by PATRICK COCKBURN
The best aid to the poor of the world would be to stop relying on their expensively trained health workers and produce enough of our own
The British government pretends that, despite the drastic cut to its foreign aid budget, subsidies flow in one direction only, which is from the UK to poor countries. At the G7 summit, Boris Johnson is making much of Britain’s generosity in donating surplus vaccines to places where health systems are collapsing under the impact of the pandemic.
But the nasty secret about British aid is that, in reality, the subsidies are often going in the opposite direction because Britain deliberately trains far fewer doctors and nurses than it needs. It makes up the difference by recruiting great numbers of trained medical staff from impoverished countries where they are already in critically short supply.
In Kenya, for instance, where 20 million people live in extreme poverty, on less than $1.25 (89p) a day, the country loses $518,000 for every doctor and $339,000 for every nurse who emigrates to the UK. Britain gives substantial aid to Ghana to fight malaria and reduce infant mortality, but these sums are exceeded by the £65m Britain saves by employing 293 doctors trained in Ghana and a further £38m saved on 1,021 Ghanaian nurses who work here.
“The situation will never be turned around until we train more doctors here,” says Rachel Jenkins, professor emeritus of epidemiology and international mental health policy at King’s College London, who has long campaigned on the issue.
What makes the government’s position so culpable is that the Treasury is well aware of the financial advantages of training too few doctors and filling the gap by recruiting doctors and nurses who have already been trained at some other country’s expense.
A precise figure for the shortfall is difficult to calculate, but the then health secretary, Jeremy Hunt, told the Health Select Committee in 2017: “It is interesting that Health Education England estimates that we were training about 6,500 doctors a year and we needed to train about 8,000 a year to be self-sufficient.” Hunt’s expressed concern was not about the damage to poor countries of losing scarce doctors, but that there might not be enough of them to recruit.
Prof Jenkins says that Hunt’s figure is an underestimate of the number of doctors needed in Britain, particularly of GPs, psychiatrists and in emergency care. There is no shortage of people in the UK who want to become doctors and nurses, but the government has been unwilling to spend the money to train them. “Loads of people are disappointed because they cannot get into medical schools,” she says. “They should double the number of places for medical students.”
The reason this has not happened is the high cost of medical training, which in 2005 was already £220,000 for a doctor and £125,000 for a nurse, and has greatly increased since then. Medical schools are expensive and the training period is long. Even with what amounts to the poaching of trained medical staff from abroad, the number of doctors in the UK per capita is still one of the lowest in Europe, second only to Poland. A study by the Organisation for Economic Cooperation and Development (OECD) shows that the UK has 2.8 doctors for every 1,000 people compared with an average of 3.5 doctors in the OECD’s member countries as a whole.
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