International comparisons and connections


This section presents a brief international backdrop for the report, then looks at recent international flows of health professionals. It uses data from the OECD to place current UK staffing levels into an international context. There are limits to the depth of analysis possible, due to differences in data collection and definitions in different countries, but a brief examination of OECD data suggests that the UK is slightly below the OECD average for both the doctor:population ratio and nurse:population ratio.

The UK: below OECD average for doctors and nurses

Data on doctors per 1,000 population (Figure 11) show the ratio in the UK is not dissimilar to many traditional comparator countries, such as the US, Canada, Ireland and New Zealand, but is lower than countries in Europe and Scandinavia.

Data on nurses per 1,000 population (Figure 12) show the UK ratio is 8.2 nurses per 1,000 population. This is below the OECD average of 8.9, as well as below traditional comparator countries and those in Europe and Scandinavia.

Health care is labour intensive, and there is therefore a loose correlation between the amount spent on health and the relative size of the health workforce. While this in part can explain the below-average status of the UK on these two point-in-time indicators, there are also structural issues and funding trends to consider. These include evidence that the UK appears to train relatively fewer nurses than comparable OECD countries.

The UK: relatively low graduation rate of nurses

In common with several other OECD countries, such as Australia, the UK has seen rapid growth in the number of medical students in the last 10 to 15 years. In the UK context, this helps explain the relatively rapid growth in supply of newly qualified doctors in recent years, which is likely to continue if the recent commitment by DH to increase medical student numbers by 25% is fully implemented, and new expanded targets for international recruitment of GPs are met. OECD data on the number of health professional graduates (Figure 13) show the UK is now above the OECD average for medical graduates, at 13.5 per 100,000 population, which is significantly higher than the US, Canada and New Zealand.

In contrast, OECD data highlight that the UK is well below average in terms of the number of nursing graduates per 100,000 population. The UK figure is about 29 per 100,000 population. The OECD average is 45 per 100,000 population; the US figure is more than double the UK’s at 63 per 100,000 population; and Australia’s number is even higher, at 76 per 100,000 population. While some caution is required in making these international

comparisons, OECD estimates suggest the UK’s nurse graduate:population ratio has been static across the last 10 years, while there has been growth reported for many other OECD countries. Additional data from UCAS, analysed later in this report, also suggest that within the UK, England has had a markedly lower rate of applications to nursing education among 18-year-olds than the other three UK countries.

Figure 11: Number of doctors per 1,000 population in OECD countries, 2014 (or nearest year)

Source: OECD Health statistics 2017 (database), Health care resources.

Figure 12: Number of nurses per 1,000 population in OECD countries, 2014 (or nearest year)

Source: OECD Health statistics 2017 (database), Health care resources.

Figure 13: Number of medical and nursing graduates per 100,000 population in OECD countries, 2014 (or nearest year)

Source: OECD Health statistics 2017 (database), Health care resources.

Inflows and Brexit

The UK has a long history of active international recruitment of health staff from other countries, as well as being a source of skilled practitioners for other, mainly high income, countries. In a report published in April 2017, the House of Commons estimated that there were over 60,000 people from EU countries outside the UK working in the NHS in England, with a further 90,000 working in adult social care. This represented 9.2% of NHS doctors and 7% of NHS nurses (these rates doubled in London).

Trends in inflow of EU nurse registrants show that these have replaced non-EU countries such as India and the Philippines as the main source of international nurses since about 2008 (Figure 14). There was particularly rapid growth in nurses registering from EU countries such as Spain, Portugal and Italy in the period from 2012/13 to 2016/17.

Figure 14: Number of EU and non-EU nurse registrations, 1990/91–2016/17

Source: Data obtained from Nursing and Midwifery Council.

This relatively high level of reliance on international staff has been brought into sharp relief by the UK’s vote in June 2016 to leave the EU. This has raised questions about the longer-term attractiveness of the UK as a place of work for EU nationals, as well as about retention rates of EU nationals already working in the NHS. It also came at the same time as new language requirements for international nurses were implemented. The combined impact proved dramatic. Monthly data on new registrants to the NMC show clear signs of a crash in inflow since the summer of 2016 (Figure 15). Similarly, 3,500 nurses with EU nationality left the NHS in 2016 – twice as many as in 2014. The new language test has now been reviewed by the NMC, with a change to include the Occupational English Test as an alternative.

Figure 15: New EU nurse registrations, January 2016–April 2017

Source: Data obtained from Nursing and Midwifery Council.

Other recent surveys, of UK-based European doctors and medical students currently studying at Edinburgh University, indicate Brexit may have a negative impact on future retention of doctors in the UK. The most recent analysis of data from the General Medical Council (GMC) suggests that, in contrast to nurses, the supply of EEA doctors remains relatively stable. Although there has been a slight decrease in the number of EU doctors applying to join the UK medical register since the referendum, there have also been fewer EU doctors leaving the register over the same period, and an increase in applications by doctors from outside the EU.

Previous Next