Britain’s National Health Service, which provides free healthcare funded from general taxation and welfare contributions, is one of the world’s largest and most cosmopolitan employers.
But the NHS — which listed 211 nationalities in England alone in 2020 — faces chronic staff shortages.
By 2029, the state-run service in England will face a shortfall of 108,000 nurses, according to the Health Foundation think-tank.
Now there are fears the crisis will further deepen due to a combination of shocks depleting its substantial foreign workforce: retirement, the coronavirus pandemic, Brexit and tougher immigration rules.
Migration has long been a “stopgap solution” as Britain suffered “recurring crises” for 40 years, said Mark Dayan, policy analyst at the Nuffield Trust health think-tank.
Retired doctor Iftikhar Ali Syed left Pakistan for Britain in 1960 and spent 45 years working in Burnley, a northern English town defined by factory chimneys belching black smoke.
Syed, 86, belonged to a generation of medical professionals from ex-British colonies who filled labour shortages after World War II.
They were directed to poorer regions — often ex-industrial heartlands like northern England and south Wales — where recruitment was hardest and health needs greatest.
Even today, the life expectancy gap between deprived areas of northern England and the more affluent southeast is more than 10 years.
“Overseas doctors had no chance. You got a practice where no-one wants it,” Syed told AFP.
Syed and other immigrant doctors of his generation “flooded” Burnley, he remembered, helping to establish its first cardiology unit and improve midwifery services.
But they retired after 2000, creating a shortage in Burnley, mirrored in places where immigrants disproportionately filled healthcare roles.
As in other countries, the pandemic has traumatised and exhausted Britain’s frontline health and social care staff and created a huge backlog in treatments for other conditions.
In the year to March 2021, international travel disruptions meant 3,700 fewer nurses came to Britain than in the previous year.
Faizan Rana, a 34-year-old NHS operations manager, said pandemic travel curbs have weakened services and exacerbated staff shortages at his London hospital and elsewhere.
Britain has become less welcoming and financially rewarding for EU staff after the 2016 Brexit referendum and the subsequent fall in the pound’s value, added Dayan.
In 2021, there were around 8,000 fewer nurses from European Economic Area nations on the official register than in 2016.
And more than half of EU nurses leaving Britain cited the country’s departure from the bloc as a reason for their decision, a 2020 Nursing and Midwifery Council survey suggested.
Syed remembered EU staff filling shortages in Burnley after his retirement and predicted “tremendous demand” again as their numbers diminished after Brexit.
Under Britain’s new points-based immigration system, migrants must meet salary and English proficiency levels and have an offer for a skilled job, although a special visa scheme exempts healthcare workers.
Naveen Keerthi, 42, runs a recruitment agency bringing foreign doctors to Britain and believes the reforms will help hire overseas staff, with a “surge” in applicants in the past four years.
But Akshay Akulwar, a 34-year-old NHS doctor from India, said compatriots were increasingly choosing Australia, Canada, New Zealand and the Middle East because of more generous visa rules.
And Dayan said the reforms will hit social care, where staff are not considered skilled and paid low wages.
The fate of social care, where trained carers look after vulnerable people in their homes and offer mental health services, is closely tied to the NHS.
Hospitals suffer greater pressures when patients cannot be discharged as adequate care services — often provided by cash-strapped local authorities — are unavailable for them to return home.
Social care has particularly suffered as Brexit sealed the “escape valve” of freedom of movement across the EU that had filled staff shortages, Dayan added.
Rebecca Bland, registered manager at a nursing agency in northwest England, told AFP the pandemic and new immigration rules have hampered recruitment.
The 42-year-old’s company works with the local NHS and has long recruited from abroad, especially the Philippines, but has only hired one-tenth of the staff required since the pandemic began.
Bland said her colleagues were “being pushed to the limit”, calling it “an existential crisis” exacerbated by pre-existing recruitment difficulties caused by low-paid, insecure work.
However, Dayan blamed workforce shortages on decades-old failures by successive UK governments to train enough staff and provide adequate long-term planning.
“The underlying problems are domestic in nature,” he stressed.
The UK government last month announced new NHS and social care funding worth £36 billion ($50 billion, 42 billion euros) over three years.
But Dayan warned cash injections alone would not resolve staff shortages, instead advocating better workforce planning to recruit and retain staff more effectively.
The UK government on Thursday announced a dramatic reduction to its coronavirus travel “red list”, scrapping bans on foreigners travelling to England from 47 countries.
Under the new rules that come into effect from 0300 GMT on Monday October 11, only seven countries — Colombia, the Dominican Republic, Ecuador, Haiti, Panama, Peru, and Venezuela — will remain under the restrictions.
Removal from the “red list” for the 47 countries and territories, including Brazil, Mexico and South Africa, means passengers will no longer be required to enter hotel quarantine.
Transport Secretary Grant Shapps said the move was possible because of “the increased vaccination efforts around the globe”.
The government also announced it was extending inbound vaccinated arrivals to a further 37 countries and territories including India and Turkey.
The United Kingdom has reviewed its travel protocols for travellers from Nigeria who have taken their complete jabs of the COVID-19 vaccines approved by authorities in the country.
This was announced in a statement by the British High Commission on Thursday.
“From Monday, 11 October 2021, fully vaccinated travellers from Nigeria will be able to come to England without needing to provide a pre-departure test, undertake a day 8 test or self-isolate for 10 days, although will still need to book and pay for a day 2 test,” the statement read in part.
The revised policy applies to those who have been fully vaccinated with AstraZeneca (including Covidshield), Pfizer, Moderna and Johnson and Johnson vaccines.
“Fully vaccinated means that you have had a complete course of an approved vaccine at least 14 days before you arrive in England. The day you had your final dose does not count as one of the 14 days,” the statement added.
“You must be able to prove that you have been fully vaccinated under a vaccination programme and have a valid proof of vaccination recognised by the British Government (for Nigeria, the certificates with valid QR codes as issued by Nigeria’s National Primary Health Care Development Agency are recognised).”
Acting British High Commissioner, Ben Llewellyn-Jones, described the changes to travel rules for fully-vaccinated Nigerians as “a very welcome development”.
“To make this happen, we have been working closely with Nigeria’s National Primary Health Care Development Agency (NPHCDA) on recognising Nigeria’s vaccine certification, which we have now done,” he was quoted as saying in the statement.
“The UK remains committed to opening up international travel and enabling those who wish to enter the UK, to do so safely.”
Travellers from Nigeria who are not fully vaccinated would be required to take a pre-departure COVID-19 test – three days before they travel, as well as complete a passenger locator form – any time in the 48 hours before arrival.
After arriving in England, they would also need to book and pay for day-2 and day-8 COVID-19 tests, self-isolate for 10 days, as well as take a pre-booked COVID-19 test on or before day-2, and on or after day-8.
“Vaccines work and – as the pandemic has shown – no one is safe until we are all safe. I would encourage all eligible people to get vaccinated,” Llewellyn-Jones said.
Dubai’s ruler Sheikh Mohammed bin Rashid Al-Maktoum authorised the use of spying software to hack the phone of his ex-wife, according to a British court ruling published on Wednesday.
The phone of Princess Haya Bint Al Hussein, 47, and those of her lawyers and others in her entourage were hacked using Pegasus spyware during the pair’s acrimonious divorce custody case in London, the High Court found.
The 72-year-old sheikh, who is the vice-president and prime minister of the UAE, gave his “express or implied authority” for the phone of Princess Haya to be hacked with the multi-million-pound software only available to national governments, the ruling said.
Presiding judge Andrew McFarlane concluded Sheikh Mohammed was “prepared to use the arm of the state to achieve what he regards as right”, explaining the surveillance of at least six phones was attempted.
“He has harassed and intimidated (her) both before her departure to England and since,” he added.
In March 2020, McFarlane ruled on the balance of probability that the billionaire Emirati sheikh had ordered the abduction of two of his daughters by another marriage and subjected Princess Haya to a campaign of fear.
She was forced to flee to London in 2019 with their two children, Al Jalila, 13, and Zayed, aged nine, as a result.
After Sheikh Mohammed applied for the two children to be returned to the Gulf kingdom, Princess Haya — his sixth wife and a half-sister of Jordan’s King Abdullah II — filed for the children to be made wards of court and requested a non-molestation order for herself.
The use of the Israeli-developed Pegasus software, which can track a person’s location and read texts and emails, was revealed in August 2020 following a tip-off by lawyer Cherie Blair, whose husband is former British prime minister Tony Blair, to the princess’ legal team.
Rights groups have accused software developer NSO of allowing its spyware to facilitate state-sponsored repression after it was used to hack the phones of activists and journalists around the world.
Sheikh Mohammed has denied any knowledge of the hacking but his lawyers suggested another country like Jordan could be responsible in efforts to embarrass him.
He has previously strongly denied the claims made by the princess in the case about their children’s welfare.
The United Kingdom’s National Health Service on Tuesday announced what it described as a “life changing treatment” for sickle cell disease (SCD).
“Known as Crizanlizumab, the new drug will be delivered by a transfusion drip and works by binding to a protein in the blood cells to prevent the restriction of blood and oxygen supply that lead to a sickle cell crisis,” a statement from the NHS said.
The drug is expected to help persons living with SCD have “a much better quality of life.”
SCD, according to the World Health Organisation (WHO), is a major genetic disease where the normal round shape of red blood cells become like crescent moons, leading to blood clots which can cause extreme pain in the back, chest, hands and feet.
There is no known cure yet, except stem cell transplants, a procedure which requires a donor, is expensive, emotionally exhausting and carries fatal risks.
The disease is prevalent in Nigeria, perhaps more than anywhere in the world.
About 30 percent of the population are carriers of the sickle cell trait. And almost three percent of Nigerians are living with SCD.
It is considered to be the most common genetic disorder in Nigeria, but testing is not available to the vast majority of infants, leading to thousands of deaths every year.
The number of UK nationals left behind in Afghanistan is in the “low hundreds”, British Foreign Secretary Dominic Raab said on Tuesday, after the two-decade Western military presence there ended.
Raab added he was unable to give an exact figure for how many British nationals and others potentially eligible to leave Afghanistan had not been evacuated following the Taliban’s takeover.
“It’s very difficult to give you a firm figure,” he told BBC radio, hours after the last US troops flew out of country.
Britain concluded its airlifts from Kabul airport on Saturday.
“I can tell you that for UK nationals we’ve secured since April over 5,000, and we’re in the low hundreds (remaining),” Raab said.
Prime Minister Boris Johnson hailed Britain’s evacuation efforts as they ended over the weekend, noting it had airlifted over 15,000 people in the last two weeks.
But his government has faced scathing criticism over its handling of the crisis, prompted by the decision of its ally the United States to end its 20-year Afghan presence.
That led the Taliban to recapture power earlier this month — and the West scrambling to exit the country amid chaotic scenes.
Critics have argued the Taliban’s return and Western forces’ hasty withdrawal leaves Afghanistan open to becoming a sanctuary for terrorism again, 20 years on from the 9/11 attacks.
Fears are growing in particular that the Islamic State’s Afghan offshoot, which has claimed responsibility for last week’s suicide attack that left scores of Afghans and 13 US troops dead, could strengthen there.
Air Chief Marshal Mike Wigston, the head of Britain’s air force, suggested Tuesday the country’s military would continue to target the Islamic State — also known as Daesh — inside Afghanistan despite the West’s total withdrawal.
“We’ve got to be able to play a global role in the global coalition to defeat Daesh, whether it’s strike, or whether it’s moving troops or equipment into a particular country, at scale and at speed,” he told the Daily Telegraph.
“If there’s an opportunity for us to contribute I am in no doubt that we will be ready to,” Wigston added.
“Afghanistan is probably one of the most inaccessible parts of the world, and we’re able to operate there.”
The Taliban’s takeover of Afghanistan is a “failure of the international community”, Britain’s Defence Secretary Ben Wallace said on Monday, assessing that the West’s intervention was a job only half-done.
“All of us know that Afghanistan is not finished. It’s an unfinished problem for the world and the world needs to help it,” he told BBC television.
The former British Army officer last week said US President Joe Biden’s predecessor Donald Trump had secured a “rotten deal” with the Islamist militants that allowed their return.
He maintained the 20-year intervention by US-led forces in Afghanistan “wasn’t a waste, it wasn’t for nothing” but accused Western powers of being short-sighted in policy matters.
“If it’s a failure, it’s a failure of the international community to not realise that you don’t fix things overnight,” he said.
“I’m afraid when you deal with a country like Afghanistan, that is 1,000 years of history effectively and civil war, you manage its problems and you might have to manage it for 100 years.
“It’s not something that you just rock in, rock out, and expect something to be fixed.”
Wallace also said there had been “a failure to recognise that military might on its own” could not completely resolve the situation in Afghanistan.
“Half the mission on its own… was entirely successful,” he said, pointing to the removal of the Taliban after the September 11, 2001 attacks and the death of Al-Qaeda chief Osama bin Laden, which made the world safer.
But “that doesn’t mean that the next 20 years are going to be the same”, he added, echoing concerns about the impact of the hardline group’s resurgence on world security.
Britain last month withdrew the majority of its 750 remaining troops in Afghanistan, but last week announced that 600 soldiers would return to help with repatriation.
Wallace told Sky News 370 embassy staff and British citizens were flown out on Saturday and Sunday, with 782 Afghans scheduled to leave in the next 24 to 36 hours.
Officials are aiming to evacuate 1,200 to 1,500 people from Afghanistan a day, he added.
Prime Minister Boris Johnson has said Britain would help some 3,000 nationals to leave.
Senior politicians and military top brass have strongly criticised the withdrawal of international troops from Afghanistan.
Parliament has been recalled on Wednesday to discuss the situation, including asylum and support for Afghan nationals who have fled.
Members of the President’s delegation to the UK included the Minister of Foreign Affairs, Geoffrey Onyeama; Minister of State for Education, Chukwuemeka Nwajiuba; Director-General of the National Intelligence Agency, Ambassador Ahmed Rufai Abubakar and the National Security Adviser, Major General Babagana Munguno (retired).
President Buhari had on July 26 travelled to London, United Kingdom to participate in the Global Education Summit on Financing Global Partnership for Education (GPE) 2021-2025 and see his doctors.
At the summit, he pledged to increase the budget for the education sector by as much as 50 per cent over the next two years.
During the visit, the Nigerian leader also met and played host to various dignitaries including the UK Prime Minister, Boris Johnson.
The Prime Minister during the meeting assured Buhari that the UK is available to assist Nigeria in its war against terrorism.
After 19 days abroad, President Buhari returned to the country.
Six people, including the suspected gunman, died Thursday following a “serious firearms incident” in the southwestern English city of Plymouth, police said, with reports one victim was a child aged under 10.
Devon and Cornwall Police declared a “critical incident” in the Keyham area of Plymouth early Thursday evening after the shooting, but later said it was not being considered terrorism related.
Officers responded alongside other emergency services, including air ambulance staff, to reports of gunshots in the residential neighbourhood near some of the city’s docks.
“Two females and two males were deceased at the scene,” Devon and Cornwall Police said in an update early Friday after hours of uncertainty around the incident.
Police added another male — believed to be the gunman — was also found dead nearby while another female treated at the scene died a short time later in hospital.
“All are believed to have died from gunshot wounds,” the force said.
Shortly after police confirmed the death toll, local lawmaker Luke Pollard reported one of those killed “was a child under ten years old”.
“More people are being treated for their injuries in hospital,” the Labour MP tweeted.
“Just so unspeakably awful. My condolences and thoughts are with the families.”
It was unclear how the victims and suspected perpetrator were connected, with many details of what unfolded in the city of around 262,000 residents in the sleepy southwest English county Devon remaining unclear.
“Police would stress this is not a terrorism related incident,” Devon and Cornwall Police said, noting officers were not looking for anyone else in connection with it.
“Investigations are continuing,” the force added, urging people with mobile phone footage of the aftermath of the events not to share it online.
Interior Minister Priti Patel called the incident “shocking” and said her thoughts were “with those affected” but did not reveal further details of what had happened.
“I have spoken to the Chief Constable and offered my full support,” she tweeted.
“I urge everyone to remain calm, follow police advice and allow our emergency services to get on with their jobs.”
‘Randomly started shooting’
British media said residents had reported hearing loud bangs and gunshots before police swarmed the area.
Witness Sharron, who did not want to give her full name, told the BBC she had heard shouting followed by several gunshots.
“This was when the shooter kicked in the door of a house and randomly started shooting,” she said.
“He ran from the house shooting as he ran and proceeded to shoot at a few people”.
Robert Pinkerton, a second witness, told the British broadcaster he “walked around the corner” and “bumped into a bloke with a shotgun” dressed all in black.
South Western Ambulance Service said it had responded with a significant number of resources, including Hazardous Area Response Teams, air and ground ambulances, multiple doctors and senior paramedics.
Keir Starmer, leader of the Labour Party, said “tragedy has hit Keyham”.
“I pay tribute to our emergency services who ran towards events we’d all run from,” he added.
Mass casualty shootings are rare in Britain, where most police officers are unarmed, while southwest England — a popular domestic holiday destination — is typically known as a tranquil part of the country.
Plymouth, the region’s biggest city, is home to the biggest naval base in western Europe, including nuclear submarines and large warships.
Families wept as they were reunited at London’s Heathrow Airport on Monday, with fully vaccinated passengers arriving in England from the US and EU no longer required to quarantine.
Tight controls on foreign travel have been in place in Britain for over a year, leaving families separated during the coronavirus pandemic.
But restrictions in England and Scotland eased on Monday, leading to emotional scenes at Heathrow, Britain’s busiest hub.
“We’re feeling very excited, almost overexcited,” said Michael Blake, 71, as he waited with wife Sue to see their son Eliot and 8-year-old grandson for the first time in 18 months.
“It’s been such a big chunk of (our grandson’s) life that he hasn’t seen any grandparents,” Sue told AFP, as she waited for the 6:20 am (0520 GMT) flight from New York.
Onsight of her son, Sue ducked under the barrier at arrivals and embraced her grandson, wiping tears from her eyes.
Her family was one of the first to take advantage of the new policy, which came into force in England and Scotland from 4:00 am.
Under the new rules, people fully jabbed with a vaccine approved by the US Food and Drug Administration or the European Medicines Agency can travel from any country on the British government’s “amber” traffic light list without having to self-isolate at home for 10 days.
They still need to do a pre-departure test and take another test on day two after arriving.
– ‘Disaster’ warning – Separate rules will continue to apply for those arriving from France due to the government’s concern over the “persistent presence” of the Beta variant, which is believed to be more resistant to vaccines.
Those who are not fully vaccinated will still have to quarantine on arrival.
Britain is in the midst of another wave of the virus due to the Delta variant, although case numbers appear to be stabilising, while its vaccine drive has seen more than 70 percent of adults fully jabbed.
While England and Scotland have loosened their quarantine requirements, the previous rules still apply in Wales and Northern Ireland.
Embattled airline bosses called the rule changes a positive step but said industry recovery efforts were being hampered by continued international restrictions.
Heathrow Airport chief executive John Holland-Kaye told BBC radio that the industry would not “get back to normal” until the US opens its borders to people travelling from Britain.
Industry leaders also warned the government against introducing another category to its traffic light list, designed to warn travellers of the possibility that countries with rising cases could be put onto the red list at short notice.
“It would be a disaster to bring in an amber watchlist on top of the amber list, the green list, the red list,” Paul Charles, chief executive of travel consultancy The PC Agency, told ITV.
“At the moment the system in the UK is choking off recovery, and it’s not helping the sector because there’s no confidence to book because people are worried about places changing at short notice anyway,” he added.
“President Buhari has been with the same doctors and medical team for upward of 40 years,” he said when asked why the President couldn’t have been treated in Nigeria.
“It is advisable that he continues with that who knows his medical history and that is why he comes to London to see them. He has used the same medical team for over 40 years. Once you can afford it, then stay with the team that has your history.”
When asked if the President would pilot the nation’s affairs from the UK, the presidential spokesman said there is no vacuum within the seat of power.
He explained that the Constitution empowers Vice President Yemi Osinbajo to act as President if President Buhari is not back to the country within 21 days.
“The nation is running, there is a vice president who will attend to critical issues. There is no vacuum and a constitutional amendment has sorted that out,” Adesina explained.
On the out-of-school children, Adesina who noted that there is a reduction of the situation said President Buhari would brief participants of the development in the country.
On the five-year commitment to the funding of education, Adesina stressed that his principal would make pronouncements on that.
At the UK Summit, President Buhari is expected to hold a bilateral meeting with Prime Minister Johnson and would return to the country by the second week of August
Top officials that accompanied Buhari on the trip included the Minister of Foreign Affairs, Geoffrey Onyeama, and the Minister of State for Education, Chukwuemeka Nwajiuba.
Others are the National Security Adviser, Major General Babagana Monguno (rtd), and the Director-General of National Intelligence Agency (NIA), Ambassador Ahmed Rufai.