Health Foundation report details how immigration makes a positive contribution to NHS workforce and funding

A new briefing by the charitable Health Foundation finds that available evidence suggests immigration makes a positive contribution to the NHS, with people who migrate to the UK more likely to work in the health service, less likely to use health services on average, and contributing significantly to NHS funding.

The report can be read online here.

It reviews existing research and analyses publicly available data to assess the relationship between immigration and the NHS. While immigration is often cited in debates about pressures on the NHS, the Health Foundation says available evidence does not support narratives that link immigration to the health service's performance.

The report emphasises: "Political and media narratives that link immigration to pressures on the NHS are not supported by the evidence. This is in line with previous research showing that media and political debate on immigration is often misleading, focusing on headline numbers without context, overemphasising particular types of migration and not reflecting people's different experiences. Our polling suggests many people overestimate migrants' use of services and their share of the workforce. Broader evidence also finds gaps in public understanding of immigration. For example, in 2025, only 14% of the public correctly identified that net migration fell between 2023 and 2024, while over half believed it had increased."

According to the report, NHS pressures are largely driven by factors including funding constraints, workforce shortages, an ageing population, rising prevalence of complex health conditions and the lasting effects of the COVID-19 pandemic. It cites a 2018 study which found that immigration generally reduced NHS outpatient waiting times and did not affect accident and emergency waiting times.

The Health Foundation's analysis found that people who migrate to the UK generally use NHS services less than people born in the UK. National studies reviewed in the report consistently found lower use of most health services among migrants, including primary care, hospital services and mental health services. One study found healthcare use among people born outside the UK was up to 40% lower than among those born in the UK before adjustments were made for other factors.

Lower NHS use is partly explained by the fact that migrants are generally younger and healthier than the UK-born population. Research reviewed by the Health Foundation found that differences in service use largely disappear when age and health status are taken into account. The report also notes that migrants' use of health services tends to increase over time and gradually converge with that of the UK-born population.

At the same time, the report identifies significant barriers to accessing healthcare. Reviews of existing evidence found that migrants often face difficulties related to language and problems accessing translation support. The report also states that NHS charging policies can discourage people from seeking care. It notes that charges have been found to deter some migrant women from accessing maternity services and that concerns about charging can affect people who are entitled to free care but are unaware of their rights.

With regard to the financial impact of immigration on the NHS, the Health Foundation finds that available estimates generally suggest migrants pay more in taxes and visa charges than the cost of the public services and benefits they use in the short to medium term.

Many migrants are required to pay the Immigration Health Surcharge (IHS) in addition to visa fees. The surcharge currently stands at £1,035 per year for most visas and generated more than £2.6 billion in gross revenue during 2024/25, equivalent to around 1.1% of total health spending. However, the report notes that the methodology used to calculate the surcharge has limitations and may overestimate healthcare costs incurred by those who pay it. If further notes: "Those who pay the IHS contribute taxes like everyone in the UK, so effectively pay twice for the NHS. And the UK charges more for visas than other similar countries."

On the contribution made by care workers, the report notes: "Care workers are low paid and exempt from the Immigration Health Surcharge, so generally pay less towards the NHS than other migrant workers. But reducing their international recruitment affects social care supply, with potential knock-on effects for NHS services. And policies banning family from joining care workers and proposing longer qualifying periods for settlement for these roles impact people's wellbeing and rights."

According to the latest NHS data cited by the Health Foundation, 22% of NHS staff in England report a non-British nationality.

The report highlights: "The most recent analysis based on country of birth suggests migrants contribute disproportionately to the NHS workforce, finding that people born abroad made up 14% of the overall UK population in 2018, but 19% of the UK health and care workforce (23% of hospital workers). The UK draws on international recruitment more than other similar countries: for example, 38% of UK doctors in 2023 were 'foreign trained', compared with 20% for all OECD countries."

The Health Foundation notes that governments have alternated between encouraging international recruitment and seeking to reduce reliance on overseas workers. Recent policy commitments aim to reduce international recruitment, with a target to reduce the proportion of non-British NHS recruits from around a third to 10% by 2035. Nursing visas, for example, falling by 92% between 2023 and 2025. The Health Foundation argues that this risks worsening workforce shortages and may not be realistic given current staffing needs.

It says: "The NHS faces substantial and persistent workforce shortages, and most of the public tends to think levels of international recruitment should stay the same in the future. The latest arbitrary target risks worsening staff shortages and is highly ambitious: for example, in nursing, the proportion of new registrants trained outside the UK has not fallen to this level since 1990. Plans to phase out the care worker visa route by 2028 also risk exacerbating capacity problems in the health and care system. In the forthcoming NHS workforce plan, government must take a fairer, longer term approach to workforce planning, expanding domestic training and improving retention, while recognising that the UK is likely to continue to rely on international recruitment."

Evidence reviewed in the report also suggests that internationally recruited staff bring wider benefits to the NHS. They are more likely to work full time, more likely to work additional paid hours and have lower rates of leaving the workforce. However, the report also found that internationally recruited staff are more likely to experience discrimination, harassment and violence. In 2025, 27% reported discrimination from patients or members of the public, compared with 8% of other staff.

Alongside its review of research, the Health Foundation conducted polling on public attitudes. The polling found that 22% of respondents identified increased demand due to immigration as the main cause of current NHS pressures, compared with 37% who cited lack of funding and 29% who cited staff shortages. The report also found that the public frequently overestimates both migrants' use of health services and their share of the NHS workforce.

In concluding, the Health Foundation says: "Ultimately, immigration policy is determined by political choices extending beyond the NHS that often involve complex trade-offs. Governments in the UK and other countries use immigration policy to pursue a range of objectives, such as boosting economic growth, maintaining public services and protecting people during international conflicts. These could each point to different approaches and the priority afforded to them changes over time. But when it comes to the NHS, our findings suggest policies and political narratives focused on reducing immigration risk unintended consequences. Ensuring policy decisions are informed by the available evidence is critical to the future sustainability of the NHS."