New APPG report calls for fairer approach to international health recruitment

NHS has saved over £14bn by recruiting overseas staff – but current system “isn’t fair”, APPG inquiry finds 

A new cross parliamentary report supported by Global Health Partnerships (formerly THET) and the Center for Global Development (CGD) is calling for a new approach to international health recruitment – one that matches the UK’s gains with meaningful investment in the world’s most vulnerable health systems. 

Published today at the UK Global Health Summit in London, the report: An honest account of the benefits and costs of international health worker recruitment, was produced by the All-Party Parliamentary Group (APPG) on Global Health & Security after hearing evidence from NHS leaders, frontline staff, partner governments and global institutions. 

It argues that the NHS is structurally dependent on health workers trained overseas, including from countries that are themselves facing critical workforce shortages. 

Its central recommendation is proportionate co-investment: linking the benefits the UK gains from international recruitment to targeted investment in training, retention and health system strengthening in partner countries. 

The case for change is stark. The inquiry found that the NHS has saved at least £14 billion in training costs by employing doctors, nurses and midwives trained overseas rather than funding their education in the UK.  

That cumulative figure is based on historic average training cost estimates. But looking at more recent recruitment using today’s higher training costs – particularly for doctors – the savings are even more striking: the UK is estimated to have avoided more than £1 billion in training costs in the last year alone, even as aid to lower-income countries has been reduced. 

Ben Simms, Chief Executive of Global Health Partnerships, said: “The NHS is one of the most internationally connected health systems in the world. But when we recruit from countries that can least afford to lose staff, the consequences can be measured in lives. If Britain benefits, Britain must contribute, through co-investment. That’s how we build a fairer system.” 

A system the NHS depends on 

The report makes clear that international recruitment is not a short-term solution or temporary pressure valve for the NHS. It is now a structural feature of the workforce. 

As of October 2025, 36% of doctors and 24% of nurses and midwives working in the UK were trained overseas. The report also highlights that around 49% of new nurses joining the register in 2024 were trained abroad.  

While the UK must continue to grow its domestic workforce, the inquiry argues that this cannot be treated as an either/or debate. The NHS depends on internationally trained staff – but many of the countries it recruits from are already struggling to train, retain and support the health workers they need.  

Globally, almost a quarter of the world’s doctors, nurses and midwives are concentrated in just ten high-income countries. The UK has around 30 doctors per 10,000 people, compared with nine in India, six in the Philippines and just one in Ghana. 

Evidence from Kenya and Uganda described the loss of experienced doctors, nurses and clinical educators – in some cases up to a fifth of senior staff – with direct consequences for patient care, training and the resilience of already overstretched health systems. 

Dr Beccy Cooper MP, Chair of the APPG on Global Health & Security, said: “International health workers are part of the NHS’s DNA. In a world where diseases don’t stop at borders, their global expertise strengthens our health system. Supporting home-grown talent and ethical international recruitment are not competing goals – they are both essential.” 

From benefit to responsibility 

The report argues that the question is no longer whether the UK should recruit internationally, but whether it is willing to do so more fairly.  

Its proposed model of proportionate co-investment would link health workforce recruitment to practical support for the countries health workers come from – particularly those with the most fragile systems. That means moving beyond voluntary ethical codes towards stronger, enforceable government-to-government partnerships. 

It also underlines the scale of the policy challenge at home. Analysis cited in the report suggests that replacing just 20% of international recruits with domestic training would cost the UK around £700 million more per year. 

Rt Hon Andrew Mitchell MP, Chair of the Inquiry, said: “We must grow our own workforce. But in a shrinking world, pretending health workforces are purely national assets is no longer credible. If we benefit from health workers trained overseas, we also have a duty to help strengthen the systems they come from.” 

A moment for UK leadership 

With a projected global shortfall of 11 million health workers by 2030 – including 6.1 million in Africa – the pressures on health systems are only set to grow. 

With the Global Partnerships Conference in May 2026, the World Health Assembly later this year, and the UK’s G20 Presidency in 2027 all approaching, the report says there is a key window of opportunity for Britain to shape a fairer model of international recruitment. 

Helen Dempster, Policy Fellow at the Center for Global Development, said: “The question is no longer whether countries recruit internationally – they will. The question is whether they do so in a way that sustains the global workforce over time.” 

For the APPG inquiry, this is ultimately about more than workforce policy. It is about whether the UK is willing to match the benefits it gains from international recruitment with a fairer contribution in return – and help build a system that is stronger, more honest and more sustainable for everyone.