The UK must match its dependence on overseas health workers with investment in the countries that train them, according to a new Parliamentary report
International recruitment is not a temporary response to NHS vacancies but a structural feature of the health service, according to a new report from the All-Party Parliamentary Group on Global Health and Security.
An honest account of the benefits and costs of international health worker recruitment examines the value overseas-trained staff bring to the UK and the consequences for countries already facing serious shortages. It outlines that the UK benefits from a global health workforce and must therefore help sustain it.
Around one in five NHS workers in England reports a nationality other than British, while one in three doctors was trained overseas. About a quarter of nurses on the UK register were educated internationally in 2025, and internationally educated professionals accounted for nearly half of new nursing joiners in 2023/24. They also fill vacancies in underserved areas and bring experience gained in different health systems.
Prepared by Global Health Partnerships, formerly THET, the report draws on evidence from governments and health workers. Its analysis is intended to move the debate beyond headline staffing numbers towards the wider consequences of international recruitment.
Costs beyond the NHS
The authors estimate that overseas-trained doctors and nurses have saved the UK approximately £14 billion in training costs, including £1.1 billion in the most recent year. The attractions for overseas health workers are better employment and opportunities for professional development. Their remittances may support families and national economies, while returning professionals can bring valuable knowledge home.
However, the inquiry also heard how the departure of experienced clinicians and educators can weaken services in lower-income countries. Losing senior staff reduces clinical capacity and can damage the training pipeline for the next generation. The effects are most serious in fragile health systems that cannot readily replace the people who leave.
The World Health Organization projects a global shortfall of 11m health workers by 2030. Against that background, competition between countries for the existing pool of global health professionals risks deepening existing inequalities unless mobility is managed more responsibly.
The APPG rejects a simple choice between recruitment and no recruitment. International movement will continue, and the NHS is unlikely to end its dependence quickly. The relevant choice lies between short-term recruitment and a predictable partnership model that benefits destination and source countries.
An ambitious domestic target
The government’s 10-Year Health Plan aims to reduce international recruitment to below 10 per cent by 2035, yet around 30 per cent of new NHS appointments in 2024/25 were recruited internationally. Replacing only one fifth of those posts through domestic training would have required an estimated additional £700m of government investment.
The inquiry questions whether the target can be achieved without a major expansion in UK training and much stronger retention. However, falling nursing applications and an ageing workforce add to the difficulty. The report therefore calls for workforce planning with published assumptions about future international recruitment, alongside contingency arrangements if the 2035 ambition proves unattainable.
Better working conditions and career development could help the NHS retain more of the people it already employs, including internationally recruited staff whose previous experience is not always recognised.
Partnering with governments
Existing bilateral agreements often regulate how workers move without requiring sustained investment in the systems that trained them. The APPG proposes ‘proportionate co-investment’, a predictable contribution from recruiting countries to workforce development in the most fragile source countries.
Funding would be linked to the benefits gained through recruitment and could support training or employment according to priorities set by partner governments. Agreements should cover the full health worker lifecycle, combining measurable commitments with independent evaluation and accountability.
The report also calls for stronger protection for internationally recruited staff in the UK. Consistent induction and recognition of prior experience would help new arrivals build stable NHS careers. Enforceable safeguards should address recruitment fees and unequal employment conditions, with access to redress when exploitation occurs.
A global public good
Well-staffed systems strengthen universal health coverage and preparedness for cross-border health threats, as weakness in one country can ultimately create risks elsewhere. Health workforce capacity is therefore not just a national asset but a global public good.
The report stresses that the UK can use its role at the World Health Assembly and its 2027 G20 presidency to promote a partnership model based on ethical mobility and shared investment. Transparent government-to-government agreements could give source countries greater certainty while allowing the NHS to plan more effectively.
A more sustainable global workforce would support partner countries while improving the long-term resilience of the NHS. The report’s message is that responsibility must now catch up with reliance. Greater self-sufficiency remains important, but it will take time.
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