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BRIEFING PAPER

Number 7783, 8th July 2019

NHS staff from overseas: statistics

By Carl Baker

Contents: 1. Nationality of NHS staff 2. Doctors 3. Nurses 4. Clinical support staff 5. Infrastructure support staff 6. GPs

2 NHS staff from overseas

Contents Summary 4

1. Nationality of NHS staff 5 1.1 Changes since the EU referendum 6 1.2 Changes since 2009 7 1.3 Joiners and leavers to the NHS 8 1.4 Differences between English regions 9 1.5 EU nationals in NHS Trusts 10

Map: EU staff in NHS Trusts 11

2. Doctors 12

3. Nurses 14

4. Clinical support staff 16

5. Infrastructure support staff 17

6. GPs 18

Data sources and limitations

The data analysed here is published by NHS Digital. A range of data downloads on NHS staff nationality can be found on their website here. Quarterly data also accompanies the routine workforce data publication, as part of the ‘HCHS staff in NHS trusts and CCGs’ file. This document concerns NHS staff in England only. No equivalent data on staff nationality has been published for Scotland, Wales or Northern Ireland. The data here relates to staff in the NHS’s hospital and community health services, CCGs, and support organisations.

Cover page image credit: Flags Collage by AlexR.L. Licensed under CC-BY 2.0. Image modified.

3 Commons Library Briefing, 8th July 2019

UK/British 1,021,257 Czech 721 Jordanian 177

Indian 21,207 Bangladeshi 684 Russian 175

Filipino 18,584 New Zealander 663 Eritrean 172

Irish 13,320 Trinidadian 613 Swiss 169

Polish 9,272 Sudanese 598 Syrian 165

Portuguese 7,178 Latvian 535 Libyan 162

Nigerian 6,770 Sierra Leonean 519 Slovenian 158

Italian 6,396 Ugandan 516 Guyanese 158

Spanish 5,899 Zambian 466 Tanzanian 148

Romanian 4,451 Cypriot 424 Afghan 133

Zimbabwean 4,049 Brazilian 423 Colombian 123

Pakistani 3,975 Belgian 403 Barbadian 114

Greek 3,194 Singaporean 402 Hong Kong 114

Ghanaian 2,570 Finnish 394 Albanian 110

German 2,427 Danish 391 Ethiopian 107

Malaysian 2,298 Burmese 365 Saint Lucian 103

Australian 2,132 Austrian 345 Algerian 93

Jamaican 1,884 Maltese 342 Serbian 81

Dutch 1,785 Iraqi 333 Central African 77

Nepalese 1,760 Iranian 331 Moroccan 64

South African 1,663 Thai 313 Indonesian 64

French 1,644 Cameroonian 284 Grenadian 63

Egyptian 1,608 Croatian 271 Mexican 63

Lithuanian 1,344 Norwegian 270 Korean 61

Sri Lankan 1,329 Somali 264 Israeli 60

Hungarian 1,305 Japanese 264 Lebanese 59

American 1,288 Mauritanian 240 Bruneian 57

Mauritian 1,278 Gambian 234 Fijian 57

Bulgarian 1,090 Malawian 232 Venezuelan 55

Canadian 919 Turkish 198 Motswana 54

Slovak 859 Nigerien 183 Ivorian 53

Chinese 839 Ukrainian 180 Peruvian 51

Kenyan 742 Congolese 178 Tunisian 48

Swedish 735 Estonian 177 Rwandan 48

ONE NHS, MANY NATIONALITIESNationality reported by NHS staff in England as of March 2019

Data: NHS Digital. Graphic by @commonslibrary - read more at tinyurl.com/nhsnationality

Top 102 nationalities shown of 212 total. Total number of staff: 1.2 million. For 5.2% of staff (63,842), nationality is unknown. Nationality is self-reported & might sometimes reflect cultural heritage instead of country of birth. FAQ: Nigerian

& Nigerien are separate nationalities. 'Motswana' is a singular term for a person from Botswana. 'Congolese' covers Congo and DRC. British includes English, Scottish, Welsh and Northern Irish. Flags: © 2017 Go Squared Ltd.

http://www.gosquared.com/

Nationality of NHS staff in England86.9% of NHS staff in England are British. 5.5% are nationals of other EU countries - just over 65,000 staff.

This varies in different parts of the country. In London, 11% of staff are nationals of other EU countries. In North East England the proportion is 2%.

The percentage of EU staff has remained at 5.5% since EU referendum but recorded numbers have risen. However, EU nationals joining the NHS have fallen.

9.5% of hospital doctors and 6.4% of nurses are nationals of other EU countries.

13% of doctors and 7% of nurses report an Asian nationality.

37% of hospital doctors gained their medical qualification outside the UK. Over half of these qualified in Asia. 9% qualified in other EU countries.

There are 33 NHS trusts where over 10% of staff are estimated to be nationals of other EU countries. Most are in London and the South East.

There are 34 trusts where less than 2% of staff are nationals of other EU countries. 22 of these are in the North of England.

At 24 NHS trusts, more than a quarter of staff report a non-British nationality. 17 are in London.

BRITISH

OTHER EU

AFRICAN ASIAN

The figures on this page are calculated as a percentage of those staff for whom nationality is known. For 5.2% of staff, nationality is unknown. See the full briefing for further details.

5 Commons Library Briefing, 8th July 2019

1. Nationality of NHS staff The majority of NHS staff in England are British – but a substantial minority are not. As of March 2019, 153,344 NHS staff report a non-British nationality - 13.1% of all staff for whom a nationality is known. Between them, these staff report over 200 nationalities. Just over 65,000 are nationals of other EU countries, of which two thirds are from countries which joined the EU before 2004.1 The graphic on page 3 shows the most common 100 nationalities among NHS staff. Indian, Filipino and Irish are the most common non-British nationalities.

The table below shows staff nationality summarised by country groups, with a comparison to figures for 2009. You should exercise caution when comparing the ‘number’ fields between 2009 and 2019, because of improvements in data coverage. There were nearly 200,000 fewer staff with ‘unknown’ nationality in 2019 than in 2009. This means that some increases in number are likely due to improved data coverage and may not reflect genuine increases. It is more meaningful to compare the percentage columns, which measures the percentage of all staff for whom nationality is known.2

Nationals of ‘old’ EU countries (pre-2004 members) increased from 2.2% to 3.8% of staff with a known nationality between 2009 and 2019. Nationals of ‘new’ EU countries increased from 0.7% to 1.8%. Meanwhile South Asians decreased from 2.8% to 2.5%, Sub-Saharan Africans from 2.2% to 1.9%, and Brits from 88.9% to 86.9%.

1 ‘EU post-2004 members’ are: Malta, Cyprus, Estonia, Latvia, Lithuania, Poland,

Czechia, Slovakia, Slovenia, Hungary, Bulgaria, Romania, and Croatia. 2 Falls in number between 2009 and 2019 are, however, likely to be meaningful.

‘Nationality’ as discussed here is self-reported - so it may not always reflect the person’s citizenship or country of birth and can instead reflect cultural heritage. This is not a measure of immigration. For 5.2% of NHS workers, nationality is unknown. The data in this publication is sourced from NHS Digital. It includes only staff directly employed by NHS trusts and CCGs in England. It doesn’t include contracted-out staff, GP practice staff, independent sector healthcare workers, or those working in social care. The data is correct at March 2019.

Nationality of NHS staff by country groupingMarch 2019 and September 2009 in England, with comparison to wider economy in Q1 2017. Headcount

Whole economyNationality Group Number % of known estimated % Number % of known

UK 1,021,257 86.9% 88.3% 850,091 88.9%EU (PRE-2004 MEMBERS) 44,124 3.8% 3.4% 21,262 2.2%SOUTH ASIA 28,992 2.5% 1.2% 26,668 2.8%SUB-SAHARAN AFRICA 22,133 1.9% 0.9% 21,414 2.2%SOUTH EAST ASIA 21,517 1.8% 0.2% 15,413 1.6%EU (POST-2004 MEMBERS) 20,949 1.8% 4.2% 6,945 0.7%LATIN AMERICA & CARIBBEAN 3,111 0.3% 0.1% 3,487 0.4%OCEANIA 2,892 0.2% 0.3% 2,572 0.3%NORTH AFRICA 2,216 0.2% 0.1% 1,373 0.1%NORTH AMERICA 2,210 0.2% 0.4% 1,773 0.2%MIDDLE EAST & CENTRAL ASIA 1,692 0.1% 0.2% 1,798 0.2%EAST ASIA 1,374 0.1% 0.3% 1,432 0.1%EUROPE (NON-EU) 1,198 0.1% 0.2% 916 0.1%SOUTH AMERICA 936 0.1% 0.2% 807 0.1%

NHS 2019 NHS 2009

6 NHS staff from overseas

The table above also shows the percentage of employees in England by nationality as of Q1 2017.3 The percentage of British workers in the NHS is broadly similar to the wider economy, but other country groups differ. The NHS has a lower proportion of staff from new EU countries (1.8%) than the wider economy (4.2%). The NHS has a higher proportion of staff from South Asia, Sub-Saharan Africa & South East Asia than the wider economy. The wider economy data is based on survey estimates, so some of the differences may be due to sample error.

1.1 Changes since the EU referendum Because data coverage of NHS nationality data has improved over time, comparisons of the number of EU staff in the NHS over time should be made only with caution. In June 2016 there were 89,546 staff with unknown nationality. That has now decreased to 63,842 (a fall of nearly 30%), while the total number of staff employed by the NHS has increased. This means that some apparent increases in staff numbers for nationalities and nationality groups are likely to be due to improved data coverage rather than genuine increases.

In June 2016 there were 58,698 staff with recorded EU nationality, and in March 2019 there were 65,073. But to present this as the full story would be misleading, because we know that there are nearly 26,000 more staff for whom nationality is known now than in 2016. While it is likely that there has been an overall increase in the number of NHS staff with EU nationality since 2016, we can’t be sure about the scale of the change. Claims about changes in the number of EU staff which don’t account for the importance of ‘unknowns’ should be regarded with due scepticism.

3 Source: Labour Force Survey. The table above measures employees only.

Changes in the number of EU staff since 2016 Headcount basis

All staff Scientific, Therapeutic and Technical

DateAll

nationalitiesEU

nationalityUnknown nationality

EU as % of known

DateAll

nationalitiesEU

nationalityUnknown nationality

EU as % of known

Jun 2016 1,164,996 58,698 89,546 5.5% Jun 2016 147,276 6,638 10,605 4.9%

Mar 2019 1,238,061 65,073 63,842 5.5% Mar 2019 161,877 8,797 7,482 5.7%

Hospital Doctors Support to Clinical Staff

Date TotalEU

nationalityUnknown nationality

EU as % of known

All nationalities

EU nationality

Unknown nationality

EU as % of known

Jun 2016 110,084 10,106 5,812 9.7% Jun 2016 358,151 11,811 28,348 3.6%

Mar 2019 119,597 10,873 4,684 9.5% Mar 2019 379,740 15,310 20,335 4.3%

Nurses and Health Visitors Ambulance Staff

DateAll

nationalitiesEU

nationalityUnknown nationality

EU as % of known

DateAll

nationalitiesEU

nationalityUnknown nationality

EU as % of known

Jun 2016 317,428 21,826 23,536 7.4% Jun 2016 19,759 255 3,609 1.6%

Mar 2019 324,872 19,841 15,324 6.4% Mar 2019 22,924 513 3,185 2.6%

7 Commons Library Briefing, 8th July 2019

The table above shows changes in the number of EU nationals in each staff category as well as changes in the number of staff with unknown nationality and EU staff as a percentage of those with a known nationality.4 Overall, the percentage of staff with a known EU nationality has remained at 5.5% since June 2016. During this period Asian staff have risen from 4.1% to 4.6% of NHS staff with a known nationality.

Nurses and health visitors are the only staff group to record a fall in the number of recorded EU nationals since the EU referendum. EU nurses as a percentage of those with a known nationality have fallen from 7.4% of the total to 6.4%. EU doctors have fallen to 9.5%, having risen as high as 9.9% in March 2017. EU clinical support staff have risen from 3.7% to 4.3%. Other staff groups shown above have also seen an increase in the percentage of EU staff.

Looking at individual EU nationalities, only Spanish staff have seen a substantial recorded decrease since June 2016, from 7,240 to 5,899 (a fall of 19%).

1.2 Changes since 2009 The table below shows trends back to 2009 in EU staff as a percentage of staff with a known nationality. There was a sustained increase int he ‘all staff’ column until 2016, with little change since.

4 Note that the percentage of known staff with EU nationality is also sensitive to rises

and falls in staff in other nationality groups, so is not a definitive way of measuring changes. It does, however, abstract from changes in ‘unknown nationality’ staff.

Date All staff DoctorsNurses &

health visitorsSupport to

clinical staffSep 2009 3.0% 6.8% 2.8% 2.2%Sep 2011 3.3% 7.5% 3.3% 2.4%Sep 2013 3.8% 8.6% 4.0% 2.7%

Aug 2014 4.3% 9.1% 5.0% 2.9%Sep 2015 5.0% 9.4% 6.5% 3.4%Dec 2015 5.2% 9.5% 6.8% 3.5%Jun 2016 5.5% 9.7% 7.4% 3.6%Dec 2016 5.5% 9.8% 7.4% 3.6%Jun 2017 5.6% 9.8% 7.3% 3.9%Dec 2017 5.5% 9.7% 6.9% 4.0%Jun 2018 5.6% 9.7% 6.8% 4.2%Dec 2018 5.5% 9.5% 6.5% 4.2%Mar 2019 5.5% 9.5% 6.4% 4.3%

NHS staff with a known EU nationality since 2009 The 2009-2014 and 2015-2018 data in this table are taken from two separate NHS Digital publications. As a result they may differ in calculation and methodology. This break is marked by a dotted line.

Changes in non-UK NHS staff since 2016

5.5% 5.5%

4.1%

4.6%

1.9% 2.0%

0.8% 0.9%

2016 2019

EU

Asia

Africa

Other

8 NHS staff from overseas

1.3 Joiners and leavers to the NHS The charts below show the percentage of joiners to the NHS and leavers from the NHS in recent years who were of UK, EU/EEA or Other nationality. As with all calculations this document, these charts show percentages of staff for whom a nationality is known.5 Note that being a ‘leaver’ in this data does not necessarily mean that the person has left the UK – just that they have left NHS employment.

In 2017/18, the percentage of joiners with EU/EEA nationality fell, while the percentage of leavers with EU/EEA nationality rose.

This change was particularly pronounced for the Nurses and Health Visitors staff category, as the charts below show. In 2015/16, 19% of nurse joiners were of EU nationality, while in 2017/18 this fell to 7.9% and in 2018/19 it fell to 7.0% Meanwhile the percentage of nurse leavers with an EU nationality rose from 8.9% to 12.8% in 2017/18, before falling to 11.8% in 2018/19.

5 This data is taken from NHS Digital supplementary information, as well as the routine quarterly publication.

JOINERS BY NATIONALITY, ALL STAFF LEAVERS BY NATIONALITY, ALL STAFF

84.6% 83.8% 81.8% 80.4% 81.9% 82.2% 80.8%

6.9% 8.4% 9.9% 10.9% 9.0% 7.9% 7.6%

8.5% 7.8% 8.3% 8.7% 9.1% 9.9% 11.6%

2012/13 2014/15 2016/17 2018/19

UK EU/EEA Other

87.0% 88.1% 86.8% 86.5% 86.1% 85.5% 84.9%

4.8% 4.6% 5.8% 6.5% 7.5% 8.1% 8.1%8.2% 7.2% 7.3% 7.0% 6.4% 6.3% 6.9%

2012/13 2014/15 2016/17 2018/19

UK EU/EEA Other

JOINERS BY NATIONALITY, NURSES LEAVERS BY NATIONALITY, NURSES

83.8%78.8%

75.1% 73.4%78.5% 81.3%

77.3%

7.9% 13.5% 17.9% 19.0% 12.4% 7.9%7.0%

8.3% 7.7% 6.9% 7.6% 9.0% 10.8% 15.7%

2012/13 2014/15 2016/17 2018-19

UK EU/EEA Other

85.3% 85.9% 84.4% 82.9% 82.1% 81.3% 81.7%

5.0% 5.0% 6.9% 8.9% 11.3% 12.8% 11.8%9.7% 9.1% 8.8% 8.2% 6.5% 5.9% 6.5%

2012/13 2014/15 2016/17 2018-19

UK EU/EEA Other

9 Commons Library Briefing, 8th July 2019

The percentage of leavers from the NHS with EU nationality has increased in the past five years. However, it’s important to note that the percentage of all staff with EU nationality has risen over this period. Because of this, some increase in the percentage of leavers who have EU nationality would also be expected over time. The reduction in joiners from the EU is a more notable trend here.

The number of leavers with unknown nationality is higher than the number of joiners with unknown nationality. As a result, any raw net change figures for particular nationalities may underestimate falls or overstate rises (depending on the trend).

1.4 Differences between English regions 86.9% of NHS staff report a British nationality across England as a whole – but this percentage varies substantially between English regions.6 In the North East of England, 94.9% of staff with a known nationality are British and 1.9% are from other EU countries. In North West London, 72.6% are British and 12% are from other EU countries. Outside of London, the percentage of staff with EU nationality is highest in Thames Valley (10.5%), Kent, Surrey & Sussex (7.9%), and the East of England (7.4%).

Just under one third of non-British NHS staff work in London, compared with 16% of all NHS staff with a known nationality. Similarly, just under one third of all NHS staff from other EU countries work in London.

The chart and table below show more information on variation between regions.

6 The regions used here are Health Education England Regions, which differ slightly from

the standard ‘Government Office Regions’. HEE regions divide London into three parts, and the South East is split into two (Thames Valley and Kent, Surrey & Sussex).

NHS staff by region and nationality group, March 2019

90%

82%

83%

76%

73%

74%

95%

92%

90%

80%

86%

91%

93%

4%

7%

8%

11%

12%

11%

5%

10%

7%

4%

8%

6%

6%

8%

7%

5%

5%

4%

5%

4%

5%

East Midlands

East of England

Kent, Surrey and Sussex

North Central and East London

North West London

South London

North East

North West

South West

Thames Valley

Wessex

West Midlands

Yorkshire and the Humber

UK EU Asia Africa Other

10 NHS staff from overseas

1.5 EU nationals in NHS Trusts The map on the following page shows estimates of the percentage of EU staff at each NHS trust as of March 2019. There are 33 trusts where more than 1 in 10 staff reports an EU nationality, with the highest being Royal Brompton & Harefield NHS Foundation Trust (19.2%).

Note that some trusts have a substantial number of staff with unknown nationality, so comparisons between trusts should be made with some caution. Full data for each trust can be found on the NHS Digital website.

HEE Region UK EU Asia Africa Other Unknown TotalEast Midlands 90,052 3,511 3,842 1,665 503 1,940 101,513East of England 84,813 7,543 7,999 2,422 928 8,918 112,623Kent, Surrey & Sussex 69,723 6,647 5,276 1,741 802 7,639 91,828North Central & East London 58,217 8,486 4,887 3,776 1,565 1,283 78,214North East 67,653 1,384 1,638 503 161 918 72,257North West 179,648 5,934 6,107 2,020 703 3,707 198,119North West London 36,782 5,988 4,296 2,091 1,498 6,948 57,603South London 46,938 6,763 4,728 3,359 1,510 3,121 66,419South West 81,304 4,744 2,685 929 571 9,488 99,721Thames Valley 27,445 3,572 1,808 949 424 6,326 40,524Wessex 49,420 3,902 2,743 740 414 1,157 58,376West Midlands 114,207 3,518 4,904 1,947 804 5,720 131,100Yorkshire & the Humber 115,669 3,149 3,294 1,616 464 6,684 130,876England 1,021,265 65,073 54,191 23,733 10,339 63,843 1,238,444

NHS staff by region and nationality group, March 2019

12 NHS staff from overseas

2. Doctors 72% of doctors in hospital and community health services (HCHS) are British. This is lower than other NHS staff categories.

13% (15,019) doctors report an Asian nationality, of which almost two-thirds are Indian or Pakistani.

9.5% (10,894) of doctors report an EU nationality other than British, with Irish people making up one-fifth of this number. Most are from countries that joined the EU before 2004.

There are 4,586 doctors with an African nationality (4%). The highest ‘Other’ nationalities are Australian and Canadian, both with 365.

These figures vary by English region, as the chart below shows. However, the percentage of non-British doctors has the most uniform regional distribution of any staff category – there is relatively little difference between regions compared with the figures for nurses, which are presented in the next section.

Unlike in other categories, London does not have an above-average percentage of non-UK doctors. In the South West, 82% of doctors are British. In the East of England, 64% are British. North Central and East London has the highest percentage of EU doctors, at 13.5%.

HCHS doctors by region and nationality group, March 2019

67%

64%

72%

73%

73%

72%

75%

71%

82%

72%

77%

71%

74%

7%

11%

10%

13%

13%

13%

7%

8%

7%

11%

9%

7%

7%

19%

18%

12%

9%

9%

10%

12%

15%

7%

13%

10%

16%

14%

6%

5%

5%

5%

4%

5%

4%

East Midlands

East of England

Kent, Surrey and Sussex

North Central and East London

North West London

South London

North East

North West

South West

Thames Valley

Wessex

West Midlands

Yorkshire and the Humber

UK EU Asia Africa Other

British 82,565

Indian 7,115

Pakistani 2,871

Irish 2,228

Greek 1,718

Malaysian 1,640

Egyptian 1,526

Nigerian 1,402

Italian 1,034

German 890

Sri Lankan 806

Romanian 765

Nationality of Doctors, March 2019

72%

13%

9%

0%

50%

100%

UK AsiaEU AfricaOther

13 Commons Library Briefing, 8th July 2019

Data is also available on the country in which doctors gained their primary medical qualification. A summary breakdown is shown in the chart to the right. The percentage of doctors who gained their primary qualification in the UK (63%) is lower than the percentage who report British nationality (74%). This may be because people who qualified in another country have since become British citizens.

20% of doctors qualified in Asia. In total, over 17,000 doctors qualified in India or Pakistan, while just under 9,000 now report either India or Pakistani nationality. 6% of doctors qualified in Africa, compared with 3% who now report an African nationality. Meanwhile, 9% of doctors qualified in another EU country, compared with 10% who now report an EU nationality.

The table below shows variation in country of qualification between region. There are three regions were over 40% of HCHS doctors qualified outside the UK: East of England (47%), West Midlands (44%) and East Midlands (42%). In these three regions, over a quarter of doctors qualified in Asia. In every region, at least one in five doctors qualified outside the UK.

Hospital doctors by country of qualification, June 2018

58%

53%

61%

64%

66%

65%

67%

63%

79%

67%

74%

56%

65%

7%

10%

9%

12%

12%

12%

7%

7%

6%

9%

8%

7%

6%

25%

26%

21%

16%

14%

15%

18%

22%

9%

18%

12%

28%

21%

7%

7%

7%

5%

5%

5%

6%

6%

4%

4%

4%

7%

6%

East Midlands

East of England

Kent, Surrey and Sussex

North Central and East London

North West London

South London

North East

North West

South West

Thames Valley

Wessex

West Midlands

Yorkshire and the Humber

UK EU Asia Africa Other

Great Britain 71,134

India 12,610

Pakistan 4,659

Egypt 2,014

Nigeria 1,903

Greece 1,373

Ireland 1,267

Italy 1,052

Romania 1,018

Iraq 1,015

South Africa 1,013

Sri Lanka 968

DOCTORS: COUNTRY OF QUALIFICATION, JUN 2018

63%

20%

9%6%

0%

50%

100%

UK AsiaEU AfricaOther

14 NHS staff from overseas

Changes since 2009 There are now substantially fewer Indian doctors in England’s NHS than in 2009. In 2009, Indian doctors made up almost 12% of those with a known nationality – this has now fallen to 6%. There have also been reductions in doctors from other non-EU countries such as Zambia, Syria, Iran, Zimbabwe and South Africa.

The number of recorded Greek doctors has more than doubled. The number of Romanian doctors has increased from 174 to 765; Italians from 416 to 1,052; and Irish doctors from 1,389 to 2,228.

3. Nurses 84% of nurses & health visitors in hospital and community health services (HCHS) are British.

7.1% (21,930) of nurses report an Asian nationality. Of these, 92% are either Filipino or Indian.

6.4% (19,849) of nurses report an EU nationality other than British. Of these, 53% are either Irish, Spanish or Portuguese.

There are 7,256 nurses with an African nationality (2.3%). The highest ‘Other’ nationality is Jamaican, with 466.

These figures vary more between English regions than those for doctors, as the chart below shows. In the North East, British nurses make up 95% of the total. In North West London, the figure is 65%. The proportion of nurses from other EU countries varies from 1.2% (North East) to 15% (Thames Valley). 36% of nurses from other EU countries work in London.

Note on changes over time: the number of staff with an ‘unknown’ nationality has fallen substantially, so some increases in individual nationalities may be due to improved

British 257,544

Filipino 12,483

Indian 7,771

Irish 4,568

Portuguese 3,074

Spanish 2,962

Zimbabwean 2,448

Italian 2,351

Romanian 1,777

Nigerian 1,471

Polish 1,462

Ghanaian 881

Nationality of Nurses & Health Visitors, March 2019

83%

7%6%

0%

50%

100%

UK AsiaEU AfricaOther

15 Commons Library Briefing, 8th July 2019

Changes since 2009 There are now substantially fewer nurses from some nationalities than in 2009. There has been a reduction of over 1,300 Zimbabwean nurses (34% of the total). There has also been large reductions in the number of Nigerian nurses. There are estimated to be 55% fewer South African nurses, 44% fewer Malaysian nurses and 32% fewer Australian nurses than there were in 2009.

For several European nationalities there have been very large increases since 2009. The number of Portuguese nurses has risen from 210 to 3,074; the number of Italian nurses from 192 to 2,351, and the number of Spanish nurses from 406 to 2,962.7 However, numbers of all of these nationalities have fallen in the last year.

7 Note that the 2018 figures here differ from those in the table above: they include

midwives in order to allow comparability with the 2009 figures.

Nurses & health visitors by region & nationality group, March 2019

89%

73%

78%

70%

65%

66%

95%

92%

88%

72%

82%

89%

93%

4%

9%

9%

13%

15%

13%

6%

15%

8%

14%

10%

10%

14%

14%

4%

5%

7%

8%

5%

6%

5%

5%

4%

East Midlands

East of England

Kent, Surrey and Sussex

North Central and East London

North West London

South London

North East

North West

South West

Thames Valley

Wessex

West Midlands

Yorkshire and the Humber

UK EU Asia Africa Other

16 NHS staff from overseas

4. Clinical support staff This category includes staff who are not professionally qualified – e.g. support to doctors and nurses, support staff for ambulances, support staff for scientific and therapeutic services, trainees, and healthcare assistants.

90% of support to clinical staff report a British nationality. 4.3% (15,317) are from other EU countries. 54% of these are either Polish, Irish, Spanish or Portuguese.

2.9% (10,421) report an Asian nationality. 78% of these are either Filipino or Indian.

2.1% (7,418) report an African nationality, of which half are either Nigerian or Ghanaian.

As with the figures for nurses, there is substantial variation between regions. In London, around three-quarters of clinical support staff are British, while in the North East, 98% are British. In London North West, 8% of support staff are Asian and 11% are from other EU countries – the highest proportion of all regions in both categories. The highest proportion of African clinical support staff is found in South London, at 9%.

Clinical support staff by region and nationality, March 2019

94%

87%

85%

76%

72%

75%

98%

96%

92%

82%

89%

94%

96%

6%

7%

9%

11%

8%

4%

9%

6%

4%

5%

5%

8%

5%

4%

8%

6%

9%

East Midlands

East of England

Kent, Surrey and Sussex

North Central and East London

North West London

South London

North East

North West

South West

Thames Valley

Wessex

West Midlands

Yorkshire and the Humber

UK EU Asia Africa Other

British 322,182

Filipino 4,479

Polish 3,702

Indian 3,624

Nigerian 2,689

Irish 1,847

Portuguese 1,580

Italian 1,336

Romanian 1,239

Spanish 1,101

Ghanaian 1,068

Jamaican 948

Nationality of Support Staff, March 2019

90%

0%

50%

100%

UK EUAsia AfricaOther

17 Commons Library Briefing, 8th July 2019

Changes since 2009 Notable changes include: the recorded number of Romanian clinical support staff rose from 108 to 1,239; Portuguese from 321 to 1,580; Nepalese from 177 to 684; and Polish from 1,232 to 3,702.

5. Infrastructure support staff This category includes those working central functions, hotel, property & estates, managers, and senior managers. Note that these figures include only directly employed staff, not contracted-out posts.

92% of infrastructure support staff report a British nationality. 8,252 (4.4%) report another EU nationality. 42% of all EU infrastructure support staff are from Poland or Ireland.

1.9% (3,555) of infrastructure support staff report an Asian nationality. 62% of these are either Indian or Filipino. 1.3% (2,518) report an African nationality. 44% of these are either Nigerian or Ghanaian.

In each region of England, over four-fifths of infrastructure support staff are British. As in other categories, the North East has the highest proportion of British staff, at 98%. In three regions, 9% of infrastructure support staff are from other EU countries.

Infrastructure support staff by nationality and region, March 2019

94%

91%

86%

85%

82%

83%

98%

96%

91%

84%

90%

95%

95%

6%

9%

7%

9%

7%

6%

9%

6%

4%

5%

East Midlands

East of England

Kent, Surrey and Sussex

North Central and East London

North West London

South London

North East

North West

South West

Thames Valley

Wessex

West Midlands

Yorkshire and the Humber

UK EU Asia Africa Other

British 172,976

Polish 2,229

Indian 1,416

Irish 1,218

Portuguese 1,008

Filipino 785

Nigerian 723

Italian 647

Spanish 444

Romanian 417

Ghanaian 379

Lithuanian 334

Nationality of Infrastructure Staff, March 2019

92%

0%

50%

100%

UK EUAsia AfricaOther

18 NHS staff from overseas

Changes since 2009 The number of Chinese infrastructure support staff has almost halved to 115. The number of Polish staff in this category increased from 1,113 to 2,229. Portuguese infrastructure support staff levels rose from 445 to 1,008.

6. GPs No data is collected on the nationality of GPs. However, NHS Digital publishes data on the country where GPs in England gained their primary medical qualification. Country of qualification is recorded for around 9 in 10 GPs. This data is only recorded by country groups, so we do not know how many GPs qualified in specific countries.

As of March 2019, 77% of GPs with a known nationality qualified in the UK. This is higher than the equivalent for hospital doctors (section 2).

1,323 GPs (4.3%) qualified in EU or EEA countries. 3,809 GPs, 12.3% of the total, qualified in Asia. 1,313 GPs (4.2%) qualified in Africa, and 751 (2.4%) gained their primary qualification elsewhere.

These figures vary by region. In the East of England, 32% of GPs qualified outside the UK. In the South West, the figure is 9%.

GPs by Country of Qualification, March 2019

74%

68%

76%

73%

72%

76%

79%

78%

91%

82%

87%

72%

77%

4%

6%

5%

5%

6%

4%

4%

4%

4%

4%

4%

15%

16%

11%

14%

15%

11%

12%

13%

9%

5%

17%

14%

5%

6%

6%

6%

5%

5%

4%

4%

East Midlands

East of England

Kent, Surrey and Sussex

North Central and East London

North West London

South London

North East

North West

South West

Thames Valley

Wessex

West Midlands

Yorkshire and the Humber

UK EU & EEA Asia Africa Other

BRIEFING PAPER Number 7783 8th July 2019

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