The NHS is in a constant state of crisis, but why, and what can be done?

Working in the NHS and healthcare services in general takes an incredibly special type of person. Not only are they highly trained (in the most part), they must also possess intangible qualities such as empathy and a caring nature.

The role can be rewarding and frustrating in equal measure, as new lives enter the world, just as others are lost from it. Sharing in the joy of parents welcoming a child into their family. Sharing in the grief of families who have lost loved ones.

It is not an easy vocation.

That said, it is not done for free either. These are paid roles with remuneration commensurate with the responsibilities that those individuals take on board. Are NHS and healthcare workers paid enough? Probably not, but the NHS has a finite amount of resources available to it. Resources which are being stretched thinner every year, even though government funding is increased year on year.

Something is sadly wrong.

The UK’s birth-rate is currently at 1.8, which is well below the 2.1 replacement rate. A figure that also more than offsets people living longer (an often quoted and inaccurate reason for the NHS requiring increased resourcing on an annual basis).

If the UK population is shrinking in net terms year on year, why is more funding required year on year? It makes no sense, and this is a question that was never put to any party, by any mainstream media outlet during the 2019 UK election campaign. That is because the true reason for needing more funding across all sectors – NHS, housing, school places, etc. – makes for an uncomfortable response.

A response that you will never receive from the Tories, Labour, the Lib Dems, SNP, Greens, Plaid Cymru, or the established parties of Northern Ireland. Hence why the mainstream media never asked it. They don’t want the answer.

The reason for this extra burden year on year is down to one cause, and one cause only: unchecked immigration. However, one of the main excuses weaponised in the promotion of unchecked immigration is the fact that the NHS needs it.

Does it?

How often – when reducing immigration is even mentioned – are we rebutted with the throw-away (and unqualified) comment: “And there goes your NHS!”

Because every immigrant entering the UK is a qualified medical professional, right? That is what the progressive left and media activists would have everyone believe.

This simply isn’t true.

Over 86% of the NHS workforce is British (86.2%). This is based on current statistical data1. It is not true that the NHS is upheld by an immigrant workforce. In fact, the number of immigrants working in the NHS breaks down as: 5.5% from the EU, 5.2% Asian, 2.2% African and 0.9% other.

With the outbreak of the COVID-19 coronavirus health crisis, the NHS was further weaponised (by the usual media sources) to make everyone in the country believe that the NHS is manned solely by peoples from the BAME (Black, Asian and Minority Ethnic) community.

Again, this simply is not true.

The BAME community makes up around 16.7% of the NHS workforce2, and while that is higher than the Office of National Statistics (ONS) 2011 census figure of 13% BAME individuals living in the UK, it is likely that 16.7% is probably more reflective of the total number of BAME people living in the UK right now.

And – contrary to what The Guardian would have everyone believe with their outrageous “You Clap for Me Now” video – the NHS was not built by immigrants.

The NHS began on July 5th, 1948, delivering healthcare at the point of need, free of charge, and financed 100% through taxation. This is less than 3 weeks after the first of the Windrush generation ships docked in Essex on 22nd of June 1948 (carrying 500 immigrants from the West Indies).

Prior to this the UK immigrant population was around 2%3. Are we to believe that the UK had no hospitals, surgeries, doctors or nurses of its own before 1948? This is a nonsense at best and unhelpful propaganda at worst.

Anyone with a smart device, laptop or desktop computer, an internet connection, and a search engine can find holes in this false rhetoric, and many do. However, what is lacking from these (often vocal) observations is any form of cogent solution.

Let us assume for one moment that we are dependent on immigration to backfill NHS staffing numbers, then how do we become independent of this burden?

The answer is twofold, is a long-term strategy, spanning two or three generations (rather than the five-year election cycle that career politicians only care about), and can be summed up in two words:

  1. Training.
  2. Retention.

It takes around 10 years to become a fully fledged medical doctor. This includes gaining a medical degree (either through an undergraduate or graduate programme), foundation training, and speciality training.

Since the Labour government introduced tuition fees for higher education courses (yes, to those who have forgotten, it was Labour not the Tories that did this under Tony Blair’s second year in office), and replaced cost of living grants (paid for by the state) with student loans (paid for by the student); after 10yrs of even the most frugal existence, UK medical doctors enter their working lives with around £100,000 pounds worth of debt.

If this financial commitment weren’t deterrent enough, the competition to get into a UK based medical school is fierce. This is because the medical qualifications from the UK are recognised as being of the highest calibre the world over.

There is a cap on the number of international students that UK medical schools can admit. In England and Wales this is currently 7.5%4. This sounds like a tiny proportion of the overall admission numbers however, the term “international” only applies to students outside of the EEA (European Economic Area).

Given this, the number of “foreign” students studying medicine in UK medical schools we can safely assume is higher than 7.5%. These students are often funded by their own governments in lieu of a fixed term period of service in their national medical facilities. UK medical students have no such incentive to remain within the NHS once their internship has been completed.

In a House of Commons Briefing Paper entitled “Medical school places in England from September 2018”5 the government considered the problem of retention where the BMA (British Medical Association) stated that:

The proposals to train more doctors and tie them in to working in the NHS after graduation would reduce staff numbers and could worsen the health service’s recruitment crisis.”

Harrison Carter (co-chair of the BMA’s medical students committee at that time) then goes on to state:

Rather than forcing doctors to work in a health service in which they can see no future, the Government must urgently address the reasons why, after years of training to become doctors, fewer people are choosing to apply to or remain in the NHS.”

Without any financial incentive to remain within the NHS beyond their internship, and with a huge debt bill hanging over their heads, is it any wonder that UK medical students look to start careers and make lives for themselves outside of the UK? Predominantly in other developed nations within the anglosphere (the US, Canada, Australia and New Zealand). Often quoting a better quality of life and standard of living as the main reason for abandoning their own nation.

In a nutshell: we train the best doctors in the world so that the rest of the developed world can reap those benefits.

And because of this, we have to poach doctors from the developing world, doctors who are desperately needed in their own countries, doctors who are likely less well-trained than our own.

What if the UK government decided to pick up the student loan tab for UK medical graduates in lieu of service within the NHS? The government would pay off £10,000 pounds of that debt per year. If the UK medical graduate decides to leave the NHS after their two-year internship, then they are still personally liable for £80,000 pounds of debt. If they leave after five years, then they are still liable for £50,000 pounds of debt. After seven years £30,000, and so on, on a pro rata basis.

The key thing here however is the five-year interval. By this time most doctors will be established in their careers, more than likely have families, and will have put down roots within their communities. Also – without the crippling burden of debt repayments – the NHS remuneration is now far more attractive and is now on a par with the levels of remuneration they could expect from other developed nations within the Anglosphere.

They also become the first generation of doctors to educate and bring through subsequent generations of UK medical graduates. It would become a self-fulfilling prophecy. It wouldn’t happen overnight, and it wouldn’t happen within a single election cycle. It would require a long-term commitment, spanning two or more generations.

A similar approach could be taken in the education and retention of our nursing staff as well. An estimated cost would be around £40,000 pounds. Again, we would pay this debt off at £10,000 pounds per year for each year’s service within the NHS. The government were looking to incentivise nurse training from September 20206 but there is no guidance or literature on what they are going to do about nursing staff retention within the NHS. Moreover, it is not clear if this incentive programme is available to everyone (both from within and without the UK), or if it is available solely to UK students.

Obviously, there is a cost. The nay-sayers will say that such a programme would be unaffordable to the UK purse. However, can we afford not to?

For a government that was quick to borrow a quarter of a trillion pounds in order to fund the furlough of a huge swathe of the UK workforce, to enforce lock-down measures because of COVID-19; the funding of educating our own medical staff, for our NHS, is negligible in comparison.

But what about those jobs that “no one else will do” within the NHS?

Government officials and the media establishment alike, love to use this excuse in order to justify mass immigration from anywhere in the world.

The welfare system in the UK is a necessary safety net for those with disabilities, those suffering from poor health, and for those – who through no fault of their own – find themselves out of work (for example, after a business goes into administration, etc.). It should not be seen as a lifestyle choice. For every genuine welfare case in the UK, there are several “lead swingers” – people who take their weekly or monthly cheque and who contribute nothing for it.

The last time I checked, “some” money is far preferable to “no” money. If there is a need for an unskilled workforce within the NHS, then we should incentivise these people into fulfilling those roles. They would be paid at a level commensurate with the role undertaken, which is more than what they would receive through benefits but work they will. Some money, or no money? Your choice.

This workforce could also be used to clean and maintain all government owned properties, thus removing the necessity of having to pay exorbitant contract monies to 3rd party businesses for their services. If a person does not like the government role to which they have been assigned (and are being paid to do), then they are free to find employment elsewhere in the private sector.

Either way, we get a return on the monies doled out in lieu of benefits, or they finance themselves through private employment (thus removing themselves as a state dependent).

Finally, the above suggestions are moot unless we also reduce the burden that is being put on the NHS. A burden which we know is caused by mass immigration – the very thing that the establishment says that we need in order to prop up the NHS. Hopefully you can now see that this simply is not true.

The cessation of pointless immigration – if you would excuse the pun – would actually be a shot in the arm for the NHS.

If you work for the NHS or healthcare services in general, irrespective of which country you are from, we thank you for your service.

1 Source: House of Commons Library “NHS staff from overseas: statistics” (published 4th June 2020).

2 Source: NHS Digital Workforce Statistics June 27th, 2019.

3 Source: Migration Watch UK “The History of Immigration to the UK” April 23rd, 2020.

4 Source: Medical Schools Council “The Sunday Times is wrong about international medical students” March 13th, 2019.

5 Source:, March 29th, 2017

6 Source: