The National Health Service (NHS) faces a critical threat as foreign doctors and nurses are increasingly avoiding the UK due to a perceived “hostile environment” fueled by anti-migrant rhetoric and rising racism. Jeanette Dickson, chair of the Academy of Medical Royal Colleges, which represents 220,000 doctors across the UK and Ireland, has issued a stark warning that without the invaluable contribution of overseas health professionals, the NHS could “quite easily fall over” and lack the “critical mass of people there to run the service safely”.

Record numbers of foreign-born doctors are now quitting the NHS, while the post-Brexit influx of international staff has stalled. Simultaneously, the number of nurses and midwives joining the service has experienced a sharp decline over the past year. Dickson attributes this exodus and disinterest to various factors, including antagonism from politicians towards migrants, pervasive negative media coverage of immigration, racist abuse from NHS colleagues towards international medical graduates, and racist aggression from patients directed at minority ethnic NHS staff.

Dickson, an NHS consultant clinical oncologist, described the prevailing sentiment as creating a culture where the rhetoric suggests ‘foreigner bad’. She noted that for those considering working in Britain, the portrayal in social media, press, and political discourse makes the country appear “unwelcoming, racist”. Foreign health staff observe Britain’s retreat from Europe, an increase in societal tensions such as attacks on synagogues and anti-Muslim protests, alongside the strong political message that immigration is a significant problem. These perceptions lead them to question why they would choose a country that seemingly does not want or need them, especially when compared to a decade ago, the prevalence of hostility towards migrants is significantly higher.

Historically, the NHS has relied on overseas staff since its inception in 1948, with this dependence now reaching unprecedented levels; General Medical Council (GMC) figures indicate that 42% of all UK doctors qualified abroad. The current atmosphere is so unpleasant that some foreign-born NHS staff report feeling unsafe in their daily lives. Selina Douglas, chief executive of the Whittington health trust in London, recently highlighted instances of hospital and community-based staff experiencing a rise in racism, including overseas nurses of 25 years being racially abused and even spat at.

While Wes Streeting, the health secretary, has warned abusive patients that their right to free healthcare does not permit abusing staff, the effectiveness of actions taken by NHS trusts or the police against such abuse remains unclear. Workforce data from the GMC and the Nursing and Midwifery Council confirm that more and more foreign medical and nursing graduates are “voting with their feet,” either opting not to come to the UK or leaving for opportunities elsewhere.

Dickson’s concerns echo Streeting’s own acknowledgments of an increasingly overt “1970s, 1980s-style racism” targeting NHS staff. She also criticized the Labour government, claiming it is partly to blame by prioritizing UK medical graduates over those qualified overseas for specialist medical training places. This issue, alongside pay, is central to the ongoing resident doctors’ dispute in England. Dickson suggested this prioritization might be shortsighted, given a global shortage of doctors who can find better pay and easier working conditions outside the UK.

She highlighted that doctors and nurses possess highly portable skills, and with countries like Canada, Australia, and New Zealand offering more welcoming environments, it is unsurprising that staff are leaving or choosing not to come. Dickson urged Prime Minister Keir Starmer and Health Secretary Streeting to publicly affirm that foreign-born frontline NHS doctors and nurses are welcome, emphasizing their “invaluable service to patients but also to the NHS and their colleagues,” without whom the service would be “completely snowed under.”

In response to Dickson’s remarks, a spokesperson for the Department of Health and Social Care affirmed the NHS’s reliance on international staff and its commitment to supporting and attracting talented overseas professionals. They stated the NHS has a zero-tolerance policy for racism. However, they also defended the prioritization of UK medical graduates in specialty training, citing the return on investment for British taxpayers and a historical failure to train enough domestic professionals, as outlined in the 10-year health plan.