Briefing

Immigration and the NHS: the evidence

Published June 2026

Last updated June 2026

Time to read

About 23 mins

Authors

Three nurses talk in a hospital ward reception area

Topics

Key points

The NHS is often part of debates about immigration and its impact in the UK. We reviewed existing research and analysed publicly available data to assess the relationship between immigration and the NHS.
Overall, evidence suggests immigration makes a positive contribution. The average person who migrates to the UK is more likely to work in the NHS, less likely to use health services and contributes significantly to NHS funding. NHS pressures are largely down to funding constraints, workforce shortages and changing health needs.
People who migrate to the UK likely use the NHS less on average because they are generally younger and healthier than the UK-born population, but also face additional barriers to access. Studies find differences between migrants and non-migrants reduce over time, with use tending to converge the longer people live in the UK.
Available estimates generally suggest people who migrate to the UK pay more in taxes and visa charges than the cost of NHS and other public services they use in the short to medium term. Meanwhile the migrant charging system contributes to inequalities. Upfront charges for some migrant groups deter people from seeking care, with potential long-term health impacts.
Non-British nationals account for around 1 in 5 NHS staff in England. International recruitment policy has alternated between periods of expansion and efforts to reduce reliance. The latest target to reduce international recruitment is not realistic and risks worsening workforce shortages. A longer term, fairer approach to NHS recruitment is needed.
The evidence base is uneven: there are good, timely data on NHS workforce nationality but more limited evidence on NHS use and fiscal impacts. There are no national studies comparing use of health services by migration status using data from 2021 onwards. Given recent shifts in migration, this is a key gap.
Our polling shows the public often overestimates both migrants’ use of services and their share of the workforce. People who have more experience using the NHS themselves and think migrants use the NHS less are more likely to view the impact of immigration positively.
Ultimately, immigration policy decisions are not just about the NHS and often involve complex trade-offs, with governments pursuing a range of objectives. But focusing narrowly on reducing immigration risks unintended consequences for the NHS. Ensuring policy is informed by available evidence is critical to the future sustainability of the health care system.

Introduction

The NHS was founded on the principle that care should be available to all, based on need rather than ability to pay. Satisfaction with the NHS has declined in recent years but the majority of the public still believes this principle should apply. Yet there has been a slight but notable decline in support for the NHS being ‘available to everyone’, according to the long-running British Social Attitudes (BSA) survey.

Public views on immigration are also shifting. Just 6% of the public cited immigration as an important issue facing Britain in 2022, compared with 32% in 2026. Since Brexit, there have been significant changes in migration to the UK, including increased recruitment of people from outside the EU to work in the NHS and social care. Views on immigration are mixed but, increasingly, people in Britain believe it has negative economic and cultural impacts. These perceptions are shaped in part by political and media narratives, including anti-immigration messaging.

Changes in public attitudes to migration and to the NHS appear to be linked: the BSA finds negative views on migration are associated with lower support for NHS care being available to all. This is perhaps unsurprising, given the prominence of the NHS in mainstream political debate about immigration. During the Brexit campaign, leaving the EU was partly framed as ‘relief to a beloved NHS strained by non-paying migrants’. In the 2024 general election, Reform UK’s 'contract' with voters linked higher immigration to high NHS waiting lists. And the home secretary has argued that extending the ‘settled status’ period for people who migrate to the UK would prevent ‘yet more pressure’ being placed on the NHS.

Claims like these are not new, but frequently ignore reality. For example, a 2018 study found immigration generally reduced NHS outpatient waiting times and did not affect A&E waits. Instead, long waits for care are down to a combination of factors, including funding constraints, chronic staff shortages and an ageing population with complex health and care needs – compounded by the COVID-19 pandemic’s lasting impact on the NHS.

Yet evidence on the relationship between migration and the NHS is often contested, and no recent study has brought together the evidence on the variety of ways migrants interact with the NHS – for instance, on their contribution to NHS funding and use of health services.

To inform public debate and policy, we synthesised the latest evidence on the impact of immigration on the NHS. We summarise the evidence across three domains: using the NHS, funding the NHS and working in the NHS. We also analyse new data on public perceptions on immigration and the NHS to see how people’s views compare with the evidence. We then discuss the implications of our findings for national policymakers.

Approach and methods

We used a mix of methods and data to understand the relationship between immigration and the NHS, including reviewing existing evidence, analysing publicly available data and surveying public opinion.

There is no single definition of a ‘migrant’ and the term is used inconsistently – for example, sometimes conflating migration status with ethnicity. We took a broad definition, looking at people who move country to the UK to study, work, seek asylum and join family, and how they use and contribute to the NHS. The evidence we review uses different definitions, mostly based on country of birth or nationality, and generally looking at long-term migration rather than ‘visitors’ (see Box 1).

Box 1:

In UK data, migration is generally measured using country of birth and nationality. These measures capture different groups: for example, ‘foreign-born’ includes people who are UK citizens and ‘UK national’ includes people born outside the UK. Most estimates focus on long-term migrants (people moving for at least a year), rather than ‘visitors’.

Net migration – which accounts for people arriving and leaving – is currently falling after growing significantly from 2021 to 2023. The provisional, long-term net migration estimate for the UK is 171,000 for the year ending December 2025. This is down by almost half from the previous year – primarily because fewer non-EU nationals came for work – but similar to the pre-Brexit period. Unusually high immigration from 2021 to 2023 was down to the introduction of a post-study work route, humanitarian routes for Ukrainians and Hong Kongers, and a care worker visa route. Population growth from migration across UK nations ranged between 0.3% (Northern Ireland) and 1.2% (England) in 2024.

Study and work have been the main reasons people migrate to the UK since the 1990s. For example, in the year ending June 2025, around 7 in 10 non-EU nationals moving to the UK came to study or work. The next most common reasons are to seek asylum, to join family or for humanitarian reasons (eg through the Ukraine scheme). The significant majority of people arrive legally. A relatively small number of people arrive without authorisation, most commonly via small boat arrivals and often to claim asylum – 95% of people arriving on a small boat since 2018 have claimed asylum. Some people who migrate to the UK legally become unauthorised, for example if they overstay their visa. Data on this are limited and estimates are highly uncertain, but migrants without documentation made up an estimated 1% of the total UK population in 2017.

Overall, 16% of the UK population was born abroad in the 2021 Census. The same year, an estimated 9% of people in the UK had a non-British nationality (not including dual British nationals). The current migrant population is likely slightly higher, given higher net migration since 2021. The OECD finds the UK has a similar foreign-born share of the population as countries like France and the US. While people on family visas account for a small proportion of immigration each year, they are more likely to stay long term, so joining family is the most common reason for migration among the population overall.

To understand the existing evidence, we reviewed recent studies on health service use among migrants in the UK and how this compares to the wider population (see Appendix 1). We searched three databases for quantitative studies comparing migrant and non-migrant use of health services published in English between January 2019 and April 2026.

The search identified 476 papers after removing duplicates. Studies were screened by multiple reviewers and 12 studies met our criteria for inclusion in the review – four focused on migrants’ use of health services at a national level and eight at a regional or local level. We extracted data on scope, approach and findings of each study and developed a database to categorise and compare the data. We use a narrative approach to synthesising the results.

To contextualise this evidence, we also conducted a review of reviews on migrants’ experiences using and accessing health care in the UK. We used the same search strategy and screening approach as the review on migrants’ service use. We included 12 systematic reviews and seven scoping reviews, using standardised tools to critically appraise them.

To examine the contribution of migrants to the NHS workforce and compare this to the wider UK population, we used publicly available data from the NHS, Nursing and Midwifery Council, Home Office and Office for National Statistics (ONS). We drew on existing analysis and government information to summarise the impact of immigration on NHS funding and wider public finances.

To understand public perceptions on the impact of immigration on the NHS, we commissioned Ipsos to poll a representative sample of the public in the UK in December 2025 (see Appendix 2).

We involved migrants in the research. In January 2026, we held a workshop with 14 people with experience of migrating to the UK, recruited through Migrateful and Doctors of the World. We heard their views on public opinion and language on immigration and the NHS, as well as on our approach and early findings. The views of these individuals – mostly refugees and mostly living in London – are not representative of the migrant population in the UK. But their reflections helped inform our interpretation of the evidence and choices about language and framing.

Our study has several limitations. First, the quality of the evidence we reviewed on immigration and the NHS is mixed. Generally, there are good data on international recruitment but significant evidence gaps on people’s use of health services. For example, quantitative studies comparing use by migration status look at number of appointments, not appointment length and patient pathways. We critically appraised studies on use and make clear where evidence is uncertain.

Second, the timeliness of evidence varies. There are recent data on NHS workforce nationality but few recent studies on the fiscal impact of migration and no national studies on health service use using data from 2021 onwards. The UK saw unusually high immigration from 2021 to 2023 (see Background), so this limits how far findings on use apply to the current context. We minimised the time between our literature search and publication to include the latest studies, and make clear when studies cover earlier periods.

Third, health care use and fiscal contributions vary among people who migrate to the UK – as they do among those born in the UK. Evidence on these differences – for example, by visa route and length of time in the UK – is not consistently available. And some areas of the evidence base focus disproportionately on certain groups of migrants. For example, reviews on experiences using and accessing NHS services often look at refugees and asylum seekers. We specify where findings relate to overall migrant population or specific groups.

Finally, we look at the whole of the UK where possible but, in some cases, data are not available. We make clear the country or region to which findings apply. The UK government sets immigration policy for all four UK nations but health care is a devolved matter, so the nations have different NHS policies.

Public perceptions of immigration and the NHS

In general, the public does not see immigration as one of the main causes of pressures facing the NHS. 22% identifies increased demand due to immigration as the main cause of the current pressures on the health service. People are more likely to see lack of funding (37%), poor NHS management (36%), lack of staff (29%) and other factors as drivers.

But views are divided and heavily influenced by voting intention (Figure 1). Immigration is the factor most likely to be mentioned by people intending to vote Reform UK (59%), while those intending to vote Labour (7%), Liberal Democrat (10%) or Green (3%) are much less likely to say this.

Figure 1

Views on the impact of immigration on the NHS are mixed but almost half the public thinks it has a positive impact (43%) (Figure 2). Views vary by voting intention, with Reform UK voters most likely to think the impact is negative (52%), although a substantial minority of them see it as neutral (30%) or positive (16%). Views on how immigration affects the NHS are also linked to both people’s perceptions of how migrants use services and their own NHS usage. For example, people who think migrants use the NHS less are more likely to believe immigration has a positive impact (73%). And people who used the NHS at least six times in the past year were more likely to think immigration has a positive impact (56%).

Figure 2

Public perceptions of how people who migrate to the UK use the NHS are also mixed. 40% of the public thinks migrants use health care services about the same as people born in the UK. Slightly more people think migrants use services more (26%) than think they use them less (20%). Views vary significantly by voting intention, for example Reform UK voters are most likely to think migrants use services more (60%).

When asked to estimate the nationality of NHS staff, around 1 in 3 people (30%) believe non-British nationals make up more than half of the workforce. Most people think the number of migrants coming to the UK to work in the NHS should stay about the same (40%) or increase (28%) in the future. 22% thinks it should decrease.

Using the NHS

Here, we look at evidence on how people who migrate to the UK use NHS services compared to those from the UK, and the factors explaining differences. To do this, we synthesise data from quantitative studies comparing use of services and reviews of evidence on migrants’ experiences using and accessing the NHS (see Box 2). Overall, available evidence suggests migrants use the NHS less on average, likely because of their age and health, but also because they face barriers to accessing care.

Box 2:

We included 31 papers published between 2019 and April 2026.

We included four national, quantitative studies comparing use of health services between migrants and non-migrants. One study is UK-wide and three look at England only. They used data from 2009 to 2020 and their methods varied: one study used an interrupted time series analysis, two studies used multivariate analysis and one study used latent class analysis. They looked at a range of service areas, covering primary care, hospital care, maternity care, dental care, mental health care and sexual health care. Study quality varied. All studies used nationally representative survey data or electronic health record datasets. Limitations included challenges accurately measuring migration status and accounting for differences in health needs between migrant and non-migrant populations.

We included eight local and regional quantitative studies comparing use of services. Three looked at services in London and two in Scotland – the rest used data from Northern Ireland, Nottinghamshire and Bradford. Five used multivariate analysis, two studies used descriptive analysis and one study did not describe its methods in detail. Studies used data from 2011 to 2023. They covered maternity care, vaccination services, mental health care, emergency care and primary care. These studies were often small and the quality varied but was generally lower than the national studies.

We included 12 systematic reviews and seven scoping reviews on experiences using and accessing health care among migrants in the UK. Reviews often focused on specific service areas (eg five reviews focused on maternity care), groups of migrants (eg five reviews focused on the experiences of refugees and asylum seekers and four reviews focused on migrants from specific geographies) and policies (eg two reviews focused on the intersection between immigration policy and health care). Some scoping reviews looked at the evidence on migrants’ experiences of using the UK health system more broadly. The quality of the reviews varied, with most reviews considered low (10) and some high (3), moderate (3) or critically low (3).

Overall comparison of NHS use

Available national studies consistently find lower use of most health services among people who migrate to the UK. Saunders et al analysed UK health survey data from 2013 to 2017, finding people born outside the UK used primary care, hospital, mental health and other services at lower rates than those born in the UK. On average, this study found health care use among people born outside the UK was up to 40% lower in unadjusted findings.

Zhang et al (2022) found migrants in England had a 6% lower rate of primary care consultations than non-migrants from 2015 to early 2020 – the gap widening to 16% during the first year of COVID-19. The two national studies of more specialist services have similar findings: Rhead et al's study suggests lower use of mental health services in England from 2014 to 2015 among employed migrants than among employed white British people; Pathak et al’s analysis finds lower all-cause primary care consultation, emergency contraception and cervical screening rates among migrant women of reproductive age in England between 2009 and 2018. Findings from regional and local studies generally align with this.

There is evidence of variation depending on where people live, their experiences of migration and the type of service. For example, Zhang et al (2022) found migrants in London had higher primary care consultation rates than non-migrants, in contrast to the national picture. Pathak et al found migrant women had higher consultation rates for some sexual health care, such as management of fertility problems, despite using overall services less. Saunders et al found no statistically significant difference in use of inpatient maternity care based on country of birth, despite people born outside the UK using other health services less. For most services, this study also found no differences between migrants born in the EU and migrants born outside the EU, but the latter used primary care slightly more than the former and vice versa for physiotherapy. Smaller, regional studies also suggest variation. For example, a cross-sectional study of maternity and mental health services for perinatal women in South London from 2018 to 2023 found migrant women with no recourse to public funds were particularly likely to have inadequate contact with services.

Factors affecting NHS use

Lower overall use of the NHS by people who migrate to the UK is partly explained by their generally being younger and healthier than people born in the UK. After adjusting for differences in age and self-reported health, Saunders et al found differences in use by country of birth were no longer observed for most services – only dental care use remained lower among migrants. Zhang et al (2022) found migrants older than 50 years had slightly higher primary care consultation rates than people born in the UK of the same age. Saunders et al found migrants’ use of health services tended to converge with that of the UK-born population over time, potentially reflecting greater familiarity with the NHS or lower access to preventative care. This effect was strongest for primary care: migrants’ use of these services reached the levels of non-migrants after 10 years living in the UK, and was higher after 25 years.

Available evidence on people’s experiences using and accessing NHS care also identifies other factors that might explain lower health care use among people who migrate to the UK. For example, a systematic scoping review on Eastern European migrants’ use of UK health services described that some return to Eastern Europe when they need care. A scoping review on use of transnational care by Central and Eastern European migrants in the UK identified the main factors explaining this as their cultural expectations of medical services, distrust of health care in the UK, transnational ties and barriers to access in the UK.

There is significant evidence that people who migrate to the UK face barriers to accessing the NHS, likely affecting use. Nearly all reviews identify problems with limited understanding and awareness of NHS services and language barriers, often compounded by a lack of suitable translation services. For example, in a systematic review of asylum-seeking women's experiences of maternity care, all six studies reported communication challenges. Nearly all reviews also identify the NHS charging system for migrants as a barrier to accessing care. For example, a systematic review of migrant women’s experiences of maternity care found costs deterred those not entitled to free services from accessing antenatal care. Charges can be a barrier even when people are entitled to free care. For example, an evidence synthesis on experiences of refugees, asylum seekers and undocumented migrants accessing primary care found lack of awareness that it is free for everyone in the UK.

While the overall migrant population in the UK is healthier than the wider population on average, some groups may have additional health needs and problems accessing care. For example, most evidence reviews of asylum seekers’ and refugees’ experiences of UK health care report this group are at high risk of mental health problems. All reviews find asylum seekers and refugees face barriers to accessing care, for example one study cited additional barriers due to the ‘vulnerability’ of their status. Women born outside the UK are more likely to give birth than UK-born women but all reviews of migrant women’s maternity care experiences find issues with access.

Finally, reviews commonly identify that people who migrate to the UK suffer discrimination and stereotyping when accessing health services. For example, a systematic review of access to maternity care for immigrant women finds direct and overt discrimination was reported in 12 studies, including not meeting cultural and religious needs regarding breastfeeding.

Funding the NHS

Here, we look at the evidence on the impact of immigration on NHS finances. People who migrate to the UK contribute to NHS funding through both taxes and additional charges for NHS access. Available estimates generally suggest they pay more in taxes and visa charges than the cost of providing public services and benefits to them in the short to medium term. Individuals’ fiscal impact depends significantly on their migration route and how long they stay in the UK.

Direct contributions to the NHS

The NHS is largely funded through general taxation and national insurance. Anyone living in the UK, including people from other countries, pays taxes on shopping and services, such as VAT, and is liable to pay national insurance contributions and taxes on income, company profits and assets. Looking at contributions through income tax and national insurance, for example, forthcoming Nuffield Trust analysis finds migrants contribute substantially to the NHS annually through their salaries.

On top of general taxation, many who migrate to the UK pay charges for using the NHS. The 2014 Immigration Act introduced two charges for NHS access: the Immigration Health Surcharge for those ‘not ordinarily resident’ and secondary care charges for ‘overseas visitors’. The latter apply only to a small group of the migrant population (see Box 3). The surcharge is paid on top of other visa fees by most people coming to work, study or join family in the UK for more than 6 months – but not those staying permanently. Some are exempt, including people on heath and care worker visas, asylum seekers and diplomats.

Currently set at £1,035 per year for most visas, the Immigration Health Surcharge has increased from £200 in 2015. The UK government raised over £2.6bn in gross surcharge revenue in 2024/25 – approximately 1.1% of total health spend. Government documents state the surcharge is calculated based on average health care use by surcharge payers but there are limitations with the methodology, including that it uses proxy measures of people’s use of services. Forthcoming Nuffield Trust analysis suggests it may overestimate costs of surcharge payers’ health care. It does not account for the other contributions that surcharge payers make towards the NHS through general taxation and national insurance.

Box 3:

‘Overseas visitors’ refers to people not ordinarily resident in the UK – generally, those visiting for 6 months or less, or undocumented migrants. This group is subject to upfront charges for using most NHS secondary care services and some community services, set at 150% of the national NHS tariff for treatment. Charging is based on a patient’s immigration status at the time they receive care. Some groups are exempt, such as victims of modern slavery, as are some services, such as A&E services and treatment for COVID-19. Reciprocal health care agreements between the UK and some countries also cover some costs for visitors.

Generally, patients must pay in advance of treatment unless a clinician determines care to be ‘urgent or immediately necessary’, which can result in patient debt. NHS providers must report patients owing over £500 for 2 months to the Home Office, which may affect any future immigration applications.

There are limited data on the financial impact of charging overseas visitors but available information suggests it is small. Policy Exchange analysis of FOI returns from some NHS providers in England suggests they invoiced an estimated £380m to overseas visitors between 2021 and 2024 – approximately 0.1% of NHS provider sector total operating income over this period. There are costs involved in implementing the policy, for example employing overseas visitor teams to identify ‘chargeable’ patients and debt collection agencies to pursue patient debts.

Evidence suggests the charges have a negative impact on health and inequalities in access, which can deter people from seeking care due to fears about costs, deportation or future visa applications. The policy is complex and there are reported inconsistencies in its implementation, including cases of incorrect charging or denial of care.

Overall impact on public finances

Estimates of the overall impact of immigration on funding for UK public services vary, but studies generally conclude that, on average, people who migrate to the UK make a small, net positive contribution – paying more in taxes and visa charges than the cost of providing the services and benefits. Pre-Brexit analysis of the short-term impact of migration, by Oxford Economics and by Dustmann and Frattini, both concluded that the average person from the European Economic Area (EEA) made a net positive contribution to UK public finances; people from outside the EEA made a net negative contribution; and people born in the UK made a small net negative contribution.

People’s contributions vary significantly, including depending on their migration route. For example, most people seeking asylum do not have the right to work so contribute less in taxes. People on worker visas have higher employment rates and wages than the average person in the UK and generally arrive in early adulthood, with high potential tax contributions but avoiding the costs of childhood to the UK state.

The Migration Advisory Committee (MAC) recently explored the fiscal impact of people on skilled worker visas and their dependants, compared with that of all UK residents (including people born in the UK, people on visas and migrants with settled status). Excluding visitors, the skilled worker visa was the second most common visa type granted in 2022. The MAC estimated the average person on a skilled worker visa – including those on health and care visas – made a net positive fiscal contribution in 2022/23 (£21,800), compared with a small net positive contribution for the average UK resident adult (£3,400). On average, adult dependants of those holding skilled worker visas made a small net positive fiscal contribution (£2,000). The analysis estimated net fiscal deficits for both the average skilled worker visa holder’s child (-£12,800) and the average UK child (-£14,900). MAC analysis of the ‘partner visa’ for international partners of British citizens and settled residents estimated a small net fiscal deficit (-£30) for each applicant in 2022/23, due to lower tax receipts.

Changes over time

Many people who migrate to the UK, including those on work and study visas, do not initially have access to the welfare state. Over time, some people on visas will leave the UK while others remain and may attain settled status or citizenship. This affects the long-term fiscal impact of immigration as people with settled status no longer pay visa costs, gain access to the welfare state and may rely on state-funded services more as they age.

Differences in earnings among different groups of migrants have significant implications. For example, on average, the MAC estimates a substantial net positive lifetime contribution (£689,000) for someone who arrived on a skilled worker visa (excluding health and care visas), but a large net deficit for someone on a partner visa (-£109,000), compared with a smaller net deficit (-£39,000) for the average UK resident.

Working in the NHS

Here, we look at the contribution of immigration to the health care workforce, looking at staff nationality, where they train and where they are born. Overall, the evidence shows migrants contribute disproportionately to the NHS workforce. While policy on international recruitment often changes, migrant workers have long contributed to the health service. But internationally recruited staff may have poorer experiences and there are concerns about the implications of international recruitment for global health workforce shortages.

Overall share of the NHS workforce

Migrant workers are more likely to work in the NHS and social care than workers from the UK. Migration Observatory analysis of people’s nationality on entering the UK labour market shows 19% of jobs held by employees with non-UK nationalities in 2024 were in health and care, compared with 14% of jobs held by UK nationals (Figure 3).

Overall, employees with non-UK nationalities held a quarter of all health and care jobs in the UK. Similarly, latest NHS data show 22% of staff in England report a non-British nationality. The most recent analysis based on country of birth suggests migrants contribute disproportionately to the NHS workforce, finding that people born abroad made up 14% of the overall UK population in 2018, but 19% of the UK health and care workforce (23% of hospital workers). The UK draws on international recruitment more than other similar countries: for example, 38% of UK doctors in 2023 were ‘foreign trained’, compared with 20% for all OECD countries.

Figure 3

Reliance on international recruitment varies across the NHS, including depending on role and location. For example, 36% of doctors in hospital and community health services in England report a non-UK nationality, compared with just 7% of ambulance staff. Non-UK nationals hold a significantly lower proportion of health and care jobs in Scotland, Wales and Northern Ireland than in England. And London has the highest proportion of migrant workers in the NHS of all regions in England: 32% of NHS staff in London reported a non-UK nationality in 2025, compared with 13% in the North East and Yorkshire.

Changes in recruitment over time

The NHS has recruited staff internationally since its creation but recruitment has changed over time, including recent shifts since Brexit and the pandemic. From 2020 to 2024, the proportion of staff joining the NHS in England with a non-UK nationality increased from a fifth (21%) to a third (32%) (Figure 4). This was driven by recruitment from outside the EU. As a result, the proportion of NHS staff in England with a non-EU nationality rose from 14% in 2020 to 26% in 2025. A series of national policy commitments and changes contributed to this, including a pledge to increase international recruitment in the 2019 Interim NHS People Plan and the introduction of a new health and care worker visa in 2020, with lower fees and faster visa processes. From late 2019 to early 2024, an NHS England programme provided grants and guidance to NHS trusts to recruit nurses internationally to meet a key government target to increase nurses by 50,000 in England. The evaluation found the NHS recruited 87,000 internationally educated nurses during the programme.

Figure 4

More recently, governments have signalled a shift in approach to NHS recruitment, with both the 2023 workforce plan and 2025 10-Year Health Plan committing to reduce international recruitment. The nursing international recruitment programme and investment ended in 2024. From 2023 to 2025, the number of nursing visas granted decreased by 92% (Figure 5).

Figure 5

While NHS workforce policy has a significant bearing on international recruitment, some NHS staff from outside the UK initially moved for other reasons (for example people on spousal visas or with refugee status). Some people from outside the UK are not allowed to work in the NHS due to visa restrictions. For example, asylum seekers are only allowed to work from 12 months after submitting their asylum claim and only in certain jobs – since March 2026, this has included some health care occupations such as nurses, doctors and pharmacists. This is distinct from countries such as Canada and Sweden, where most asylum seekers have the right to work.

Wider implications of international recruitment

Migrant workers not only make up a significant share of the workforce but also bring wider benefits to the UK health care system. Leaver rates are lower among staff with a non-UK nationality, likely at least in part since those on a health and care worker visa must apply to update it to change employers. The NHS staff survey finds internationally recruited staff are more likely to both work full time and work over their contracted hours. For example, 60% reported working additional paid hours in 2025, compared with 29% of those recruited in the UK. And some evidence suggests some internationally recruited staff may be overqualified for the roles they are in, for example if previous qualifications are not fully recognised, meaning they could bring additional skills. More broadly, an umbrella review found greater health care workforce diversity is associated with better care quality.

Internationally recruited staff may have poorer experiences. The NHS staff survey finds they are more likely to experience discrimination, harassment and violence. For example, 27% reported discrimination from patients and other members of the public in 2025, compared with 8% of other staff.

There are wider system concerns about international recruitment in the NHS. While it helps address workforce shortages, it may affect opportunities for staff recruited in the UK when NHS funding is constrained. In particular, there are concerns about competition for medical specialty training posts. International recruitment also impacts global health care workforce shortages. UK nurses increasingly come from ‘red list’ countries, with high workforce shortages themselves.

Discussion and implications

Debates about immigration in the UK often focus on its impact on the NHS, particularly on performance and pressures. To inform this debate, we reviewed existing research and analysed publicly available data to assess the relationship between immigration and the NHS. Overall, available evidence suggests people who migrate to the UK are more likely to work in the NHS and less likely to use health services than people born in the UK, and likely contribute significantly to NHS funding. There are important limitations (Box 1) and evidence gaps – including a lack of national studies looking at service use by migration status since post-Brexit immigration changes in 2021.

Impact on the NHS varies depending on who migrates, their age, health and employment, and the balance of contributions and use varies, as it does for everyone in the UK. The overall positive contribution of immigration to the NHS is largely driven by people generally migrating to the UK as working-age adults – meaning they likely contribute more taxes while having lower health care needs – as well as the NHS’s longstanding reliance on international recruitment. The impact also likely changes depending how long someone stays in the UK. Use of health services tends to increase and converge with that of the UK-born population the longer someone lives in the UK, while long-term fiscal impact varies significantly depending on earnings. Most migrants do not settle long term – around 70% of people arriving in the UK between 2005 and 2014 were expected to have left by 2024 – but settlement rates differ depending on migration route.

Our research reflects how politicians and the media often frame this topic, looking relatively narrowly at the relationship between migration and the NHS. This risks reducing the role of people who migrate to the UK to a simple balance of costs and contributions, and sits uneasily with the principle of a universal health care system based on need not ability to pay. It also overlooks impacts of migration on other public services and society, and people’s experiences living and working in the UK.

Growing restrictions on care worker visas illustrate the complexities and trade-offs. Care workers are low paid and exempt from the Immigration Health Surcharge (IHS), so generally pay less towards the NHS than other migrant workers. But reducing their international recruitment affects social care supply, with potential knock-on effects for NHS services. And policies banning family from joining care workers and proposing longer qualifying periods for settlement for these roles impact people’s wellbeing and rights.

Three key implications for policymakers

Political debate does not reflect the evidence and risks fuelling misconceptions

Political and media narratives that link immigration to pressures on the NHS are not supported by the evidence. This is in line with previous research showing that media and political debate on immigration is often misleading, focusing on headline numbers without context, overemphasising particular types of migration and not reflecting people’s different experiences. Our polling suggests many people overestimate migrants’ use of services and their share of the workforce. Broader evidence also finds gaps in public understanding of immigration. For example, in 2025, only 14% of the public correctly identified that net migration fell between 2023 and 2024, while over half believed it had increased.

Policymakers have an important role in supporting evidence-informed debate. Our polling shows people with a more accurate understanding of migrants’ use of services, and those with more experience of using the NHS themselves, are more likely to see immigration as having a positive impact. False narratives also risk driving policy decisions that restrict migration in ways that could exacerbate NHS workforce shortages and place further strain on health services. Pressures on the NHS are very real but the evidence suggests they are largely driven by factors such as an ageing population, rising prevalence of complex and chronic conditions, longstanding workforce gaps and constrained funding. Policymakers should focus on addressing these challenges.

Policy on international recruitment is short term and erratic

The NHS has long relied on internationally recruited workers but this has often followed a cyclical pattern: increasing recruitment from other countries to tackle workforce shortages, then looking to reduce reliance when political priorities shift. The previous government relied heavily on migrant workers following Brexit and the pandemic to meet targets to expand the NHS workforce, when public attitudes towards migration were more positive. Now, the workforce policy approach has reversed, with the government setting a target to reduce the proportion of new NHS recruits from non-UK backgrounds from around a third to 10% by 2035.

There are valid concerns about the ethics of international recruitment when NHS trusts recruit heavily from countries facing their own workforce shortages. We find evidence that NHS staff recruited internationally may have poorer experiences, suggesting a need for better support. But there are also risks in sharply reducing international recruitment. The NHS faces substantial and persistent workforce shortages, and most of the public tends to think levels of international recruitment should stay the same in the future. The latest arbitrary target risks worsening staff shortages and is highly ambitious: for example, in nursing, the proportion of new registrants trained outside the UK has not fallen to this level since 1990. Plans to phase out the care worker visa route by 2028 also risk exacerbating capacity problems in the health and care system.

In the forthcoming NHS workforce plan, government must take a fairer, longer term approach to workforce planning, expanding domestic training and improving retention, while recognising that the UK is likely to continue to rely on international recruitment. The All-Party Parliamentary Group on Global Health and Security recently recommended a shift in approach based on co-investment with source countries.

Current policy on NHS charging contributes to inequalities

We find strong evidence that people who migrate to the UK face additional challenges accessing NHS care compared with others, particularly because of language barriers. Studies also show people’s use of services tend to increase the longer they spend in the UK and eventually converges with – and may exceed – that of the UK-born population. This underlines the importance of ensuring access to preventative care for everyone in the UK to avoid poorer health in the long term.

The NHS charging system contributes to inequalities in access. Our research suggests upfront charges for short-term ‘visitors’ and undocumented migrants deter people from seeking the care they need, even for people who are not liable to pay these charges. This also risks greater health care needs in the long term. Studies often describe fear and distrust of the UK health care system, which has become a site of immigration control as a result.

The IHS on visas partly explains why migrants likely have a positive fiscal impact. But, while the stated aim of the surcharge is to reflect average health care use by payers, the level of the charge may be based on an overestimate of their NHS use and it does not account for the other contributions towards the NHS. Those who pay the IHS contribute taxes like everyone in the UK, so effectively pay twice for the NHS. And the UK charges more for visas than other similar countries.

Ultimately, immigration policy is determined by political choices extending beyond the NHS that often involve complex trade-offs. Governments in the UK and other countries use immigration policy to pursue a range of objectives, such as boosting economic growth, maintaining public services and protecting people during international conflicts. These could each point to different approaches and the priority afforded to them changes over time. But when it comes to the NHS, our findings suggest policies and political narratives focused on reducing immigration risk unintended consequences. Ensuring policy decisions are informed by the available evidence is critical to the future sustainability of the NHS.

Acknowledgements

We would like to thank Hero Ahmed, Amro Amin, Tagwa Hamed, Maral Nuriyeva and others who wish to remain anonymous who participated in a workshop to shape the work, supported by Migrateful and Doctors of the World. We are also grateful to Ben Brindle, Jim Buchan, Catrin Evans, Nuni Jorgensen and Yingxi Zhao whose insights and reviews have improved this research, as well as colleagues from the Health Foundation for their contributions, in particular Yi Mu, Rhiannon Barker, Illizane Pinfold, Alyssa Ordu and Sean Agass. Errors or omissions remain the responsibility of the authors alone.

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