NHS staffing crisis: Plans to halve number of medics being recruited from abroad
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”.
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“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%
NHS ‘reliant on overseas staff’
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%.
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.
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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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.”
No mention of pay
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”.
The widow of Dr Michael Mosley has posted an emotional tribute to him – and revealed plans to continue the work that gave him “such a sense of purpose”.
Mosley, a TV doctor and health expert, went missing while on holiday with his wife Clare on the Greek island of Symi on 5 June.
The 67-year-old’s body was found four days later in rocky terrain following an extensive search effort in sweltering temperatures.
In a post on Instagram, Clare Bailey Mosley – who is also a doctor – wrote: “Thank you all for your wonderfully supportive messages. The outpouring of love from so many people has meant a huge amount to me and my family.
“I’m going to be quiet for a while. I’m sure you will understand. But I will be back here soon. I very much want to continue with the work that gave Michael and myself so much joy and such a sense of purpose.
“Once more thank you so much for respecting my family’s privacy so kindly.
“Michael was an amazing man. Thank you for seeing that too. We miss him so much.”
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Greek police said Mosley, who disappeared after going for a walk, died of natural causes.
CCTV footage appeared to show him falling over close to where his body was found and no one else was with him.
He was just metres from safety.
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‘So close to us’: Worker who found Dr Mosley
Mosley first trained as a doctor before moving into the world of broadcasting, presenting a host of science programmes and films on the BBC including the series Trust Me, I’m A Doctor, which looked at healthcare in Britain.
He is credited with popularising the 5:2 diet, a form of intermittent fasting, through his book The Fast Diet which he co-authored with journalist Mimi Spencer, and later advocating for The Fast 800 diet, which follows a “moderately low-carb, Mediterranean-style diet”.
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Who was Michael Mosley?
In 2002, he was nominated for an Emmy for his executive producer role on BBC science documentary The Human Face, and he also ingested tapeworms for six weeks for a 2014 documentary called Infested! Living With Parasites.
“I was sleepwalking,” a public schoolboy, wearing only his boxing shorts, was heard to say after brutally attacking two fellow students and a housemaster.
Henry Roffe-Silvester, a teacher at the exclusive boarding school, was awoken in the middle of the night by footsteps coming from the dormitory directly above.
He went to investigate, and as he opened the door to the pitch-dark room, he saw a silhouetted figure who turned and struck him on the head with a hammer.
“I stumbled backwards into the corridor,” said Mr Roffe-Silvester, during his attacker’s two-month trial. “There was a second blow – I can’t remember if it was before I stumbled back – that’s a little bit hazy for me.”
He suffered six blows to the head before managing to get the weapon off the boy he now recognised as one of his students, who “slumped down” in a squat position and was heard to say: “I was dreaming.”
When paramedics arrived at Blundell’s School in Taunton, Devon, they found “carnage” like “a scene from a horror film” with blood over the desks, the walls and the cabin-style beds.
There was no question the boy, then 16, caused the “awful injuries” to the housemaster and two sleeping dorm-mates – both boys suffered skull fractures, as well as injuries to their ribs, spleen, a punctured lung and internal bleeding.
Scene was ‘like horror film’
‘Zombie apocalypse’
He told a jury at Exeter Crown Court he kept hammers by his bed for “protection” from “the zombie apocalypse” or the end of the world.
He remembered going to sleep on 8 June last year, he said, and the next thing he recalled was being in the room which was “covered in blood”.
“I knew something really bad had gone on and everyone was looking towards me,” he said.
“I didn’t remember doing anything so the only rational thing I was thinking was that I was sleepwalking.”
Prosecutors said he had armed himself with three claw hammers, then waited for his victims to fall asleep before attacking them.
But his barrister, Kerim Fuad KC, said he must have been “sleepwalking to have committed these extraordinary acts” – meaning he would be not guilty of attempted murder by reason of insanity.
The history of the sleepwalking defence
The idea that acts of violence can be committed by people who are sleepwalking isn’t new – since the 14th century, the Catholic Church recognised the idea that a sleeper shouldn’t be held responsible for killing or injuring someone.
The first English case is believed to be the Old Bailey trial of Colonel Culpeper in 1686, who was said to have shot a guardsman and his horse during a dream. He was convicted of manslaughter while insane but pardoned a few weeks later.
More incidents came to light in the Victorian era as scientists began studying the mind, among them the famous case of Simon Fraser, a known sleepwalker, from Glasgow.
Believing he was saving his family from a wild beast that had burst through the floorboards, he killed his 18-month-old son by throwing him against a wall. He was cleared but was told by the judge to sleep alone in a locked room for the rest of his life.
Jules Lowe was cleared of murdering his father. Pic: PA
More recently, in 2005 Jules Lowe was found not guilty of murder by reason of insanity and made the subject of a hospital order after claiming he was sleepwalking when he beat his father to death at the family home in Walkden, Greater Manchester, after a drinking session.
Three years later, father-of-two Brian Thomas strangled his wife Christine while they were on holiday in west Wales, believing an intruder had broken into their campervan.
The nightmare was suggested to have been triggered by an earlier incident when they were disturbed by youths doing wheel spins in the car park.
Thomas was described as a “decent man and a devoted husband” by the judge after being cleared of murder when prosecutors dropped the case.
The sleepwalking defence is rare – according to sleep expert Dr Neil Stanley, who was not involved in the Blundell’s case, and tells Sky News it has been successfully used just 200 times in the English-speaking world.
Sexsomnia
But it has become increasingly common over last 30 years, says Dr John Rumbold, a lecturer at the Nottingham Law School, who tells Sky News there is a growing number of sleep experts and a greater awareness among lawyers.
In the past, reported cases more commonly involved violence, he says, but now around 80% to 90% of cases involve sexsomnia, an extreme variant of sleepwalking, that can cause people to engage in sexual activity while unconscious.
“Very often it’s drunk young men” who are accused of rape or other sex offences, he says. “They don’t really have any other defence and it’s fairly complex actions.”
Dr Stanley believes that some people who are guilty have successfully used the defence in the past and says there is a lack of knowledge of the subject among judges, lawyers and juries.
He says that in theory he could use his expertise to tell someone how to behave and what to say to convince a court they were a genuine sleepwalker.
‘Get out of jail free card’
Some see it as “a get out of jail free card”, he says, but he adds that “people, in their sleep, can kill, they can rape, they can assault – sexually or physically”.
Barrister Ramya Nagesh, who has written a book on sleepwalking and other automatism defences tells Sky News that just because it is being used more “that doesn’t mean that it’s being used in bad faith because you do have to have expert opinion”.
She thinks there should be a change in the law to allow a verdict of not guilty by virtue of a medical condition to encompass cases involving sleepwalking, epileptic fits and hypoglycaemia.
“Automatism is an outright acquittal – it feels a bit odd to say we’ll excuse them, but they might go off and do it again,” she says.
“They don’t deserve to go to prison and wouldn’t benefit from a hospital order, so it would give judges a bit more power.”
Blundell’s school, Tiverton, Devon
The public schoolboy, now 17, who can’t be identified because of his age, has been found guilty of three counts of attempted murder after a jury deliberated for 40 hours and he will be sentenced in October.
His relatives told the jury there was a history of sleepwalking in the family and he said his mother had found him at the bottom of a staircase in their home around a decade ago.
A ‘textbook example’?
After the attacks, the teenager told a student he was watching horror movies, while others heard him say: “I am sorry, I was dreaming.”
At his trial, sleep forensic expert, Dr Mark Pressman, who has decades of experience in the field, has seen 20,000 patients and more than 100 cases of sleepwalking violence, was called as a witness.
He described the case in court as a “textbook example”, explaining sleepwalkers could be fearful for their lives and “respond with violence to protect themselves at a very primitive level”.
“The defendant swivelled around and attacked his housemaster without knowing who he was,” he said. He was not aware he had attacked the housemaster.”
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But another expert witness, Dr John O’Reilly, told the court he did not believe the boy was asleep as a sleepwalker does not initiate violence because it is triggered by noise or touch.
Prosecutors said he had been awake shortly before the attacks, with an examination of his iPad showing he had been listening to music on Spotify, and that he had a fascination with serial killers.
‘Lucky to still be alive’
In his room, he kept a locked stash of what other pupils described as “weapons”, including shards of broken glass, screwdrivers and multiple hammers.
Police discovered he had carried out internet searches for “rampage killers”, “school massacres”, “murder with a hammer” and “killer kills while sleeping”.
He had sent alarming messages to one of his victims in the months before the attack – including a character from the horror film Texas Chainsaw Massacre wielding a hammer.
“These violent actions were repeated again and again,” said prosecutor James Dawes KC, and there was “no other explanation for his actions other than his intention to kill them”.
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Following his conviction, senior crown prosecutor Helen Phillips said the two boys were “lucky to still be alive”.
“The boy, who had a macabre interest in murder, serial killers, and violence, showed no remorse and naïvely thought that by concocting a story about sleepwalking at the time of the attack he could evade punishment,” she added.
Helicopters, rescue dogs and drones have continued to scour the holiday island of Tenerife for a missing British teenager as concerned family and friends endure a “living nightmare”.
The hunt for 19-year-old Jay Slater from Oswaldtwistle, near Blackburn in Lancashire, is now in its sixth day.
Lancashire Constabulary said that while the case “falls outside the jurisdiction of UK policing”, it has offered to support Spanish police “if they need any additional resources”.
The force added: “They have confirmed that at this time they are satisfied that they have the resources they need, but that offer remains open and they will contact us should that position change.”
Jay Slater. Pic: Lucy Law
The apprentice bricklayer was holidaying with friends on Tenerife before he disappeared on Monday.
He was last heard from when he called a friend to say he was setting off on an 11-hour walk to get home, after he missed his bus.
Pic: PA
Ofelia Medina Hernandez, who was the last person to see Mr Slater, told Sky News: “I saw the boy in the morning, at around 8am.
“He asked twice what time the bus came.
“I told him ‘at 10 o’clock’.
“He came back and asked me again, and I told him again – at 10 o’clock.
“After that, he walked off and I didn’t see him anymore.
“Later, I went in my car, and I saw him – he was walking fast.
“But I didn’t see him again after that.”
Her account came as photographs showed the property where he was last seen in the northwestern mountain village of Masca after attending the NRG music festival.
Pic: PA
Pic: PA
‘We are drained beyond words’
In a post on the Facebook page Jay Slater Missing, the administrator of the group Rachel Louise Harg said family and friends were “drained beyond words”.
She said: “There isn’t an update for anyone unfortunately.
“Struggling to find words at this time but all I can say is we are looking still and everyone is doing all they can.
“We are drained beyond words – I just can’t say no more, I wish I could.
“I wish this would end now, this living nightmare.
“Searches are ongoing and we remain positive.
“Thanks to you all supporting and helping we can’t thank you any more, much love.”
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Focus on unusual details will only grow
In the mountains on the outskirts of northern Tenerife, a narrow road winds upwards, with a dramatic view of the sea below.
Beneath the beauty of the scenery, parts of the area where British teenager Jay Slater was last located are barren and remote.
One of the properties on the route through the national park is Casa Abuela Tina, the villa Jay travelled to with two men in the early hours of Monday, before he disappeared.
Just yards away from the villa’s front door you can see the bus stop that would have taken Jay back to Los Cristianos – the part of the island he was staying in near a bustling strip full of British tourists.
The teenager was agonisingly close to being able to make his way home – and as search teams comb the mountains, that fact will surely be on their minds.
Why did Jay decide to try the 11-hour walk, and why did he go to the villa with two strangers in the first place?
As the search continues, a focus on highly unusual details of this story will only grow.
Searchers check river at bottom of ravine
On Friday, search and rescue personnel joined officers from the island’s Guardia Civil near Masca to comb an area of overgrown terrain.
Teams also paid close attention to a river called Barranco Madre del Agua at the bottom of a ravine, where emergency workers carefully picked their way through fallen dead palm trees.
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Mr Slater’s friend Lucy Law, who attended the music festival with him, said he called her at about 8.30am on Monday and told her he was “lost in the mountains, he wasn’t aware of his surroundings, he desperately needed a drink and his phone was on 1%”.
Meanwhile, members of the local community rallied together at a church service in his home town to express their hope of his safe return.
A Foreign, Commonwealth and Development Office spokesman said: “We are supporting the family of a British man who has been reported missing in Spain and are in contact with the local authorities.”
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