Heated rhetoric and highly restrictive policies on immigration threaten the resilience of the NHS and social care

That legacy continues today. Currently, around 20% of NHS staff and 30% of social care staff are born abroad – they are the scaffolding that keeps our health and care system standing. But heated rhetoric and increasingly restrictive migration policy means that scaffolding is on shaky foundations.

The Health and Care Secretary, Wes Streeting, recently acknowledged the damaging impact that a rise in racist rhetoric and behaviours is having on people of colour working in the NHS and in social care. Recent surveys from health bodies point to a rise in racist abuse and intimidation too.

These attacks against people of colour – both British and from overseas - and the public discourse and online rhetoric promoting it, is clearly completely unacceptable and should be called out and challenged in the strongest terms.

At the same time, the Home Office is putting forward immigration proposals which include not just a major crackdown on irregular migration but also a significant tightening of the rules around regular skilled migration.

What’s lacking from the current discourse? An analysis of how these proposals would affect the NHS and social care workforce and by extension the quality and extent of care the workforce is able to offer to patients.

The consequences of hostile rhetoric and restrictive policy are already visible. Figures from the Nursing and Midwifery Council show a 50% drop in international recruitment compared to last year.

Research from the Royal College of Nursing shows that 42% of internationally educated nurses plan to leave the UK, citing discrimination, low pay and immigration restrictions as reasons to leave. Many international GPs who train in the UK often leave once qualified. The dashboard is flashing red.

As it stands, there are over 200,000 vacancies across the NHS and social care. The most recent NHS workforce plan projects that staffing will need to grow from 1.5 million today to around 2.1 million over the next ten years to meet rising demand. Another major study predicts the social care workforce will need to find over 500,000 staff by 2040. While the upcoming workforce plan may indeed lower staffing targets in line with productivity gains from technological advances, it’s difficult to see how the health and care service will keep up with the churn of vacancies.

Of course, there are huge positives to increasing the levels of home-grown staff and the government has every right to strive for this. It will require a longer-term approach that can generate enough desire to work in health and social care from domestic workers. At the heart of that strategy will need to be conversations about pay, working conditions, and support for staff experiencing record high levels of burnout.

But let’s be realistic: domestic recruitment and tech-driven productivity gains won’t fill the gap overnight and there may be a lag before we see the intended benefits of policy changes. In the meantime, if international recruitment slows further, patients could be waiting longer for care as staff become increasingly overstretched and feel undervalued.

We need an honest debate about immigration’s vital role in sustaining health and care, especially as the population ages and demand rises. Joined-up, cross-departmental thinking is essential to this. If we fail to think holistically, the consequences will be felt in every waiting room and community across the country.

Sarah Woolnough is the Chief Executive at The King’s Fund

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