The 5th of July 2023 marks the 75th anniversary of the NHS – a major milestone for the first nationally funded universal health service. The NHS now treats over a million people a day, requiring a workforce of over 1.5 million, making it one of the biggest employers in the world. The NHS has relied on international medical graduates since its beginnings, and it is impossible to celebrate the NHS without celebrating its international workforce.
The History of International Medical Graduates in the NHS
The NHS, established in the aftermath of the Second World War, set out to provide high quality medical care to the entire population of the UK – regardless of their ability to pay. This required an unprecedented number of healthcare professionals, and from the early days of the NHS it was clear that internationally educated clinicians would be essential to keep the service functioning. Much of the healthcare system prior to the NHS was already reliant on overseas clinicians. Relying on internationally trained clinicians to provide healthcare services to UK citizens has been a running theme throughout the history of healthcare in the UK. It is difficult to pinpoint the first internationally educated clinician working in the UK healthcare system, though there are several famous examples, such as Sake Dean Mahomed, an Indian born clinician who was appointed as King George IV’s official ‘shampooing surgeon’ in 1822.
Post-World War Two to Windrush
The 75th anniversary of the NHS coincides with the 75th anniversary of the HMT Empire Windrush’s arrival in the UK. The HMT Windrush’s passengers became known as ‘The Windrush Generation’, and became representative of the wider mass-migration movement that spanned from the 1940s – 1970s. The UK encouraged immigration to help bolster the workforce following the devastating losses sustained in the war. The recent creation of the NHS provided employment opportunities for recent arrivals, especially as nurses. By 1948, there were 54,000 nursing vacancies in the NHS. By 1949, the British government was working with the Colonial Office, the Royal College of Nursing and the General Nursing Council to actively recruit nursing professionals from overseas. 12% of all student nurses and midwives in Britain were recruited from overseas by 1977, and by 1960 40% of junior doctors in the NHS came from India, Pakistan, Bangladesh, and Sri Lanka. Overseas recruitment has been essential to the function of the NHS since its beginning.
Though reliance on internationally educated clinicians was clear even before the creation of the NHS, IMGs often found difficulty in practicing medicine after arrival in the UK. In particular, doctors hailing from India and Pakistan were only able to get jobs at ‘district general hospitals’, and were limited to becoming registrars – their job applications were often rejected due to their heritage and education, and they faced poor treatment from both colleagues and staff. While we are celebrating the contribution of internationally educated clinicians to the NHS, and to the wider culture in the UK, it is important to recognise the difficulties they faced upon arrival in the UK.
The Swinging Sixties to the New Millennium
By 1961, the NHS was the biggest employer in Britain. It was already heavily reliant on International Medical Graduates, and was often the first place the British public came into contact with people of colour. As one of the largest employers of international workers, the NHS was pivotal in shaping social change and the public attitude around race and migration.
It was hard to deny the need for, and impact of, IMGs in the first 50 years of the NHS. By 1962, the NHS performed its first hip replacement – a massive feat that has since improved the quality of life for thousands of patients. These developments would not have been possible without the contribution of international clinicians’ knowledge and expertise. By the close of the 1970s, the NHS had reached 1,000,000 employees– and the Royal Commission on the NHS estimated that between 18,000 – 20,000 registered doctors in the UK were born outside the UK, with half of those being from India or Pakistan. Though there are gaps in our understanding of the individual contributions of internationally educated clinicians in the NHS, it is clear they had a significant impact on the development of the service, of care delivery, and of medical advancements.
COVID-19 and the NHS
The COVID-19 pandemic threw the enormous contribution of internationally educated clinicians in the NHS into sharp focus. During a period of uncertainty, fear and stress, the NHS’s workforce displayed incredible resilience and dedication to patient care. International clinicians were at the forefront of the fight against the pandemic, with a £15 million Medical Support Worker grant introduced to support IMGs living in the UK obtain their GMC membership. The UK’s need for IMGs has been evident throughout its history, but it has never been as desperate as it is now as the NHS grapples with ‘historic’ vacancy rates.
People from all over the world carved out successful careers in the NHS – both in clinical and non-clinical roles – making a lasting difference in the communities they served and shaping the NHS into what we know it as now. Without their contributions, the NHS would not stand as the historic institution and symbol of health and unity that it does today.
1 in 6 staff in the NHS report a nationality other than British, and the NHS now reports having the most diverse workforce in its history. The incredible achievements and progress made by the NHS since its inception would not have been possible without the contribution of IMGs and other non-British support workers.
Remedium has supported over 100 organisations recruit and onboard over 3,500 clinicians since 2013. To find out more about our approach to international recruitment, get in touch today.