Thread by @sam_bidwell

When we talk about immigration, we're often told that we need immigration because our public services, like the NHS, are reliant on it.

A short 🧵 on why this is nonsense - and why we shouldn't let the NHS be a thought-terminating cliché when discussing migration:

Let's start with a basic point - most migrants don't come to the UK to work in the NHS.

In fact, according to analysis from @BernoulliDefect, just 2.6% of the 1.22 million migrants who came to the UK in 2023 did so using the Health and Social Care Visa route.

It's not even fair to say that immigrants are *disproportionately* likely to work in the NHS - thanks again to @BernoulliDefect.

Clearly then, it's possible to cut immigration - even radically so - without impacting the NHS' access to an overseas labour pool...

But maybe it's still fair to say that the system is 'dependent' on migration? After all, we don't have enough people training to be doctors and nurses here in the UK - it's simply inevitable that we have to prop up our system with foreign-trained practitioners, right?

Nope - this is entirely a self-imposed problem.

In partnership with the British Medical Association, the Government caps the number of training places at UK medical schools - currently it's 7,500, though there are indications that this might be increased over time to 15,000.

When the cap was temporarily lifted in 2020/21, demand for medical training places shot up - before the cap was reimposed in 2022.

The obstacle to a self-sustaining NHS workforce is the UK Government's reticence to make a long-term investment in the UK's domestic workforce.

This decision stems back to 2008, when the BMA voted to cap the number of medical places and ban the opening of new medical schools - for fear of "overproducing" doctors and "devaluing the profession".

This is racketeering and protectionism, plain and simple.

Between 2010 and 2021, 348,000 UK-based applicants were refused a place on a nursing course.

The House of Lords found that, in 2016 alone, 770 straight-A students were rejected from all medical courses to which they applied.

Failing to train our own workforce is a choice.

And, of course, there are second-order impacts of migration on public services as well. Like the rest of us, migrants use the NHS - between 2010 and 2020, there were 7 million new GP registrations by migrants.

That's BEFORE the 2022/23 spike in overall migration.

"But what if we rejected those applicants because they weren't good enough? We don't want low-quality medical practitioners."

As @93vintagejones notes, foreign-trained doctors are 2.5x more likely to be referred to the GMC as unfit to practice than British-trained doctors.

We've known for years that foreign-trained doctors are more likely to fall below expected standards than British-trained ones.

We're substituting a high-quality domestic workforce for a low-quality international one, thanks to BMA protectionism and government incompetence.

"But training takes time! We won't be able to fill those gaps immediately."

First, successful management of public services requires a long-term perspective.

Second, that may be the case - so create a special, time-limited visa route for practitioners from certain countries.

Plenty of countries have schemes that enable high-quality migrants to come to the country for a fixed period of time, under particular conditions.

A policy of using migrant doctors to fill short-term gaps doesn't require us to open the borders in perpetuity - obviously.

"But even if you opened those training places, you wouldn't fill them with British people."

Once again, we know that this isn't true - when the cap was temporarily removed, applications increased.

And if that doesn't work, there's a case for increasing public sector pay.

However we choose to address the NHS workforce, the key takeaway is that we shouldn't allow this to be a thought-terminating cliché.

Most migrants don't contribute to the NHS.

Our "reliance" on migration is entirely self-imposed.

We can choose to do things differently.