1. The population of the UK is growing very rapidly due very largely to immigration. This is having a significant impact on a range of services from the queue for social housing (see our separate overview on housing), to hospital, maternity and GP services as well as education, public transport, the environment and the general transport infrastructure.
2. The public are already feeling the strain. Of those questioned in a 2013 poll 65% thought that access to housing had been negatively affected by high net migration (poll results here) and a 2016 poll found that six in ten voters believe that immigration is piling too much pressure on schools, hospitals and housing (results here).
3. The NHS is affected in a range of ways by a growing population. While most migrants to the UK are of working age and therefore likely to be more healthy than the UK average (which includes the elderly) they do place certain specific demands on the health service as well as more general ones.
4. Generally speaking immigration means that there are more people for the NHS to care for. New residents will of course sign up with their local GP and in areas where immigration is high this can lead to longer waiting times for GP appointments and treatments. In 2013/2014 there were 600,000 new migrant GP registrations in England, Wales and Northern Ireland – that’s a new registration every minute.
5. Migrant women have a higher fertility rate than the UK born and therefore place a disproportionate burden on maternity care – more than one in four babies born in England and Wales (27%) in 2015 was to a migrant mother.
6. While migrants might be young when they first arrive they will also inevitably age and go on to place pressure on the NHS just as the existing population does.
7. An increased use of Accident and Emergency for non-emergency health concerns as a result of the pressure on GPs services is also a problem.
8. The government introduced an NHS surcharge of £150 per year in 2015 for students and temporary migrants from outside the EU. By Autumn 2016 this had raised an extra £164 million. However, the NHS has also been criticised by the National Audit Office (NAO) for inefficiency in collecting debts from non-EEA visitors and also for not being rigorous enough in checking the status of visiting patients from other European countries. In 2014/2015, the UK paid out £674 million to European Economic Area (EEA) countries for the treatment of UK nationals visiting Europe yet received just under £50 million from other European nations in the same year for the treatment of EEA visitors in Britain (Parliamentary Answer here). The NAO adds that the failure to collect debts for treating visitors will cost the health service more than £200 million in 2017.
9. Some argue that the NHS would collapse without migrant labour. It is true that migrants make up a significant share of the workforce. OECD figures suggest that 35% of UK doctors and 22% of nurses were born abroad. (In contrast, House of Commons Library research suggests that 26% of doctors in hospital and community health services are nationals of a country other than the UK, including 10% from other parts of the EU, and that 16% of nurses in hospital and community health services are non-British, including 7% from other parts of the EU. This is likely to reflect the uptake of British citizenship.) However, those working in health and social services make up only a tiny percentage - 4% in 2013 - of annual non-EU applications for skilled work permits. In any case, no one is advocating restricting doctors or nurses from coming to work in Britain where they are needed.
10. The independent Migration Advisory Committee has criticised the government for failing to maintain the supply of UK-trained nurses. Britain is also not training enough doctors. If it did perhaps we would not need to recruit so many doctors from overseas. The OECD finds that in Italy, the percentage of doctors born abroad is 5% while in Germany it is around 11%, perhaps reflective of better planning and financing of training.
11. There are of course additional moral reasons why the UK should not be taking medical professionals from countries where medical needs are far greater. For example, there are more nurses from Malawi working in London than there are Malawian nurses working in Malawi. The World Health Organisation says that a shortage of seven million doctors worldwide is particularly acute in sub-Saharan Africa and Asia.
In summary, while migrants undoubtedly make a valuable contribution to the health profession, they also place certain pressures it.
12. Immigration is also placing a strain on UK schools, and this is being felt most keenly in England where 90% of migrants live. There is currently an overall surplus of primary school places in England however, by the academic year 2018/19, it is estimated that three-fifths of primary schools in England will have a shortfall of places. Research by the ‘FindASchool’ website also found in October 2016 that more than half of England's secondary schools are now oversubscribed (press report here). One of the effects of this pressure is that, for many parents, there is now a complete absence of choice between schools.
13. The rising number of births is exacerbating some of this shortfall. The increase has been primarily because of a rise in births to non-UK born mothers, who accounted for 78% of the increase since 2002 (See here).
14. In addition some schools will need to provide additional support for migrant children that other children do not need - such as translation services and additional teachers for those whose first language is not English. A parliamentary answer in 2016 revealed that £267 million was allocated to schools in 2015/16 to support children for whom English is an additional language. (See here) For more on the impact of immigration on England’s schools see here).
15. High levels of immigration have led to an increased use of translation services in the public sector. In 2012 it was estimated that translation services cost the NHS Trusts alone £23 million. In 2013, then Communities Secretary Eric Pickles claimed that as much as £140 million was spent each year on translation services across the public sector.
16. The immigration fuelled increase in the UK’s population will also impact our roads. The traffic on Britain’s roads is expected to increase by over one third in the next fifteen years. Congestion is a cost to both the UK economy and individual households; idling in traffic jams was said to cost UK households £4.4billion in 2011.
17. More people also means more crowding on the public transport network, which in London and the South East is already extremely busy. The total number of passengers on the London Underground rose from 800 million a year in 2002 to 1.3 billion a year in 2016 (press report here). A senior manager has warned that overcrowding was threatening to make parts of the network “inoperable” by 2031. Tube stations are already so overcrowded that some, such as Victoria, have to be closed at peak times to prevent accidents. Immigration is also putting pressure on our water supplies. It is estimated that another 850 million litres of water will be needed in the next twenty or so years. (See herehere)
18. Proponents of mass immigration often suggest that since migrants pay tax they are contributing towards their share of public services and infrastructure. According a study by UCL all migrants between 1995 and 2011 had a net fiscal cost of between £18m and £25m per day. Furthermore, the requirement to expand public services and infrastructure is due to new migrants; if net immigration were zero there would be no need for a major expansion. To pay their way, therefore, migrants should contribute more than simply the costs of running existing services.
19. High net migration threatens the UK’s environment and biodiversity. The need to provide ever-growing numbers of homes, roads and public services for a rapidly expanding population adds to pressures on our countryside and the green belt. The Times newspaper (here) has called for building on the green belt to help meet the demand for 250,00 extra homes each year, without even acknowledging the rising demand associated with high met migration. Yet polling (here) suggests 64% of people agree green belt land should be protected. The need to cut migration must be central to considerations about striking a balance between meeting infrastructure demands and preserving the UK’s fields and hedgerows for future generations.
Updated November 2016