Reliance on migrant healthcare workers in the United Kingdom: A critical discourse analysis

The UK National Health Service (NHS) has relied on Migrant Healthcare workers (M-HCWs) since its inception. These M-HCWs have typically come from Low and Middle-Income countries (LMICs) and particularly, countries that were previously under British colonial rule. Despite this, medical workforce shortages persist in the NHS and there has been a lack of policy consensus about how best to ameliorate it. In June 2021, Baroness Dido Harding made an ultimately unsuccessful pitch to lead the NHS. During this period she made a statement where she expressed an ambition to reduce reliance on M-HCWs that was met with controversy in the general and medical press. This Critical Discourse Analysis (CDA) examines the responses published in newspaper, media and journal articles in the month following Baroness Harding's statement. The dataset includes a variety of opinions about medical migration and M-HCWs and explores how language is connected to power and knowledge constructed and the effects of these discourses. It draws on theoretical approaches derived from the philosopher Michel Foucault and the postcolonial analyst Edward Said. A total of 48 articles were included in the final dataset which highlighted two main strands of discourse. The first strand is dominant and dissents against Baroness Dido Harding herself, her position, and her statement, predominantly on the grounds that it undermines historic and ongoing contributions of M-HCWs to the NHS. The second strand, which is notable in its relative absence, supports the implications of reducing reliance on M-HCWs. We identified a dominant discourse of support for M-HCWs based on their valuable contributions to the NHS. However, the relative absence of the second strand suggests a marginalisation of debate about the reliance on migration pathways which were often founded on colonial roots, the exacerbation of brain-drain from the Global South, and the inequities that this perpetuates.