellowship of the college.
The idea is for them to return to their home countries with enhanced skills and qualifications and, despite his favourable initial impressions, Mathew has no desire to stay. “At this age I don’t think I can move on to a new life in a new country,” he says. “I miss home.”
This article was amended on 28 January 2015 to clarify that the 3,000 figure came from the number of foreign-trained doctors on its register, not from NHS recruitment numbers.