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The UK has put foreign doctors on notice: Their services will soon no longer be required. The government of Prime Minister Theresa May announced plans on Tuesday to make the National Health Service “self-sufficient” in the next decade. For a nation trying to burnish its image as an open and forward-looking society even as it cuts ties with Europe, it’s hard to think of a worse policy than this one.
The National Health Service, a revered taxpayer-funded system that is struggling with staffing and funding shortages and delivers uneven care across the country, relies heavily on foreign-trained medical staff. The U.K. has a higher proportion of foreign-trained doctors than any of the 35 members of the Organization for Economic Cooperation and Development except for Israel, New Zealand, Ireland, Norway and Australia.
In 2013, over a quarter of the doctors practicing in the U.K. had been trained outside the country, according to the OECD. But even these figures don’t give the whole picture. There are 87,869 specialists in the U.K. but only 58 percent of them earned their qualifications at home. Seventeen percent had qualifications from other European countries, and nearly 25 percent were from other countries, notably India, according to the General Medical Council. (That’s similar to the U.S., where 22 percent of foreign-trained doctors earned their qualifications in India).
That’s why staff shortages are sure to get worse under a policy that favors British-trained doctors. To help plug the hole, the government is promising to train an additional 1,500 more doctors each year, a 25 percent increase to the current number of medical school students, which is capped at 6,000 per year.
Expanding education provisions for doctors in the U.K. is not a bad thing, were money no object. But of course, money is an object. The self-sufficiency drive will cost an additional 100 million pounds ($127 million) by 2020. Health Secretary Jeremy Hunt argues that this will reduce the 3.3 billion-pound annual bill to hire contract workers, often foreign-trained.
Meanwhile, doctors are threatening to flee the U.K. Morale is so low that 42 percent of doctors responding to a 2012 survey said they planned to practice overseas. To prevent defections of doctors who receive state support for their training, the new policy will require a commitment or demand doctors repay the government’s 220,000-pound investment. A lock-in may be the only way to keep them put — and it’s a fair demand given the cost of their education —but it certainly won’t make them any happier.
And even an additional locked-in 1,500 freshly minted doctors won’t begin to cover the potential shortfall. Foreign doctors will still have to be recruited, at least for a significant period of time. The executive in charge of the organization that represents NHS employers has noted in evidence to parliament that employers face continuing shortages and that the bureaucratic hurdles involved in recruiting staff from outside the European Union had become an obstacle to recruiting. Once the U.K.’s exit from the EU has been negotiated, and European doctors will no longer be entitled to work in the U.K., that problem will only become worse.
But there is a deeper problem with the new policy that goes beyond numbers and funding. It’s not clear what problem self-sufficiency is meant to solve. And what message does it send about the values of a post-Brexit Britain?
The U.K. government has been on a mission to “take back control” since the country voted to leave the EU in June. In the name of national sovereignty, there will be more control over immigration, more control over regulations governing U.K. business and more control over foreign policy. But foreign doctors pose no threat to U.K. sovereignty.
Self-sufficiency might make sense when it comes to energy (though the U.K. doesn’t have it) or for families that want to grow their own food. But no modern nation is self-sufficient in all things. All of them import food, mobile phones, clothing, building supplies, medical equipment — and, yes, workers. What’s the benefit of a home-grown medical profession? Should the U.K. also insist on home-growing taxi drivers, waiters, nannies or computer programmers?
Either this is a brilliantly Machiavellian strategy by May to discredit the worst arguments of the “leave” campaign through caricature. Or else “take back control” has just been taken too far.
— Bloomberg
Therese Raphael writes editorials on European politics and economics for Bloomberg View. She was editorial page editor of the Wall Street Journal Europe