The government plans to more than halve the number of NHS staff being recruited from abroad in the next 15 years, according to its long term workforce plan.
On Thursday, a preview of the plan announced the intention to funnel £2.4bn into solving the severe staffing crisis in NHS England.
The full document, which was published this morning, said the service aims to train more NHS staff domestically to “reduce reliance on international recruitment and agency staff”.
“In 15 years’ time, we expect around 9-10.5% of our workforce to be recruited from overseas, compared to nearly a quarter now,” the NHS plan said.
The report also says:
• Half a million trainees will begin clinical training over the next six years • The NHS hopes to recruit 300,000 new staff and retain 130,000 extra healthcare workers • Training places will be expanded across the sector including: GPs (50%), adult nurses (92%), pharmacists (29%), dentists (40%), dental therapy and hygiene professionals (28%), healthcare scientists (13%) • From autumn, recently retired consultant doctors will be given the option to return to work across England through the NHS Emeritus Doctor Scheme • Almost a quarter of NHS staff (22%) will be trained via apprenticeship by 2031/32 • New medical degree apprenticeships will train 2,000 doctors by 2031/32 • Staff will be supported to access the new childcare measures announced in the recent budget • The shortfall in mental health nursing is of “particular concern”, with plans to boost this by 73%
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The NHS, the report said, is “particularly reliant on international recruitment” to fill workforce gaps. The total proportion of NHS workers with non-UK nationalities – across all professions – has grown to more than 17%.
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Since 2017, there has been a 2% increase in UK-trained medical graduates joining the workforce. By comparison, in the same time period, there has been a 121% rise in international medical graduates.
Of the doctors who joined the UK workforce in 2023, 50% were international medical graduates.
And, in 2022/23, about half of new nursing registrants in England were trained overseas.
“This leaves the NHS exposed to high marginal labour costs and risks the sustainability of services in the longer term given the growing global demand for skilled healthcare staff,” the report said.
But achieving the productivity improvements outlined in the plan is depending on ” a sustained increase in capital investment in the ageing NHS estate” and investing in digital infrastructure to allow the NHS to make the most of new technologies.
This includes replacing equipment that has passed its recommended lifespan and expanding “capacity to accommodate the increased demand for healthcare from an ageing population”.
“This would enable staff to function more efficiently, and shorten diagnosis and treatment times in areas such as cancer,” the report said.
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New roles will be ‘trained and regulated properly’
Vacancies currently stand at 112,000, and there are fears shortfalls could grow to 360,000 by 2037.
Shorter medical degrees, apprenticeships so staff can “earn while they learn” and more medical school places in the areas of greatest need were among the previous headline announcements.
The Prime Minister has insisted people being brought into new roles in the NHS will be “trained properly and they’ll be regulated properly”.
Rishi Sunak said the General Medical Council (GMC) will bring new roles like physician associates into its remit as regulator.
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0:57
PM: ‘We’re improving culture, leadership and wellbeing’ in NHS
As the Conservatives have now been in power for 13 years, critics – including Labour’s shadow health secretary Wes Streeting – have been asking why the party hasn’t acted sooner.
He said governments from all parties had “ducked” the workforce challenge for decades but said “overcoming this won’t be quick or easy”.
He added: “It’s only possible because of the difficult decisions we’re taking elsewhere to cut the debt and by prioritising the NHS there will be other things that we can’t afford.
“But the NHS is too important. So we’re making the tough calls, and doing things differently, to protect the long term future of the NHS and this country.”
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And while the plan focuses on retention and training, as waves of strikes continue across the health service, the preview contained no mention of pay other than to say: “Everyone working in the NHS should be recognised and rewarded fairly to help ensure we attract and retain the staff we need to provide the best possible care for patients.”
In response to questions about this, the prime minister said everyone would like to be paid more, but the government’s job is to “make sure that we reward people fairly and well for the work they are doing” but also bring down inflation.
He said he is “really pleased” the NHS staff council, which represents over a million NHS workers, voted to accept the government’s pay offer, adding: “I think they did recognise that it was fair and reasonable and rewarded their members for their hard work.
“”And I’m very grateful to all them for doing that because I know that fundamentally what they care about is working really hard, to deliver excellent healthcare.”
Unite General Secretary Sharon Graham said: “This looks like a bold plan to transform the training of new staff in the NHS. But the devil is in the detail as usual. There is a promise of funding for training for three years, but nothing about money for current staff.
“If there is not enough money to pay NHS staff a decent wage now, and transform current wage structures, then all the aspirations for more staffing in the training plan will fail to address the current crisis in the recruitment and retention of staff. That is what is at the heart of the current staff exodus”.
Analysis: No benefits in the short term
England will not see the benefits of the NHS workforce plan in the short term.
Essentially what this plan does is to grow the workforce, to retrain the workforce where it needs to with the addition of extra technology, and essentially to retain that workforce.
The government wants to work towards a plan over the next five, 10 and 15 years where it is less dependent on overseas-trained health professionals.
Essentially what this means is that we won’t see the benefits of this long-term workforce plan in the short term and it won’t do anything to address things like social care or NHS estates.
The ringleader of a Romanian grooming gang was offered £1,500 by the Home Office to be deported while he was in prison awaiting trial for 10 rapes, a Sky News investigation has found.
But Sky News can exclusively reveal that in summer 2024, while in custody at HMP Perth awaiting trial for serial sex offences, officials handed him a “voluntary return” form under a government scheme paying foreign nationals to leave Britain.
The department later decided not to remove him because of the upcoming court proceedings.
Immigration status renewed during trial
In another twist, just months later – as he stood in a High Court dock facing 10 rape charges – Sky News has discovered Cumpanasoiu’s immigration status, which was due to expire, was automatically renewed under the EU settlement scheme.
Cumpanasoiu was later handed a 24-year extended sentence, with 20 years in jail and four on licence, for sexual and trafficking offences.
Image: Cumpanasoiu winking to the camera during a video filmed near a brothel in Dundee. Pic: Crown Office
Prosecutors described him as a “winking, smirking pimp” who once filmed a victim climbing a tree to escape his anger when she “failed” to make enough money in Dundee brothels.
Following days of questions from Sky News, officials have confirmed his settled status has now been revoked.
The inside story
Sky sources say Home Office workers personally met Cumpanasoiu at Perth prison while he was on remand in August 2024.
Sources say he “expressed a desire to return home” and was handed documents to sign agreeing to a cash-assisted return, but the plan was later blocked.
But in another twist, on 2 December 2024, halfway through the grooming gang trial, his EU settled status was renewed.
A source close to proceedings told Sky News the revelations “smack of incompetence”.
The Home Office does not dispute this version of events.
Image: Romanian grooming gang clockwise from top left: Remus Stan, Alexandra Bugonea, Mircea Marian Cumpanasoiu, Cristian Urlateanu and Catalin Dobre. Pics: Police Scotland
Rape Crisis Scotland said the case raises concerns.
A spokesperson for the charity said: “This was a horrific case, which involved numerous vulnerable survivors who showed tremendous strength and courage by coming forward to seek justice for what had happened to them.
“The severity of this case has, quite rightly, resulted in significant prison sentences for the perpetrators. However, it is not clear why the Home Office tried to intervene before a trial had begun, and any verdict had been reached.
“Survivors must have faith in the criminal justice process and its ability to hold perpetrators accountable for their crimes.
“This incident raises questions about what the Home Office’s intentions were, and why it was able to insert itself into active criminal proceedings in the first place.”
The EU Settlement Scheme was set up after Brexit to allow citizens from the EU, and their family members, to continue living and working in the UK.
People with “settled status” can stay in the UK indefinitely.
Those with “pre-settled status”, such as Cumpanasoiu, must reapply after five years.
Since September 2023, the Home Office has introduced automatic extensions of pre-settled status which means renewals happen electronically unless officials intervene.
There are questions now about whether this automation can lead to offenders such as Cumpanasoiu being overlooked.
Home Office ‘had power to intervene’
Jen Ang, a human rights lawyer and leading expert on migrants’ rights, told Sky News the vast majority of those processed under the EU system are law-abiding citizens.
But Ms Ang, a professor at the University of Glasgow, reveals authorities did have the power to intervene in this case.
Image: Professor Jen Ang
She said: “In this case the Home Office did have the power and the right to stop the automatic renewal. At any point where it is possible that someone is about to become unsuitable for settled status, the Home Office could have intervened.
“The optics of this in the context of such a high-profile and horrific crime are not great.”
‘The public are entitled to be concerned’
Thomas Leonard Ross KC, a leading Scottish defence lawyer, described the decision-making as “flawed”.
He said: “I mean automatically renewing pre-settled status in 99.9% of occasions can be done without any risk to the public. But clearly this particular individual has been assessed to be an extremely dangerous person.
“The public are perfectly entitled to be concerned. A decision of this type made automatically without any assessment as to the risk that he might pose is clearly a flawed decision.”
A Home Office spokesman said: “This man will serve his sentence for the abhorrent crimes he committed and will be considered for deportation at the earliest opportunity.
“A deportation order will automatically trigger the revocation of an individual’s right to be in the UK, including pre-settled status.”
The novel has survived the industrial revolution, radio, television, and the internet. Now it’s facing artificial intelligence – and novelists are worried.
Half (51%) fear that they will be replaced by AI entirely, according to a new survey, even though for the most part they don’t use the technology themselves.
More immediately, 85% say they think their future income will be negatively impacted by AI, and 39% claim their finances have already taken a hit.
Tracy Chevalier, the bestselling author of Girl With A Pearl Earring and The Glassmaker, shares that concern.
“I worry that a book industry driven mainly by profit will be tempted to use AI more and more to generate books,” she said in response to the survey.
“If it is cheaper to produce novels using AI (no advance or royalties to pay to authors, quicker production, retainment of copyright), publishers will almost inevitably choose to publish them.
“And if they are priced cheaper than ‘human made’ books, readers are likely to buy them, the way we buy machine-made jumpers rather than the more expensive hand-knitted ones.”
Image: Chevalier, author of the book Girl With A Pearl Earring, with the painting of the same name. Pic: AP
Why authors are so worried
The University of Cambridge’s Minderoo Centre for Technology and Democracy asked 258 published novelists and 74 industry insiders how AI is viewed and used in the world of British fiction.
Alongside existential fears about the wholesale replacement of the novel, many authors reported a loss of income from AI, which they attributed to “competition from AI-generated books and the loss of jobs which provide supplementary streams of income, such as copywriting”.
Some respondents reported finding “rip-off AI-generated imitations” of their own books, as well books “written under their name which they haven’t produced”.
Last year, the Authors Guild warned that “the growing access to AI is driving a new surge of low-quality sham ‘books’ on Amazon”, which has limited the number of publications per day on its Kindle self-publishing platform to combat the influx of AI-generated books.
The median income for a novelist is currently £7,000 and many make ends meet by doing related work, such as audiobook narration, copywriting or ghost-writing.
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1:12
Could the AI bubble burst?
These tasks, authors feared, were already being supplanted by AI, although little evidence was provided for this claim, which was not possible to verify independently.
Copyright was also a big concern, with 59% of novelists reporting that they knew their work had been used to train AI models.
Of these, 99% said they did not give permission and 100% said they were not remunerated for this use.
Earlier this year, AI firm Anthropic agreed to pay authors $1.5bn (£1.2bn) to settle a lawsuit which claimed the company stole their work.
The judge in the US court case ruled that Anthropic had downloaded more than seven million digital copies of books it “knew had been pirated” and ordered the firm to pay authors compensation.
However, the judge sided with Anthropic over the question of copyright, saying that the AI model was doing something akin to when a human reads a book to inspire new work, rather than simply copying.
Most novelists – 67% – never used it for creative work, although a few said they found it very useful for speeding up drafting or editing.
One case study featured in the report is Lizbeth Crawford, a novelist in multiple genres, including fantasy and romance. She describes working with AI as a writing partner, using it to spot plot holes and trim adjectives.
“Lizbeth used to write about one novel per year, but now she can do three per year, and her target is five,” notes the author of the report, Dr Clementine Collett.
Is there a role for government?
Despite this, the report’s foreword urges the government to slow down the spread of AI by strengthening copyright law to protect authors and other creatives.
The government has proposed making an exception to UK copyright law for “text and data mining”, which might make authors and other copyright holders opt out to stop their work being used to train AI models.
“That approach prioritises access to data for the world’s technology companies at the cost to the UK’s own creative industries,” writes Professor Gina Neff, executive director of the Minderoo Centre for Technology and Democracy.
“It is both bad economics and a betrayal of the very cultural assets of British soft power.”
A government spokesperson said: “Throughout this process we have, and always will, put the interests of the UK’s citizens and businesses first.
“We’ve always been clear on the need to work with both the creative industries and AI sector to drive AI innovation and ensure robust protections for creators.
“We are bringing together both British and global companies, alongside voices beyond the AI and creative sectors, to ensure we can capture the broadest possible range of expert views as we consider next steps.”
The letter sent by the House Committee on Oversight and Government Reform said members wanted to talk to him because of the widely reported allegations that have been made against him, which he denies, and because of his relationship with Epstein and what he may have seen.
The committee is looking into Epstein’s crimes and his wider sex trafficking network. Andrew was given until today, 20 November, to respond.
Legally he isn’t obliged to talk to them, and to be honest it’s hard to imagine why he would.
The only time he has spoken at length about the allegations against him and his relationship with Epstein was that Newsnight interview in 2019, and we all know how much of a disaster that was.
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2:35
Releasing the Epstein files: How we got here
Yes, this could be an opportunity for him to publicly apologise for keeping up his links with Epstein, which he has never done before, or show some sympathy towards Epstein’s victims, even as he vehemently denies the allegations against him.
But while there is the moral argument that he should tell the committee everything he knows, it could also raise more uncomfortable questions for him, and that could feel like too much of a risk for Andrew and the wider Royal Family.
However, even saying no won’t draw all this to a close. There are other outstanding loose ends.
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13:31
The new Epstein files: The key takeaways
There could also still be a debate in parliament about the Andrew problem.
The Liberal Democrats have said they want to use their opposition debating time to bring the issue to the floor of the House of Commons, while other MPs on the Public Accounts Committee have signalled their intention to look into Andrew’s finances and housing arrangements.
And then there are the wider Epstein files over in America, and what information they may hold.
From developments this week, it seems we are edging ever closer to seeing those released.
All of this may mean Andrew in other ways is forced to say more than he wants to, even without opening up to the Congress committee.