Public Services & Infrastructure

Public Services & Infrastructure: MW 433

1. Between 2001 and 2012 the UK population grew by 4.7 million people and over 80% of this growth was the result of immigration and births to migrants. (Read our full briefing on population growth between 2001-2012 here.)

2. The population is set to continue growing rapidly. If net migration continues at a quarter of a million a year, which was the average over the last ten years, then the population will grow by 9.7 million over the 25 year period from 2016 to 2041. This growth will occur very largely due to migration – indeed 82% will be the direct and indirect result of migration, that is migrants and their future children.

3. Such rapid population growth will continue to have a significant impact on the provision of public services from the queue for social housing (see our separate overview on housing), to hospital, maternity and GP services as well as education, the environment and transport.

4. The public are already feeling the strain. A 2016 poll found that six in ten voters believe that immigration is putting too much pressure on schools, hospitals and housing (To read the full Ipsos MORI results see here and to read an overview of recent opinion polls see here)

The impact on the National Health Service

5. The NHS is affected in a range of ways by a growing population. While most migrants to the UK are of working age on arrival 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.

6. Naturally, 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 2015/2016 there were almost 745,000 new migrant GP registrations in England, Wales and Northern Ireland – that is more than one every minute and the highest number on record.

7. Non-UK born women also have a higher fertility rate than UK-born women and therefore place a disproportionate burden on maternity care – more than one in four babies born in England and Wales (28%) in 2016 was to a non-UK born mother.

8. While migrants might be young when they first arrive they will inevitably age and place pressure on the NHS just as the existing population does. 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.

9. The government estimates that in England the use of the NHS by overseas visitors and migrants costs up to £2 billion a year. An NHS surcharge of £200 per year for non-EU migrants (£150 per year for students) was introduced in 2015 to try to recoup some of these costs. In 2015/16 this raised £164 million and it is estimated that the surcharge will bring in £1.7 billion between 2015 and 2025.

10. Non-EU visitors to the UK are meant to pay for the costs of their treatment in non-emergency situations. However, the NHS has been criticised by the National Audit Office (NAO) for inefficiency in collecting debts from non-EEA visitors. The NHS has been incentivised to charge patients as they can now charge 150% of the cost of the treatment.

11. Visitors from the EU are mostly covered for treatment by the European Health Insurance Card (EHIC) system under which the NHS charges their home country for treatment. However, the NAO has also criticised the NHS 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 (Read the full Parliamentary Answer here). In 2015/16 the NHS recovered £56 million from other EEA countries, far short of its target of £88 million target. (You can read a summary of the NAO report here)

12. 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 are non-UK nationals including 10% from the EU, and that 16% of nurses are non-British, including 7% from the EU. The difference is likely to reflect the uptake of British citizenship). 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.

13. 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.

14. 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.

15. There are also 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.

16. In summary, while migrants undoubtedly make a valuable contribution to the health profession, they also place certain pressures it.

The Impact on Schools

17. Immigration is also placing a strain on UK schools, and this is being felt most keenly in England where 90% of migrants live. At present almost a quarter (23%) of primary schools are either full or the number of pupils at the school is in excess of the capacity. The figure for secondary schools is lower (14%) in part because it is easier to plan for secondary school places than primary school places. However, research by the organisation ‘FindASchool’ found that over 50% of secondary schools received more applications than there were pupil places. (The press report can be read here) One of the effects of this pressure is that, for many parents, there is now much more limited choice between schools.

18. Looking ahead, by the academic year 2018/19, it is estimated that three-fifths of primary schools in England will have a shortfall of places. (You can read our report on immigration and primary school places here) The Department of Education estimates that an additional 750,000 school places will be needed in England by 2025.

19. The rising number of births is exacerbating some of this shortfall. A Parliamentary Answer revealed that the increase in births has been primarily because of a rise in births to non-UK born mothers, who accounted for 78% of the increase since 2002.

20. In addition some schools will need to provide additional support for migrant children that other children do not need - such as translation and interpretation 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.

The Impact on Roads, Transport and other Infrastructure

21. The immigration fuelled increase in the UK’s population will also impact our roads. In 2013 the average British driver spent 124 hours in traffic jams and £13 billion was lost to the economy as a result of congestion. By 2030 road users are expected to spend an average of 136 hours in traffic costing the economy £21 billion. (See the INRIX and Centre for Economics and Business Research report here)

22. More people also means more crowding on the public transport network, which especially 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). In mid-September to mid-October 2017 109 million journeys were made on the Underground, an increase of 10% on the same period the year before. (See here) A senior manager has warned that overcrowding was threatening to make parts of the network “inoperable” by 2031.

23. Immigration is also putting pressure on our water supplies. It is estimated that in 25 years time another 850 million litres of water will be needed every day in England, that is equivalent to the amount of water in 340 Olympic sized swimming pools. (To read our report on water see here) The Royal Geographical Society has ranked the South East of England 161st out of 180 areas globally for its ability to deliver sufficient water to its inhabitants.

Expansion of Public Services and Infrastructure

24. 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 largely 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.

Impact on the environment

25. 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. Polling carried out by the Campaign to Protect Rural England shows that 64% of people agree that 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 countryside for future generations.

18 December, 2017

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