Published: 10/03/2005, Volume II5, No. 5946 Page 36

Discussions about the merits of immigration are plagued by a disjuncture between public perceptions of a system in chaos and the reality of increasingly important migrant contributions. These perceptions have undermined public confidence, led to increasingly restrictive policies on asylum, and have the potential to undermine race relations.

Nowhere is this clearer than in the health sector. And nowhere is it clearer that more needs to be done to correct the myths about the impact of immigrants and highlight the benefits of migration.

Public concern about the scale and impact of immigration is at unprecedented levels. Health is at the heart of this concern. Immigrants and asylum seekers have emerged as the scapegoat for many of the frustrations that people feel about the NHS. A glance at some recent headlines reveals the nature of the chord that is being struck:

'Asylum seeker? Doctor will see you first';

'HIV risk as the crowds flood in'.

The reaction of political leaders has given them even more legitimacy. Official promises to crack down on 'health tourism' and stop 'those trying to abuse our hospitality' not only compound fears that Britain is a soft touch but also add to a feeling of suspicion towards migrants.

What little evidence of 'health tourism' that exists suggests the scale of the 'abuse' is smaller than the government's own unsubstantiated estimate, and much smaller than the contribution to the system migrants make.

More than 25,000 work permits have been issued annually to workers in health and medical services in recent years, about a quarter of all work permits. Add those who enter via other routes (family reunion, asylum, ancestry etc) and the result is that almost one in three doctors, one in six dentists and one in 10 nurses in the UK are overseas trained.

These proportions are rising and are even higher in areas like London (where nearly half of all doctors and a quarter of all nurses are overseas qualified).

Assuming that a great majority of those with overseas qualifications are migrants, the proportion of migrants in the NHS is likely to be much larger than in the overall UK workforce.

Hiring overseas-qualified health professionals has saved the public purse significant amounts. And being able to draw on a ready supply of foreign workers has saved the NHS time, allowing it to expand rapidly to meet performance targets without waiting for the domestic workforce to be trained up. Yet these benefits are rarely highlighted by politicians and the popular press.

It is ironic that a sector which draws so heavily on migrant workers is also so central to fears about the impact of migrants. However, that irony may hold an important lesson for policy makers.

Highlighting the scale of their contribution will be an important step in gaining much-needed public support for managed migration.

Similarly, public concerns about abuse of the NHS cannot be ignored, but nor should they lead to tougher measures that might compromise human rights or public health outcomes. More needs to be done to design a fair but effective system of entitlements - and not just in health.

Dhananjayan Sriskandarajah is a senior research fellow and Gareth Morrell is an intern at the Institute for Public Policy Research. IPPR's latest FactFile, Migration and Health in the UK, can be downloaded from www. ippr. org/migration