The NHS has a recruitment crisis – heightened by the ‘hostile environment’

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Disastrous NHS workforce strategy meets racism and discrimination

Our NHS is suffering a recruitment and retention crisis caused by the effects of sustained and significant underfunding, a failed workforce strategy (doctor and nurse training posts were cut in 2010) and the impact of low morale on NHS staff. There are 100,000 vacancies in a workforce of 1.3million. Of these 35,000 nursing posts are vacant. The service is currently 10,000 doctors short across both primary and secondary care and yet foreign doctors’ offered training posts in NHS hospitals have been refused visas by the Home Office as it extends its ‘hostile environment’ with racist undertones to the NHS.

According to official figures a total of 1,518 medical applications were refused by the Home Office in the period December 2017-March 2018. The figures show that ‘976 requests for specialty registrar visas were turned down, 331 for foundation year 2 doctors, and 47 for FY1 doctors. In addition, 164 rejected applications were described as being from ‘specialty doctors and equivalent’. [British Medical Journal]

In April of this year the Home Office blocked visas for 100 Indian doctors recruited by the NHS and seeking to enhance their training by working in the NHS. These individuals were part of a post-graduate training programme (Earn, Learn and Return) aimed at attracting overseas talent, and had already been offered positions in 35 separate trusts.

A failure over many years to train enough new doctors coupled with increasingly difficult working conditions due to the effects of an underfunded system, has meant that the immense talent in our NHS is being increasingly lost to countries such as Australia where the work-life balance and conditions are far more attractive a proposition. In addition, the looming prospect of Brexit means European applications for NHS staff have declined significantly. ‘According to NHS Digital nearly 10,000 EEA nationals quit the NHS in 12 months following the Brexit referendum, up 22% on the previous year’. [Business Insider UK]

The Government is clearly averse to spending what is needed in order to ensure the proper functionality of the NHS. In light of the many challenges the service faces, one would perhaps suppose that initiatives to alleviate pressures which do not require spending would be very welcome. However, this unfortunately does not seem to be the case, leading some to question the Government’s motives. Like so many other issues in the NHS, the gaping hole in staffing could be much alleviated if the Government only chose to act differently. Is denying entry to qualified overseas doctors in fact a deliberate strategic move to undermine the service further?

Academics have singled out the UK as one of the top developed countries that relies most on importing trained doctors from abroad. In some areas, such as the south east of England, 43% of doctors hail from overseas, yet foreign doctors increasingly face a hostile environment with regard to government policy. And in the context of the Windrush scandal, denial for months of treatment to longstanding residents of Afro-Caribbean origin such as Albert Thompson, deportations carried out and more threatened, this smacks overtly of racism. Prime Minister Theresa May is keen to appease her anti-immigration voters and willing to do damage to the NHS.

So how does the Home Office justify these actions? Arbitrary rules set for immigration demand salaries of visa applicants must exceed £55,000 pa in order to be considered. When ‘quota’ limits for the month are approached, the salary bar rises even higher. Many junior doctors do not meet this criterion. In 2011 during her time as Home Secretary, Theresa May imposed a limit on the amount of skilled non-EU workers that may take up residence to 20,700 a year. Certain types of doctor are exempt (including emergency care) as they are on the ‘shortage occupation list’ but there are significant shortages in an array of other departments. It is in this context, the 100 Indian doctors invited by NHS trusts to come to fill vacancies have been refused visas.

A culture of fear

Even when doctors are accepted into the country, there remains a culture of fear. Employees worry about making mistakes on their immigration forms for fear of deportation. Staff in our NHS should be enthusiastically welcomed when filling much-needed positions, but they are met with the hostile environment close in intent to that of the ‘Windrush scandal’.

Vociferous opposition from colleagues and supporters of Dr Luke Ong forced the Home Office recently to call off it’s attempt to deport him. Dr Ong is a Singaporean doctor who has lived in the UK for 10 years, qualified at Manchester Medical School and is soon to complete his GP training. However, ‘Manchester-based Dr Luke Ong, 31 was refused the right to remain in September because his application was 18 days late due to a mistake’. [BBC]

Sadly, Dr Ong is not the only doctor to find himself in this position. In Newcastle the Home Office has turned down Dr Nnaemeka Chidumije’s application for a visa 4 times and told him to leave the UK and reapply for a work permit following the breakup of his marriage.

Dr Nnaemeka Chidumije has worked in the NHS for 4 years and was undergoing surgical training when he was told he would have to leave the country because his spousal visa had been curtailed. He has therefore been unable to complete his final work rotation as a surgical registrar or apply for the next stage of his training. Health Education England sees the situation to be clearly worsening – HEE ‘has informed Dr Chidumije that it had not had these issues with doctors’ visa sponsorship until this year’.

Unforeseen consequences

The shortage of doctors in England has many knock-on or unforeseen consequences. Denying qualified overseas doctors entry into Britain to take up permanent positions puts further financial pressure on trusts forced to employ locums each of which can cost up to £150,000 a year in agency fees alone.  It also negatively impacts junior doctors who will be working extra shifts at the expense of valuable training time to cover the vacancies. In addition, the dangerous rota gaps in some areas mean that Consultants need to cover for their registrars and elective treatments and operations are inevitably cancelled.

It is evident that the Prime Minister either fails to grasp all  of this or worse, cares little. Even Amber Rudd the former Home Secretary, along with Health Secretary Jeremy Hunt, apparently appealed to the Prime Minister for several months to relax strict immigration rules for doctors in order to alleviate NHS pressures – without success. Rudd had advocated that the profession should be excluded from ‘tier 2’ visa scheme covering highly skilled workers. However, the Home Office opinion was that this could prejudice other workers in this tier, as numbers overall must be capped.

Even Jeremy Hunt appeared to recognise the ongoing need for overseas staff to help alleviate chronic shortages when he promised to raise a short-term healthcare visa scheme with new home secretary Sajid Javid. A few weeks ago, the BMA and 13 other health organisations wrote to the new Home Secretary warning of the implications of restricting doctors’ visas.

Dr Chaand Nagpaul, chair of the BMA council asserts that these immigration rules are ridiculous and negatively impact the future of the NHS:

“It’s inexplicable that, at a time when the NHS is struggling with filling positions, visa restrictions and arbitrary and outdated caps for non-EU workers entering the UK are preventing doctors, who are willing and able to work, from caring for patients. Not having the right amount of doctors will inevitably threaten patient care and safety.” [The Guardian]

The Government was forced to defend its position during a debate in the House of Lords on 8th May when Labour peer Baroness Thornton said the cap was harming patient care. However, a spokesperson for the Government said the visa system was being monitored (Evening Standard):

“The Government fully recognises the contribution that international professionals make to the UK. However, it is ¬im-portant that our immigration system works in the national interest, ensuring that ¬employers look first to the UK resident labour market before recruiting from ¬overseas.”

This statement ignores the obvious – the Government has failed to train enough of our own medics to fill these roles. It is reminiscent of various times in the past when the Government has denied reality, or worse, (as with the last two winter crises) it has made completely false statements to the public. The Government must end its hostility to immigration. In parallel it needs to start valuing its workforce, improving working conditions and crucially investing in the NHS to stop talent draining out of the health service like a sieve.

What will the future hold?

In recent days a public survey conducted by Ipsos MORI for the Evening Standard has concluded that the public is overwhelmingly in favour of relaxing immigration rules for foreign doctors, acknowledging the vital contribution they can make to our NHS. ‘It found that 37 per cent of Britons say there should be no cap on non-EU doctors, while a further 27 per cent believe more visas should be issued.’ Another poll carried out by YouGov on behalf of campaign group 38 Degrees, found that among Brexit voters, 69% said that the UK should decide on visas for NHS staff “based on what the NHS needs”. The survey also found that only 21 per cent of Conservative voters agreed with the policy.

Campaigners such as Docs not Cops and Doctors of the World UK are increasingly campaigning against the hostile environment of current immigration policy. We will see whether Jeremy Hunt can use his powers of persuasion with the Prime Minister which appeared to work well in the January reshuffle when he refused to accept another brief and was re-branded as Secretary of State for Health and Social Care (in fact, he had always been the responsible minister for personal social care). However, it will be campaigners such as ourselves, working with Docs not Cops and others, who will combine with more principled politicians to force a change of political direction that will benefit the NHS.

Join us in London on 30 June with Health  Campaigns Together, The People’s Assembly, the TUC and 14 unions to celebrate the 70th birthday of the NHS and yet to protest about the unforgivable and damaging government policy to undermine it.


Samantha Wathen, Press and Media Officer

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