For decades, the public sector has relied on immigrant workers. Now, it faces collapse
Story by Ben Butcher, The Telegraph, 3/28/26
Immigration is falling quickly. Having reached a peak of almost one million in 2023, net migration has now plummeted to 204,000 in the latest annual figures. This decline is expected to continue as a growing number of “tough-on-immigration” policies kick in.
Politically, at least, this decline had to happen; the rise of Reform having sent shockwaves through the establishment. But a sustained reversal will also highlight the follies of almost three decades of government policy. For years, mass migration has been the “sticking plaster” for dire recruitment and retention in the public sector – a tactic which started with Tony Blair and continued right up to the “Boriswave” a quarter of a century later.
The result is a public-sector workforce – from doctors to teachers to HMRC call handlers – hugely reliant on foreign labour, and which now must either be wholly rethought in a low-immigration environment or face collapse.
To see just how dramatic this situation is, The Telegraph has carried out a sector-by-sector audit of state services and their reliance on immigrant workers, highlighting the severity of this crisis, and revealing just how difficult it will be to fix.
Migrants as a proportion of workforce
No part of the public sector epitomises the scale of the problem more starkly than the NHS. Today, one in five NHS workers in England – some 325,039 employees – is a foreign national. This increases to 36 per cent of all doctors and 30 per cent of nurses.
There is no shortage of voices stating the existential role migrants play in the system. The British Medical Association, which represents doctors, has said the NHS “would not survive without the contribution of overseas healthcare workers”. The Royal College of Nursing has stated health services “would cease to function without migrant nursing staff”.
Even the former prime minister, Boris Johnson, in the aftermath of his hospitalisation with Covid in 2020, acknowledged he had been “a personal beneficiary of carers who have come from abroad and, frankly, saved my life”.
Since its foundation, the NHS has always had some level of reliance on foreign workers, in particular from the Commonwealth. As early as 1991, when just 7.3 per cent of overall staff were born outside the UK, more than 20 per cent of doctors had received licences outside the country.
However, Blair’s NHS workforce revolution saw the proportion soar. During that Labour government, the overall number of doctors increased by 37,000, but it was impossible to reach this total using just UK-trained medics.
“We knew that we did not have enough input of nurses and doctors [from the UK] to deliver the capacity that was required to achieve the main objectives of improving access,” Andrew Foster, then director of workforce at the Department of Health, told a select committee at the time. “Thus we set up the international recruitment programme.”
Campaigns to recruit from abroad were stepped up, with thousands of nurses and doctors from the Philippines, India and Australia heeding the call. While “poaching” of medical staff from developing countries was technically banned after an intervention by Nelson Mandela, loopholes were often found in the drive to meet targets.
The result was that, under New Labour, the proportion of foreign-trained doctors rose by 73 per cent. Overseas nurses registering with the Nursing and Midwifery Council also grew – from 5,000 in 2000 to 12,000 just five years later.
Even during the “austerity” introduced by the Coalition government, the numbers of foreign NHS workers increased, though at a far slower rate. But such restraint came to an abrupt halt in 2020, when the NHS funding taps were turned on again and more than 100,000 vacancies, which had accrued over the years, were filled at pace as part of the Boris Johnson government’s response to the Covid pandemic.
Key to doing so was the Health and Care Worker visa, which was designed to make it “quicker, cheaper and easier for the best and brightest health and care professionals from around the globe to work in our brilliant NHS”. In just five years, from 2020 to 2024, the proportion of foreign-national nurses jumped from 18 per cent of the workforce to 30 per cent. Doctors soared from 28 per cent to 35 per cent.
More than 70,980 nurses arrived during this “Boriswave”, including 33,046 from India alone. A further 24,965 doctors came from Pakistan, India, Nigeria and Egypt. Once everyone, from radiographers to therapists, was totted up, the total number of visas granted in the period actually hit 114,000.
As quickly as the door was opened, however, it was shut once again by Boris Johnson’s successor Rishi Sunak, as fury over the true extent of post-Covid immigration was revealed.
In just two years, the number of Health and Care Worker visas given to doctors and nurses fell by 74 per cent, as key voices, from Baroness Harding of Winscombe, the former head of NHS Improvement, to shadow health secretary Wes Streeting, called for an end to the over-reliance on foreign workers.
Doing so, however, will be a long, expensive battle.
While the number of foreign doctors in the NHS doubled in the 15 years after 2010, the number of places available to study medicine in this country increased by just 29 per cent over the same period. Those who do manage to get on to an undergraduate course then discover, after graduating and completing their first two “foundation” years, that there is also a shortage of places for the next step – specialist training.
The reason for the lack of places is clear: training doctors in this country is extremely costly – around £175,000, according to one estimate. And keeping those doctors in the UK is even more expensive. Junior-doctor strikes over pay have been ever-present since the pandemic, but not even a 29 per cent pay rise over three years has halted the exodus of younger doctors to the better paid, easier-going healthcare systems of Australia and New Zealand, which are now giving the NHS a dose of its own staffing medicine by actively targeting British doctors.
A similar story emerges for nurses and technical staff, who are also experiencing a shortage of education and training posts, financial pressures and the lure of overseas work.
In every case, the Government says they have plans in place – notably through the NHS Long Term Workforce Plan, a 15-year strategy launched under the Tories in 2023 – to address staffing shortages. Its three pillars are: “Train”, “Retain” and “Reform”. Targets (doubling medical-school places by 2031, for example) are ambitious, but the plan says the cost of failure will be dramatic – a staff shortage of 360,000 by 2037.
Yet even that dramatic figure, calculated in 2023, is out of date. Immigration levels are now far lower and so the reality of weaning the NHS off foreign workers is likely to be more painful still.
Long under-funded in comparison to the NHS, social care has for years faced what official observers concede are “chronic difficulties” in the recruitment and retention of its workforce. While the vast majority of social care is, technically, privately run, local authorities are obliged to offer care for adults and elderly people in urgent need – a situation constantly exacerbated by a rapidly ageing population.
Unlike jobs in the NHS, much of the work in the social care sector has, historically, been considered “low skilled”, making the hiring of global talent tricky. To remedy this, the government added the job of “senior care worker” to the UK’s Shortage Occupation List in the 2000s. Together with the EU’s expansion into a cluster of Eastern European countries, this paved the way for an increase in the proportion of foreign-born care workers coming to the UK, from 10 per cent to almost 20 per cent between 2004 and 2010.
Then, as care homes faced growing restrictions from hiring outside the EU throughout the 2010s, thousands of Romanians, Poles and Hungarians joined the workforce.
Brexit presented a major challenge to a sector which was, by then, reliant on migrants for one in five of its workers. A report by the charity Independent Age said the sector effectively had two choices: make the sector more attractive to British workers, or continue to rely on foreign workers and change the rules to allow them to come.
The latter solution won out. Little was done to improve the sector’s working conditions throughout the 2010s. Pay only increased with the minimum wage, a real-terms cut in many cases, and, each year, the turnover rate was upwards of 30 per cent for independent providers, according to Skills for Care, the workforce regulator. The pandemic, and its catastrophic impact on care homes, only reinforced the often brutal realities of working in the sector.
(Zack Polanski, the Green Party leader and advocate for open-door immigration, spelt out the policy in cruder terms on a recent appearance on BBC One’s Question Time: “One in five care workers are foreign nationals. Now I don’t know about you, but I don’t particularly want to wipe someone’s bum and I’m very grateful to the people who do this work.”)
So, during the pandemic, the floodgates were opened. Between 2021 and 2024, almost 150,000 migrants – predominantly from India, Nigeria and Zimbabwe – were given care-worker visas as part of the “Boriswave”. The vast majority were able to bring family and dependants with them.
In just four years, the proportion of foreign-born carers in the workforce went from 16 per cent to 31 per cent. Then, just as suddenly as they had been opened, the floodgates were closed. Care-worker visas across the sector fell from 118,214 in 2023 to just 3,512 in 2025.
Still, the broader impact of this policy is likely to be felt for years. The Office for Budget Responsibility estimates that low-paid migrant workers can represent a net cost of £150,000 to the UK taxpayer by the time they reach state pension age. And so, the care-home workers, and their dependants, who arrived during the Boriswave alone represent a long-term cost of billions.
Nor has a long-term solution for replacing foreign-born workers been found. Minimum wage increases mean that average pay remains at just £23,400 for independent-sector workers.
In the next decade, an additional 360,000 workers will be needed, according to Skills for Care. It, too, has produced a long-term staffing strategy – which, amongst other things, aims to address astonishingly high turnover rates.
For the moment, Care England, the care home body, has likened the end of mass immigration to “pulling up the drawbridge” just as the sector was stabilising after a history of labour shortfalls. “International recruitment wasn’t a silver bullet, but it was a lifeline. Taking it away now, with no warning, no funding, and no alternative is not just short-sighted – it’s cruel,” it added.
Schools across England have plugged gaps with overseas recruitment ever since the 1950s, when a bulge of post-war baby boomers entered education. The same tactic has been employed in subsequent decades to fill perpetual “teacher shortages”.
Blair’s commitment to “education, education, education” came with money and the promise, similar to the one made to the NHS, to significantly increase numbers in the workforce. Between 1997 and 2010, teacher numbers duly rose from 400,000 to 448,000.
But as far as hiring was concerned, it was a familiar story: overseas recruitment drives filled the need, so much so that the Jamaican education secretary complained about “aggressive” British tactics, claiming hundreds of teachers had been poached by the UK in one year alone.
The British government was unfazed. “I suspect we will always recruit from abroad, and as long as they have the skills to do the job I have no problem with that,” said the education secretary Estelle Morris.
In the 2010s, recruitment concerns became specific to Stem subjects (science, technology, engineering and mathematics), driven in part by Michael Gove’s reforms to education which pushed more pupils into the subjects. In 2017, it was recommended that physics and maths teachers were added to the Shortage Occupation List.
Neither the Department for Education nor local authorities produce reliable figures on foreign-born teachers, but available estimates suggest an uptick. Since the Brexit vote, overall teacher numbers have increased by 1.9 per cent, but foreign nationals in the sector have jumped by 20.4 per cent.
Across the board, 5.7 per cent of teachers were foreign nationals in 2024/25, compared to 4.9 per cent in 2015/16, according to figures released to the teachers’ pay board. Yet this seemingly small increase hides hidden pressures. The proportion of foreign secondary school teachers jumped from 6.5 per cent to 8 per cent. For maths teachers, it went from 9 per cent to 12 per cent and, in physics, from 7 per cent to 10 per cent.
Even as debates over immigration ramped up after the pandemic, the government doubled down on efforts to recruit from overseas. “I want this country to be the most attractive place in the world to be a teacher,” Conservative schools minister Robin Walker said in 2022. This ultimately included removing the need to re-qualify in the profession for a number of migrants, including from Ghana, India, Jamaica and Nigeria.
The reasons are clear: last year, the Government hit 99 per cent of its teacher-training target. Without foreign trainees though, it would have fallen to just 85 per cent. In physics, it would have filled just 31 per cent of desired places.
At British universities, long a bastion of international exchange, the rate of increase in foreign staff has been quicker. One in four lecturers, academic and support staff has non-British nationality, up from one in five a decade ago.
Unlike many other public sector roles, this is less a case of filling gaps and more an active ambition. “Our position as a global leader in science and innovation has relied on an immigration system that facilitates and supports researchers and technicians coming to the UK,” a report from Universities UK noted in 2022.
New proposals which increase the required salary threshold for work visas, lengthen the waiting time for settled status and ramp up costs of applying and living in the UK, put this at risk, the sector says. For a country determined to become a “science and technology superpower”, the decision was viewed as “counterproductive” at best.
But whether the immigration crackdown was counterproductive or not, its effect was undeniable: in 2023, 2,729 individuals applied for teaching professional visas. In 2025, this was just 794.
With numbers of foreign students – the cash cows for many universities – also plummeting, higher education is being rapidly reshaped by immigration policy alone. As a result of this, if nothing else, our three-decade experiment of “university for all” may be over.
The UK’s security forces are, for obvious reasons, far stricter about recruitment from overseas than the rest of the public sector. However, a recent string of stories from Britain’s three prison services have proved they are not immune from a reliance on overseas workers.
In December, the Ministry of Justice successfully lobbied for prison officers currently working in the country to be exempt from the increasingly stringent visa rules which had brought the “Boriswave” to a grinding halt. “There are a huge number of West African prison officers, on which many prisons are reliant, who are in danger of having their visas revoked because of changes in the policy of the Home Office,” Charles Taylor, HM Inspector of Prisons, told BBC Radio 4 last year.
The Ministry of Justice did not supply figures on what proportion of the workforce are from abroad when asked via a Freedom of Information request, but recruitment figures released in a parliamentary question give some idea.
In 2024, 22 per cent of new recruits into prisons were foreign, including 769 – or 12 per cent – from Nigeria alone. The reason for the exemption explains part of the recruitment crisis facing prisons: the increased salary threshold for new visas (£41,700) was higher than pay for guards (£33,400).
Police officers face far stricter working criteria than their counterparts in prisons. Applicants must have lived in the UK for three years with settled status, unless they are from the Commonwealth. Prior to 2003, only Commonwealth citizens could apply.
These strict residency restrictions mean hiring overseas nationals has been near-impossible. But a Freedom of Information request to police forces in England and Wales shows a small uptick in recent years. Across 16 forces, the proportion of non-British officers has doubled from 1 per cent to 2 per cent. The proportion among back-office police staff has increased from 1.8 per cent to 2.5 per cent.
Similar nationality restrictions are in place for the Armed Forces; Commonwealth citizens may apply for a limited number of places each year. Figures show they have been doing so at an increasing rate, all part of another sticking-plaster policy to boost recruitment in a sector failing to attract British nationals.
In 2018, the UK removed residency requirements, which previously meant recruits needed to have lived in the UK for at least five years before signing up. Nationals from India, Kenya, Canada, Australia and Fiji could join the Army without ever having set foot in the country.
The impact is clear. While the number of full-time regulars born in the UK has fallen by 5.7 per cent since 2020, figures from the Ministry of Defence show an increase in non-UK nationals of 25 per cent.
The 8,310 non-UK citizens in the Armed Forces, excluding Gurkhas, now represent 6.1 per cent of troops – up from 4.3 per cent in 2020 and the highest proportion in recent history.
With 2,000 more soldiers having left than joined the forces in 2024, and at a time where criticism is growing about the country’s lack of war readiness, foreign fighters are filling the gap.
Beyond these police officers, teachers, soldiers, doctors and nurses is an army of 1.3 million public administrators, controlling everything from parking fines to welfare checks.
Figures from the Office for National Statistics show that open borders have driven even these roles – the machinery of British bureaucracy – into a state of increasing dependency on foreign workers.
Since 2015, the estimated number of foreign employees working in “public administration, social security and defence” has jumped by 78 per cent. The proportion of UK nationals has fallen by 4.7 per cent.
That means that 6.7 per cent of workers across local councils, regulators and job centres are non-British citizens.
The HMRC, with its thousands of call handlers and tax specialists, is a good example.
A Freedom of Information request shows that, since the pandemic, the number of foreign nationals employed by the tax authority has tripled; the number of Nigerians alone has increased from 151 to 1,533 in just six years.
HMRC stated their recruitment was done “through fair and open competition”, with the priority on ensuring they have “the right skills and expertise to deliver value-for-money for taxpayers”. Last year, MPs found that, in 2024, nearly 44,000 customers were cut off after being on hold to HMRC for more than an hour, up more than 600 per cent on numbers of just two years earlier.
What the solution would look like
The pattern with all of these roles, from HMRC call handlers to NHS consultants, is the same: desperate short-term solutions to urgent recruitment needs.
However, the longer-term answers – from better wages to increased training – have not been put in place in the meantime, either because the state was too skint or short-sighted, or more likely, a mixture of both.
The result is a public sector with very few answers to the question of what happens when the sticking plaster of immigration is ripped off. In the coming months and years, we will undoubtedly find out – either through dire economic consequences or a return to a policy of lax migration that has helped ministers defer difficult decisions for decades.
Meanwhile, the unemployment rate is creeping up, hitting 5.2 per cent in February, the highest since the pandemic. Among young adults, 12.8 per cent of 16 to 24-year-olds are not in education, employment or training. Almost 2.8 million adults are out of work due to long-term illness – a figure which has jumped by half a million in just five years.
A fix will need a carrot and a stick approach. Tougher approaches to work and welfare, well beyond the watered-down proposals killed by Labour backbenchers last year. It is glaringly obvious, with growth having flatlined, that adding billions to the welfare bill each year is unaffordable.
The carrot should be affordable skills training, from policing to care work, for those who are willing to give work a go. However, this is unlikely to offer a solution across the board. Training a doctor takes the best part of a decade, nursing: three years. The narrative from all major national parties, bar the Greens, is that immigration must go down.
A Government spokesperson said: “Under this Government, net migration is down nearly 70 per cent. We are ending reliance on overseas labour and promoting jobs for British workers to boost economic growth. We recruit on merit through fair and open competition.
“Our priority remains ensuring we have the right skills and expertise to deliver value for money for the taxpayer.”
But with long-term solutions still years from fruition – if in place at all – the truth is that it will prove impossible to stick to the low levels of migration wanted by many voters while maintaining a public sector utterly addicted to foreign workers.