Labour migration in the British and German health sectors: challenging the demographic argument

Among all the European health and care sectors, the United Kingdom's has experienced without doubt the largest scale overseas recruitment in recent years, and forms a particularly stark contrast to the German health and care sector, which has experienced no significant recruitment of foreign health professionals for decades. In 2003, almost one-third of all doctors employed by the national health service (NHS) had acquired their qualification outside the UK, and in 2001, the number of foreign nurses registering with the Nursing and Midwifery Council exceeded the number of British nurses for the first time. While the British NHS has long employed foreign doctors, nurses and other kinds of therapists, their proportion increased gradually during the 1990s and sharply around the turn of the millennium. Although labour shortages and the occasional use of international recruitment can be observed in Germany since about 2002, figures are fairly diminutive in comparison to the British case. Furthermore the relevant actors seem to be much less inclined to consider international recruitment as an appropriate strategy.

The German and the British cases seem to represent only the two extremes of a wide array of recruitment practices in European health and care sectors. The different use and assessment of international recruitment are puzzling if we take into account an assumption that implicitly underpins most research on the migration of health professionals: ageing societies develop an increasing demand for health and care services (see, e.g. Forcier et al. 2004: 1; Ray et al. 2005). This demand cannot always be met by a ‘home-grown’ workforce in the short and medium term mainly due to the length of training. Thus the option of international recruitment emerges. Furthermore, it can at least be suspected that states might be inclined to attract highly skilled medical staff from abroad for economic reasons since training costs for doctors are particularly high.

Since most western industrial countries face similar demographic problems the migration of health and care professionals has become a matter of increasing concern for most OECD countries as well as for developing source countries which are at risk of suffering from a ‘brain drain’ of skilled personnel.