It may be controversial to say it but it's true – lifting the immigration cap for the NHS is a bad idea

It probably had to happen. All the stars were aligned: the perennial shortage of qualified medical staff in the NHS; the advance planning for next winter’s “crisis”; a loud chorus of special pleading led by the great and the good; frightened politicians, and a new home secretary keen to set a fresh tone on migration following the (totally unrelated) Windrush scandal.

And so the government will announce that it is abolishing the “cap” for recruiting nurses and doctors from outside the EU – and presumably, post-Brexit, from inside the EU, too. That such a decision had become inevitable, however, does not make it either right or desirable – and I say that as someone who has recently found it nigh impossible to make a GP appointment without a delay of at least three weeks, or at all.

Not that NHS staff shortages – or the government’s response to them – are anything new. I keep a little collection of cuttings on the subject, which goes back a decade or more. My long-time favourite is a letter to the Financial Times from 2016, asking why, a full six years after the Department of Health contracted consultants to project future requirements so that sufficient doctors and nurses could be trained, there were headlines saying “England’s hospitals are short of 15,000 nurses” and blaming visa restrictions. As the correspondent noted, the “drivers of demand for health and social care services are well-known, and restrictions on migrant workers have been in place for a considerable time. So why… are we still seeing such headlines?”

Why indeed? And why, more than two years on from those headlines and that observation, are the shortage complaints as loud and as urgent as ever? It’s no good the medical establishment wringing its hands and blaming us (the ignorant public) for not appreciating how long it takes to train even this inadequate number of nurses and doctors.

That Department of Health consultation – conducted, no doubt, at a cost that could have paid for several wards full of extra nurses – dates back more than eight years now. Even with an entirely graduate profession of nurses and the long training required to produce a doctor, the NHS could have had four years’ worth of extra nurses by now and two years’ worth of new junior hospital doctors, with a new crop of fully trained GPs, surgeons and other specialists in the pipeline. Numbers of training places have increased a bit, but at nothing like the necessary rate.

Which is how the NHS comes to be insisting once again that patients’ lives are in danger and clamouring – successfully, as it turns out – for the abolition of the migration cap. But why, after all this time, do the numbers still not add up?

Well, one reason might be that the consultants’ projections were catastrophically wrong (in which case, the Department of Health should demand its money back). And it is no good anyone citing the Blair government’s great EU migrant miscalculation; the scale of this particular blunder was already well known by 2010.

A more justified reason might be the large pay rise agreed for GPs back in 2004, which enabled many to work part-time and still take home a comfortable amount – an opportunity embraced with enthusiasm especially by women GPs (which makes it even more difficult than it was to see either a woman doctor, or the same woman doctor twice). Changes to GP pension arrangements have also had the effect of encouraging more to retire early. As for nurses, there has been the spread of the – to my mind ill-advised – 12-hour shift system – which means a day’s absence leaves a bigger and more expensive gap than it would under an 8-hour shift system.

But the biggest reason for the NHS to demand more imported medics is surely the same as it has always been: that bringing in fully, or nearly, qualified medical staff is a lot easier, more flexible, and above all cheaper than training them yourself. So here we go again. Whether the cash savings in the longer term are as great as they seem in the short term, however, may be less clear-cut.

Language competency requirements may have been increased, but I know from experience that there can be quite severe communications problems. Doctors trained abroad are more likely to be struck off than those trained in the UK (though many argue this may reflect inbuilt discrimination in the cases that are brought).

More significant, perhaps, were the findings of a peer-reviewed 2015 study, which concluded that “the use of non-UK-educated nurses in English NHS hospitals is associated with lower patient satisfaction. Importing nurses from abroad to substitute for domestically educated nurses may negatively impact quality of care.”

Now you could, and perhaps will, respond that such conclusions reflect the prejudices of patients, on the one hand, and the medical elite (the GMC) on the other. No doubt more work needs to be done. And at least as compelling an argument against the recruitment of so many foreign medics is that it is immoral, because they invariably come from countries that can least afford to lose them. But it is not hard to see how the recruitment of medical staff abroad suits NHS managers and government ministers – the rotas are staffed and the boxes ticked – and that any downside is likely to be suffered disproportionately by the patients.

So what can be done to address the shortage? It seems to me that there are two routes: the organisational and the imaginative.

Under organisational would come moves either to integrate the private sector better into the NHS or to separate the two completely. The current system blurs obligations (oh yes it does) to the disadvantage of NHS patients. There should also be a minimum period of service in the NHS for those expensively trained in the UK, or for those who leave a requirement to reimburse part of the cost. The extent of part-time working and early retirement also needs to be factored in to the training numbers in a way that has apparently not been done.

Under “imaginative”, how about developing some accelerated training schemes for particularly neglected specialities? Could younger retired people not be encouraged to train as, say, adult carers, GPs or geriatricians?

I can already hear the squeals from the Royal Colleges. School-leavers, they would object, need multiple A*s in the hard sciences to get near a medical course; then it is eight years or more of hard graft. But life experience – bringing up children, tending to sick partners or elderly relatives – has direct relevance to medicine and could be formalised in perhaps a year of modular training for a new sort of health branch tailored to the much-maligned “ageing population”. It is also what freshly minted medics most lack.

A scheme has begun to train “mature” teachers; might there not be room for a medical equivalent? The NHS may have secured its new “fix” of ready-trained staff this time around, but ministers, managers and the medical establishment must bring their unhealthy addiction to an end.