Dido Harding: Make NHS less reliant on foreigners

Baroness Harding of Winscombe has vowed to end England’s reliance on foreign doctors and nurses if she becomes the next head of the NHS.

Harding, the former head of Test and Trace, formally applied last week to succeed Sir Simon Stevens to lead the health service.

The successful applicant will become chief executive of Europe’s biggest employer, with a budget of more than £150 billion. They will be responsible for clearing the list of people awaiting treatment and surgery, which stands at about five million.

Her candidacy is controversial. The Conservative peer has chaired NHS Improvement since 2017 and is close to ministers, but her testing programme was condemned as ineffective and a waste of billions of pounds.

Harding, 53, would challenge the “prevailing orthodoxy” in government that it is better to import medical professionals from overseas and benefit from the investment of other countries because of the huge cost of training a doctor. According to the House of Commons Library, 170,000 out of 1.3 million NHS staff say their nationality is not British, amounting to almost 14 per cent of the workforce.

She is expected to argue that she would be the ultimate “insider- outsider” at the NHS, having spent decades in the private sector, including seven years as chief executive of the telecoms company TalkTalk.

Harding will tell the NHS board that she would resign from the Conservative Party if she won the role and take an indefinite leave of absence from the House of Lords, two steps she has so far resisted.

She will also argue that her divisive public reputation reflects neither her record nor her personality. She has long insisted that Test and Trace was never supposed to be a “silver bullet”, but defended her record of building a system that has carried out more tests than any other in Europe.

Harding will present herself as a change candidate and say the NHS cannot afford to return to its pre-pandemic state, while sticking to the core strategy of Stevens’s ten-year plan, published in 2019.

Matt Hancock, an ally of Harding, has a veto on the appointment by the board.

Friends say that as well as her private sector nous, Harding, whose husband is John Penrose, the prime minister’s anti-corruption champion, has the clout with ministers to raise funds.

However, a recent official report saying that failures in Test and Trace contributed to a surge in the Delta variant adds to a damning analysis of the £37 billion operation by the Sage advisory group, which said last year it had had a “minimal impact on transmission”.

A Whitehall source questioned how feasible it would be for Harding to take on the role while facing scrutiny during an inquiry into the government’s handling of the pandemic.

The other frontrunner for the role is Amanda Pritchard, the chief operating officer of NHS England and Stevens’s de facto deputy.@gabriel_pogrund

Ever since the birth of the NHS in 1948, hospitals and GP practices have relied on an army of professionals born or trained outside the UK, writes Andrew Gregory.

While the vast majority of doctors and nurses are homegrown, those in charge believe that without their foreign colleagues from more than 200 countries, the NHS would quickly run into trouble. “I don’t know how we or any other NHS trust would cope,” one chief executive said yesterday.

Yet that is the eye-catching vision for the NHS from Baroness Harding of Winscombe, one of those applying to become its next boss. She believes that the UK should become self-sufficient when it comes to healthcare workers, and indeed that the country should be exporting talent — not importing it.

Accomplishing such a goal would be no mean feat.

Health workers have been hired from overseas since the 1930s but with the launch of the health service after the war they were needed in even greater numbers.

Recruiting trained staff from abroad was the only way to keep the service open without breaking the exchequer during the 1950s and 1960s, as Britain’s population grew and demand for free healthcare soared.

Even 60 years ago, the reliance on foreign health workers was acknowledged. “The whole of our hospital service would have collapsed had it not been for the enormous influx of junior doctors from India and Pakistan,” said Lord Cohen of Birkenhead during a Lords debate in 1961.

Today is no different. About 170,000 of 1.28 million staff report a non-British nationality, a Commons briefing found last year. That is 13.8 per cent of all staff for whom a nationality is known, or almost one in seven. Analysis by the Nuffield Trust, a health think tank, found 50 per cent of the increase in the health and social care workforce over the past decade was from workers born abroad. Among doctors, the proportion reporting a non-British nationality is 28.4 per cent, according to research by the Health Foundation think tank. In March 2019, 20.1 per cent of GPs in England qualified outside the UK, compared with 28.1 per cent in parts of London and 7.3 per cent in the southwest.

The Health Foundation argues that the NHS needs more staff from overseas, not less. Health services staffing shortages stand at about 100,000, and could grow to 250,000 or more by 2030, it says.

Any drive to increase the proportion of British-born or trained NHS workers would require investment from the Treasury. Training a Briton to become a doctor can cost up to £250,000. That makes hiring foreign trained doctors attractive. There is also the extra risk of doctors heading for jobs abroad the moment they have qualified, with Australia and America among the destinations attracting growing numbers of UK health professionals each year.

Britain has also repeatedly faced accusations over the years that by poaching staff from poorer countries, it is putting other healthcare systems under strain.

There is a bigger hurdle than cash: time. It would probably take a decade to see any tangible results, given that it takes 10 years to train a GP and 14 to train a surgeon.