The headline, now increasing in pitch, capital letters and exclamation marks, is that net migration is off the charts. It is soaring. It is at an all-time high. So high that we ask, how did it come to this? The answer is, it came to this predictably and, in fact, inevitably. The way immigration numbers are reported is a sort of classification error, one forced by the overriding, unquestioned presumption that immigration is bad, that it must come down, and that politicians are in some duel with “hordes” of immigrants who are making their way into the country, managing somehow to vanquish one of the harshest immigration systems in the world.
More accurate headlines might be “UK skilled worker shortage intensifies”, “Loss of European Union research funding renders British universities increasingly dependent on overseas students”, “Business leaders call for expansion of shortage occupations due to post-Brexit recruitment challenges”, or “Funding cuts to nurse training result in staffing crisis”. Because these apparently vexingly high numbers are, to a large extent, the outcome of economic and political decisions that mean we invite immigrants to fill labour gaps that policymakers either did not anticipate, or ignored warnings about.
Think of it as a false economy, an accounting sleight of hand. A deferral of cost to the future so that the current balance sheet looks good. When David Cameron was warned by universities in 2011 that cuts to nurse training would result in a staffing shortage, he did not heed that advice, while only a year before he had pledged to bring immigration down to the tens of thousands. Last year, internationally trained nursing staff joining the register for the first time made up almost the same number as those trained in the UK. Cameron has long left the unseemly trenches of immigration scuffles, and is now a lord of the foreign policy highlands. If Brexit lore is to be believed and Cameron really did say, “Why should I do all the hard shit?” just before he resigned, then he really was on to something.
Because the “hard shit”, bequeathed to his successors and now the Labour party, includes not only the impossible task of making Brexit a success, but squaring the legacy of his “tens of thousands” pledge, one that now hangs like an albatross on all who follow him, with the realities of an ageing Britain after years of austerity. It is a futile endeavour, one in which it must never be admitted that these numbers are necessary. Policymakers in many cases – in order to finesse the balance sheet – create a lopsided global recruitment pool to compensate for the shrinking of their own, then fret in front of the cameras, incredulous as to how it came to this.
Nowhere is this more stark than in the nursing, health and care sectors. The 2010 training cuts resulted in an NHS England shortfall of 100,000 doctors and nurses. In 2015, bursaries for nurse training were abolished, resulting in a dramatic drop in student applications. The decline prompted a reintroduction of bursaries in 2020, but at a much-reduced rate. Where incentives were maintained in Scotland, Wales and Northern Ireland, the number of student nurses went up. Yet the cuts in England continue. Earlier this year, the government announced that it would slash half of its spending commitments in social care staffing and retention, at a time when vacancies stood at 165,000. And that’s not even the most alarming number.
Skills for Care, which supports the adult social care sector, estimates that the sector needs almost half a million extra workers over the next 10 years to keep up with demand. If those above 55 choose to retire, another 430,000 could be lost over the same period. In January, despite doctor shortages, universities were instructed to limit the number of medical places in order to curb the costs of medical training, or face heavy fines.
The result, contrary to the perception that we are passive receivers of immigrants, is a recruitment drive from overseas so voracious that it has reached into what the World Health Organization categorises as “red list countries”, which already have weak healthcare infrastructure that would be even more compromised by emigration. According to the Nursing Times, three of the top seven countries from which the UK employs nurses are on that red list, reducing their capacity to heal and take care of their own people. In 2021, three of the top five largest sources of doctor recruitment were red list countries. The tailwinds of austerity are global.
And those recruits are brought in to firefight, not thrive. They shoulder not only the burden of stretched care and health sectors, but high relocation costs and punitive terms of employment that hold them in a sort of bondage. In some cases, they are trapped in contracts for five years and if they wish to leave must pay thousands of pounds in exit costs that would cover the upfront spend by recruiters. There is something particularly grisly in passing off training costs to foreign health professionals and their governments, poaching those recruits, and then trying to make sure that they do not have the freedom to change jobs if conditions are poor. In other cases, pay was lower than promised and work did not start for extended periods due to bureaucratic delays in a vice of exploitation and incompetence that involves recruitment agencies, large private care providers and a sluggish Home Office.
Behind the flapping about “record numbers”, there are many of these stories: of people in shortage occupations across the board who have to pay national insurance contributions as well as a high immigration surcharge in annual health taxes and save up for the heavy cost of each leave-to-remain stamp. Who cannot negotiate better pay, hours or conditions under employer sponsorship agreements that leave them with little bargaining power. Who hold on to the hope, at the end of every month, that the numbers and the emotional tithes of leaving their homes will stack up one day.
What the record numbers constitute is not a country unable to control its borders, but one that has established a two-tier employment policy. One that refuses to invest in training and study, and deflects the moral outrage of that on to those who are brought in to plug those gaps. All while refusing to acknowledge that demographics mean that immigrants will always be essential, and so must be treated not as precarious bussed-in labourers, but with humanity, welcome and dignity. That really is the sum of it all. Doesn’t make a good headline though, does it?
This article was amended on 4 December 2023 to remove an incorrect statement that, in 2021, 81% of NHS doctors were recruited from one “red list” country. The country in question, Nigeria, accounted for 81% of NHS doctors recruited by the NHS from Africa, according to a 2022 survey.
Nesrine Malik is a Guardian columnist
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