By: Dr Indranil Chakravorty MBE
The fabric of the National Health Service, that most cherished of British institutions, has always been woven with threads from across the globe. For decades, the skill, dedication, and diversity of the immigrant medical workforce have been the bedrock upon which its very survival has depended. Yet, today, that fabric is under unprecedented strain. We find ourselves at a critical inflection point, caught between the ugly spectre of public division, the cold, hard truth of workforce data, a government in disarray, and a looming crisis in patient care. The path we choose now will define the NHS for a generation.
The recent ‘Unite UK’ demonstrations, with their rhetoric of “British jobs for British workers,” present a direct and deeply personal challenge to our community. While couched in the language of economic protectionism, their message casts a shadow of ‘otherness’ over thousands of dedicated professionals. For a doctor who has spent years treating patients in Hull, a nurse leading a team in Cardiff, or a surgeon saving lives in London, to be implicitly told they are unwelcome is not just a political point—it is a profound professional and personal affront.
The irony is staggering. These demonstrations occur against a backdrop of a health service that would simply collapse without its international workforce. The NHS Long Term Workforce Plan, published with great fanfare, explicitly acknowledges this reality. Its ambitions—to expand medical school places, increase apprenticeship schemes, and retain more staff—are laudable but, crucially, long-term. It is a ten-year plan for a five-alarm fire. The current vacancies, exceeding 112,000 across the service, are being filled today by our international colleagues. To scapegoat the very people preventing the system’s immediate implosion is not just illogical; it is dangerously irresponsible. It fosters a climate of hostility that can erode morale, well-being, and ultimately, the willingness of these professionals to stay.
This is where the recent publication of the Medical Workforce Race Equality Standard (MWRES) data becomes not just a report, but a vital piece of evidence in this debate. The data paints a familiar yet still shocking picture: a stark ethnic pay gap, significant disparities in awards and promotions, and a higher likelihood of international graduates and ethnic minority staff facing disciplinary procedures. For years, BAPIO and others have argued that the NHS suffers from an institutional bias that stifles the potential of a huge portion of its workforce. The MWRES data provides irrefutable, numbers-based proof.
The confluence of these two issues—the external prejudice of public demonstrations and the internal inequity revealed by MWRES—creates a perfect storm. It tells a story of a workforce that is relied upon yet undervalued; that is essential yet often excluded; that is asked to prop up the system while being denied a fair share of its opportunities and rewards. This is the core of the challenge we face: combating a narrative of replacement from outside, while simultaneously demanding a narrative of fairness and inclusion from within.
Into this volatile mix steps a government in profound turmoil. A weakened administration, facing an existential electoral threat from the far right, often finds its policy agenda held hostage by its most reactionary elements. The temptation to appease this faction with rhetoric and policy on immigration that is increasingly strident and restrictive is immense. We have already seen a steady drumbeat of policies making the UK a less attractive destination for international medical talent: the unfair and punitive hike in Immigration Health Surcharges, the restrictive dependent rules, and the constant, demoralising uncertainty over the visa and sponsorship process.
The current Prime Minister, therefore, faces a critical test of leadership. It is not enough to simply acknowledge the data or the staffing crisis; his government must enact strong, deliberate policy imperatives to reverse this damaging tide. This requires unequivocally condemning divisive rhetoric, and matching the NHS’s recruitment ambitions with a Home Office strategy that actively welcomes and retains global talent. This means not just pausing damaging policies, but proactively rolling them back: substantially reducing the crippling financial burden of the Immigration Health Surcharge and visa fees for NHS workers, guaranteeing the rights of dependents, and creating a streamlined, dignified path to settlement for those who dedicate their careers to our health service. Leadership must bridge the gap between the rhetoric of appreciation and the reality of policy, transforming the UK’s stance from one of perceived hostility to one of genuine, competitive welcome.
The danger is that this political imperative will directly contradict the operational needs of the NHS. While the Department of Health and NHS England rightly speak of the need to recruit globally to meet workforce targets, the Home Office enacts policies that achieve the precise opposite. This governmental paralysis creates a hostile environment by default. It signals to the world’s healthcare professionals that they are, at best, a temporary necessity—welcome to fill a gap, but not necessarily to build a life, a career, or to be treated as an equal.
The ultimate cost of this failure will not be borne by politicians or pundits. It will be borne by patients. A demoralised, undervalued, and unfairly treated workforce is less productive, more prone to burnout, and more likely to leave. When skilled consultants and experienced nurses choose to depart for Canada, Australia, or their home countries because they no longer feel welcome or valued, it is waiting lists that grow longer. It is wards that become more dangerously understaffed. It is the quality of care that declines. The ‘Unite UK’ protestors, in their misguided attempt to protect a vision of Britain, would inadvertently harm the very communities they purport to represent by undermining the NHS that serves them.
So, what is to be done? This is not a time for despair, but for clear-eyed, evidence-based advocacy.
First, we must relentlessly champion the data. The MWRES findings cannot be allowed to gather dust on a shelf. They must be the foundation for mandatory, funded, and monitored action plans in every Trust. We must hold leaders accountable for closing the pay and disciplinary gaps and shattering the glass ceiling that holds back so many talented professionals.
Second, we must change the narrative. BAPIO, alongside other organisations, must amplify the stories of the immigrant workforce not as ‘gap workers’, but as pillars of our communities. They are the clinicians in rural practices, the specialists in regional centres of excellence, the researchers pioneering new treatments. Their contribution is not ancillary; it is central.
Third, we must demand policy coherence from the government. The Home Office and the Department of Health and Social Care must align their objectives. The immigration system for health and care workers must be streamlined, affordable, and secure, reflecting their status as highly skilled professionals, not political pawns.
We stand at a crossroads. One path leads towards a divided, insular NHS, struggling to function as it drives away the talent it needs, ultimately failing the patients it serves. The other path requires the courage to confront internal inequity and the resolve to stand against external prejudice, building a service that truly values every member of its workforce. The choice seems obvious, but it will not be made by itself. It requires our collective voice, our unwavering evidence, and our shared commitment to the founding principles of the NHS: that it is for everyone, and built by everyone.