NHS staff from overseas: statistics

Click thumbnail to download graphic: One NHS, Many Nationalities

The majority of NHS staff in England are British – but a substantial minority are not. Around 170,000 out of 1.28 million staff report a non-British nationality. This is 13.8% of all staff for whom a nationality is known, or just almost 1 in 7. Between them, these staff hold 200 different non-British nationalities. Over 67,000 are nationals of other EU countries – 5.5% of NHS staff in England. Around 64,000 staff are Asian nationals.

The NHS records self-reported nationality, which may sometimes reflect a person’s cultural heritage rather than their citizenship or country of birth, and isn’t necessarily a measure of immigration. For 3.7% of NHS workers, nationality is unknown. The percentages here exclude staff whose nationality is unknown. This data doesn’t cover those working in social care or in the independent sector, or staff not directly employed by the NHS.

9.1% of doctors and 6.0% of nurses are EU nationals

Nationals of other EU countries make up 9.1% of doctors in England’s hospital and community health services. They also make up 6.0% of all nurses and 5.8% of scientific, therapeutic and technical staff. The percentage of doctors and nurses with EU nationality grew between 2009 and 2016. Since 2016, the percentage of nurses who are EU nationals has fallen.

Almost one third of all EU nationals in the NHS work in London

The highest concentration of staff with other EU nationalities is in London. Almost one third of all EU NHS staff work in London, where they make up 10.9% of all NHS staff. There are 32 NHS trusts where over 10% of staff are estimated to be nationals of other EU countries as of January 2020; most are in London and the South East.

More EU staff are nationals of ‘old’ EU countries (those which were members before 2004, such as Spain and Italy) than ‘new’ EU countries (those which have joined since 2004, such as Poland and Romania).

How to interpret 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 47,671 (a fall of almost half) 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 other words: because a greater proportion of NHS staff now have a nationality recorded, we would expect to see increases in the recorded number of staff with a given nationality, even if there were no genuine changes in the actual number of staff with that nationality.

In June 2016 there were 58,698 staff with recorded EU nationality, and in January there were over 67.000. But to present this as the full story would be misleading, because we know that there are nearly 42,000 more staff for whom nationality is known now than in 2016. It is very likely that there has been an overall increase in the number of NHS staff with EU nationality since 2016, but we can’t be sure about the scale of the change, and it would be misleading to calculate a percentage increase based on the two numbers.

Claims about changes in the number of EU staff which don’t mention the importance of staff with unknown nationality should be regarded with due scepticism.

One way to partially account for this is to present the number of EU staff as a percentage of all staff with a known nationality. On this measure, the percentage of staff with EU nationality has changed little since the referendum. Note that this measure is sensitive to changes in staff in other nationality groups and overall staff numbers, so it is still not a definitive measure of changes.

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 6.9%. The percentage of EU doctors has fallen to 9.1%, having risen as high as 9.9% in March 2017. In other staff groups, the percentage of EU staff has increased.

The percentage of NHS joiners who are EU nationals has fallen

In 2015/16, 11% of those joining the NHS were EU nationals (counting those for whom a nationality was known). In 2017/18, this had fallen to to 8%, and in 2019 to 7%. For nurses the percentage of EU joiners fell from 19% in 2015/16 to 6% in 2019. Meanwhile, the proportion of nurses joining the NHS with non-EU nationality rose from 8% in 2015/16 to 22% in 2019.

In 2017/18, 12.8% of nurses leaving the NHS were EU nationals, up from 9% in 2015/16. This fell to 11% in 2019.