Plan to end NHS reliance on foreign medics could backfire, Hunt told

Leading doctors are warning Jeremy Hunt that his plan to make the NHS “self-sufficient” with homegrown medics will not work and poses “a major risk” to the health service.

In a letter to the Guardian, the presidents of two of the profession’s medical royal colleges tell the health secretary that his move has demoralised overseas doctors already working in the NHS and could deprive it of the long-established supply of foreign medics upon whom it depends.

The intervention by Professor Jane Dacre, president of the Royal College of Physicians (RCP), and Clare Marx, her counterpart at the Royal College of Surgeons (RCS), is a direct challenge to Hunt, who unveiled his new approach to tackling the NHS’s lack of doctors at last week’s Conservative party conference.

The NHS in England would have all the home-trained doctors it needed by 2025 and end its reliance on medics who come from scores of other countries, he pledged.

“While the recent announcement by the secretary of state of 1,500 extra medical school places is welcome, as over a quarter of current NHS doctors are from overseas, the extra places will not in themselves produce a self-sufficient UK medical workforce and we will still need our overseas doctors,” Dacre and Marx state in their letter.

“The announcement has led to our colleagues from overseas feeling that they may not be as valued as UK doctors and is affecting morale. We cannot let this happen.”

They also warn Hunt that his plan could backfire because medicine is now “an international profession” characterised by “free movement of doctors around the world”.

Highlighting the important role overseas doctors perform in the NHS they add: “This model has served the UK and the NHS well for decades. Moving away from that model is a major risk to the success of the NHS.”

The RCP represents about 20,000 hospital doctors across the UK, both consultants and trainees, while the RCS represents 13,178 surgeons in UK-wide hospitals.

Hunt won widespread acclaim for his plan. However, while applauding his determination to tackle chronic understaffing in the NHS, medical organisations pointed out that the extra 1,500 newly qualified doctors a year it is intended to produce will not be ready to start treating patients for a decade or more, and even then are unlikely to prove enough on their own to meet the rising demand for healthcare driven by the ageing and growing population and rise of lifestyle diseases.

Dr Mahiben Maruthappu, the chairman of the UK Medical Students’ Association, has also voiced concern about Hunt’s plan. Contradicting the health secretary’s claim that many would-be doctors are being denied places at university, he said: “Some medical schools are actually struggling to fill their places, meaning that these ambitions may also not be practical. I also believe that creating a health service that is 100% self-sufficient, one that only trains homegrown doctors and one that doesn’t take people from overseas and vice versa, is bad for medicine and bad for patient care.”

Dr Mark Porter, chairman of the British Medical Association, endorsed Dacre and Marx’s views. “If the government’s plan is to train more UK doctors and stop recruiting from abroad, it will not address the staff shortages in any way. There simply won’t be enough doctors for the number of patients walking through our hospital and GP surgery doors.

“The reality is that training this number of extra doctors will not make the NHS self-sufficient by 2025. But the question should be whether we want or need it to be. The government should not underestimate the vital skills and expertise that overseas doctors bring,” he added.

Plan to end NHS reliance on foreign medics could backfire, Hunt told

"Diversity is good": your views on plans to end reliance on overseas doctors

Those who agree with Hunt’s proposals: ‘I think it is wrong that graduates aren’t legally obliged to stay’

I think Hunt’s proposals are excellent considering what he has said in the past. It’s important to train more British doctors and I also really like his idea to help more people from disadvantaged backgrounds get into medicine.

Foreign students already pay eye-watering fees to study medicine in this country. If you can afford to pay £35,000 per year it isn’t that much of an increase to £40,000. So the funding should be there, as should the demand for medical school places from domestic students.

I’m not put off by his proposal to work for four years. The NHS massively subsidise medical students and I think it is wrong that UK graduates aren’t legally obliged to stay in the NHS after graduating. I certainly feel morally obliged to do so.

Anonymous, 23, medical student, London

‘Doctors need to be able to communicate in English to a very high level’

Doctors need to be able to communicate in English to a very high level, so what Hunt is proposing is a good idea. Also, it is not ethical to employ doctors from countries who have a great need for doctors themselves. Especially when the need for doctors in hospitals and in GP practice is increasing.

As a nurse, I saw doctors who were far too tired to be working. I know things are better since the early 1980s, but there is still room for more improvement.

Anonymous, 64, former nurse living in Huddersfield

‘We have been draining other countries of their clinical talent for decades’

Hunt’s proposals are the right decision but have been far too long in coming. While I have complete faith in the ability and competence of foreign NHS staff of all grades, we have been draining other countries of their clinical talent for decades – this is not a newly identified issue.

While medical schools conduct fairly robust vetting processes already, which of course include a requirement to achieve specific grades at A-level, I do believe that there is room for this process to become more nuanced.

One risk to Mr Hunt’s plan, however, is that his recent battles with junior doctors may undermine any prospective student’s faith that they will receive a fair salary once they find themselves in employment as a doctor after years of studying and training – a considerable commitment.

Anonymous, 32, senior NHS analyst, Hampshire

A doctor at the accident and emergency department of Birmingham Queen Elizabeth Hospital. Photograph: Christopher Furlong/Getty Images

Those who disagree with Hunt’s proposals: ‘The NHS needs those extra 100,000 medics’

I believe having a diversity of doctors and nurses in the NHS is a good thing. Our patients are not exclusively UK-born or speak English as a first language, so why should our doctors?

There are excellent doctors, and not-so-excellent doctors. There are doctors who are wholeheartedly invested in the NHS, what it stands for, what it provides, and some who are not. My experience is that neither of these groups relate to a doctor’s immigration status.

1500 extra medical students a year will not replace 100,000 doctors, particularly in a service that is spectacularly under-staffed as it is. The NHS needs those extra 100,000 medics, regardless of what Jeremy Hunt says or believes.

Becca, 27, junior doctor, Yorkshire and Humber

‘People will just leave after four years’

This will not help the recruitment and retention crisis whatsoever. Unsatisfied with breaking every NHS target in recent years, he’s now picking fights with the people who work tirelessly to keep the NHS going. He is the most hated health secretary, and possibly politician, of recent times.

Hunt’s proposals are absolutely not workable. People will just leave after four years, or, train in European universities, the fees are much less than UK, and allows them freedom to move. We will haemorrhage the brightest and best.

I am leaving for Canada. I have no intention in taking part in the willful destruction of the NHS. Medicine as a career is finished in this country. Rather like our motor industry, we have been mismanaged to the point of rock bottom morale and people are leaving in droves. Several of my colleagues have left for Australia and New Zealand, I wish I had left sooner. If you treat highly intelligent people like this, they will leave.

Zakir Hajat, 30, anaesthetist, Sheffield

‘If I were a student now there is no way I would pursue medicine in the UK’

Hunt’s proposals are insane. We’ve never trained enough doctors or nurses to staff the NHS. We used to have a regular supply of well-trained doctors coming here from the Indian subcontinent, as well as a steady flow of doctors from Australia and New Zealand who would come for a couple of years as our training was excellent. They don’t anymore, because why would they now?

To train enough doctors to be all UK grown will take many, many years. With the haemorrhaging of staff to early retirement or overseas he’ll be lucky to have any kind of useful workforce to maintain what services we provide now. To recruit and retain doctors is easy. You treat them with respect. You offer them reasonable conditions. You pay them fairly, and you train them well. Then they will come and they will willingly work very hard, over and above what is expected or paid for. Treat them the way Hunt is, and they’ll go.

If I were a student now, there is no way I would pursue medicine in the UK. If you treat staff properly, they won’t want to leave anyway. This is home. The vast majority want to live and work here.

Tim Campbell-Smith, 47, consultant surgeon, Sussex

"Diversity is good": your views on plans to end reliance on overseas doctors

Jeremy Hunt promises to end NHS reliance on overseas doctors after Brexit

Jeremy Hunt is to pledge that the NHS in England will be “self sufficient” regarding doctor numbers after Britain leaves the European Union, as he sets out a package of measures aimed at reducing its reliance on foreign-trained medics.

The health secretary will use his speech to the Conservative party conference on Tuesday to promise that medical schools in the UK will be allowed to offer up to 1,500 extra training places every year, and released figures that said that one in four NHS doctors have been trained abroad.

Hunt will stress that foreign-trained doctors do a “fantastic job”, and say that “we want EU nationals who are already here to be able to stay post-Brexit” – but he will also ask: “Is it right to import doctors from poorer countries that need them while turning away bright home graduates desperate to study medicine?”

He wants NHS England to reach the target in 2025. “Of course it will take a number of years before those doctors qualify, but by the end of the next parliament we will make the NHS self- sufficient in doctors,” Hunt is to add.

Remain campaigners warned in the run-up to the referendum that the NHS, which relies heavily on foreign staff, would be hit if EU workers could no longer travel freely to work in the UK. Data from the General Medical Council records that 30,472 doctors come from the EU and other countries in the European Economic Area, while 71,139 were trained elsewhere in the world outside the UK.

Hunt hopes that by boosting the number of places now, he will have a pipeline of British-trained doctors ready in time. There is rapidly accumulating evidence that doctor shortages are causing serious problems, including the part-closure of A&E units at hospitals in Chorley, Lancashire and Grantham in Lincolnshire.

The move represents a partial U-turn by Hunt, as until now he has repeatedly responded to evidence of understaffing by pointing out that the NHS in England has more doctors now than when the coalition took office in 2010. Currently half of those people applying for medical school are rejected, because of the limits on the number of places.

A Royal College of Physicians report last month, which said the NHS was understaffed and overstretched, irritated health secretary Jeremy Hunt. Photograph: Carl Court/Getty Images

Before individual medical schools are allowed to lift the cap on training places, they will have to show the government they are taking steps to attract students from deprived economic backgrounds.

Trainee doctors will have to work in the NHS for four years before they can accept overseas postings in an attempt to avoid a rapid exodus of people trained in the UK. Many young doctors head to Australia and elsewhere overseas, and increasing numbers say they want to go abroad as the protracted junior doctors dispute has dragged on.

Medical organisations welcomed what the British Medical Association said was Hunt’s belated recognition that the NHS is under-doctored, especially in specialities such as A&E, paediatrics, anaesthesia and psychiatry. But they warned that the health service would not benefit from the extra medics for another decade and that others were were needed to tackle doctor shortages.

“While it is welcome that he has finally admitted the government has failed to train enough doctors to meet rising demand, this announcement falls far short of what is needed”, said Dr Mark Porter, the BMA’s chair. “We desperately need more doctors, particularly with the government plans for further seven-day services, but it will take a decade for extra places at medical school to produce more doctors. This initiative will not stop the NHS from needing to recruit overseas staff.”

The Department of Health is expected to publish a consultation paper on the details of the plans later in the autumn.

Hunt was irritated last month when a report from the Royal College of Physicians, which represents hospital doctors, said that the NHS was “underfunded, under-doctored [and] overstretched.”

Welcoming Hunt’s plan, RCP president Prof Jane Dacre said: “The RCP has long argued that rota gaps and staff shortages are the greatest threat to patient safety and have significantly contributed to low morale among junior doctors. The NHS needs more doctors, and this dramatic increase in medical school places will help relieve many of the pressures faced by the NHS in the long-term, and support a more sustainable workforce.”

Dr Simon Clark, workforce officer for the Royal College of Paediatrics and Child Health, cautioned that “with 30% of doctors deciding to take a break from medicine in the UK for a period of time before they take up speciality training, government must address the retention, attrition and career hiatus that occurs.” Ministers would need to ensure that the extra doctors would be deployed in the areas of England which are facing the greatest shortages, he added.

Labour’s shadow health secretary, Diane Abbott, said: “It appears that Hunt has taken a chapter from the Hard Brexiter’s Myth book. The idea that we can be self-sufficient in medical staff is nonsense.”

“The true picture is that the NHS has never been in a more perilous state and the Tories are cutting the health budget by £22bn.

“The reality is that Hunt has lost the trust of the medical profession and is the least popular health minister in recent history. Morale among NHS staff is at rock bottom and Hunt has shown once again just how little regard he has for the hard-working people that keep our health service running.”

The first of the extra places, which could eventually increase the number of trainee doctors by up to a quarter, will start to become available from 2018-19.

The Department of Health, which subsidises medical students by funding their clinical placements in hospitals, will pay for the expansion from its existing budget.

It plans to offset part of the cost – expected to be £100m in total by 2021 – by forcing foreign medical students to pay for their own clinical placements.

That will increase fees for medical school for students from overseas – but Department for Health sources pointed out that the current £9,000 a year is far lower than the fees for other prestigious international medical schools.

Jeremy Hunt promises to end NHS reliance on overseas doctors after Brexit

Figures demonstrate extent of NHS reliance on foreign nationals

Figures obtained by the Guardian have proven the most total picture yet of the reliance by the NHS and community wellness solutions in England on foreign nationals, with folks from much more than 200 countries employed.

The statistics, created by the Overall health and Social Care Information Centre (HSCIC), demonstrate that eleven% of all staff for whom information was obtainable and who operate for the NHS and in community wellness providers are not British.

The proportion of foreign nationals increases for professionally experienced clinical workers (14%) and even a lot more so for doctors (26%), prompting the British Healthcare Association (BMA) to observe that with out the contribution of non-British employees, “many NHS services would struggle to supply effective care to their individuals”.

Tim Finch, from the Institute for Public Policy Analysis thinktank, said the statistics held lessons for immigration policy.

“Individuals are nevertheless attracted to perform in the NHS,” he stated. “With out them we’d clearly be quick – it would be really tough to exchange that quantity overnight.

“If the single thread of immigration policy is just to get the all round figure down by any means, you have received to look at the consequences of that on the NHS.”

Finch stated that even though the NHS benefited from foreign nationals, wellness providers in the nations they had left could suffer.

He extra that as the economic fortunes of some countries providing large numbers of staff to the NHS enhanced, men and women may possibly turn out to be significantly less inclined to leave, potentially creating difficulties for Britain, albeit not in the near long term.

Finch downplayed the prospect of foreign nationals stopping British folks obtaining a job in overall health solutions, saying that beneath the government’s points method for non-EU migrants, employees would not achieve entry except if there was a vacant submit they were required to fill.

EU countries, English-speaking countries, those with ties to Britain by way of the Commonwealth, nations targeted by the NHS for workers and individuals that have knowledgeable wars all figure prominently in the checklist of those supplying the most employees.

India provided the highest quantity right after Britain, with 18,424 out of a complete of one,052,404 workers whose identity was recognized.

India also presented the highest number of professionally certified clinical staff, medical doctors and consultants, following Britain. The quantity of Indian consultants was 2,708, seven% of the total whose nationality was acknowledged.

GPs are not integrated in the HSCIC figures because they are not employed by the NHS.

The Philippines supplied the highest quantity of certified nursing, midwifery and wellness visiting employees following Britain, with 8,094 out of a complete of 309,529 for whom information was obtainable, reflecting the reality that there was a recruitment drive in the country below Tony Blair’s government to entice individuals to this kind of posts.

The Philippines also provides the third highest amount of NHS workers overall with twelve,744.

Ireland had the fourth highest amount of employees in the NHS, followed by Poland, Nigeria, Zimbabwe, Portugal, Pakistan, Spain and Germany.

A BMA spokeswoman stated: “Overseas medical professionals have for numerous years made a valuable and crucial contribution to the NHS, particularly in important solutions in which there has been a historic shortage of United kingdom-skilled physicians.

“This includes consultant posts in emergency care, haematology and old-age psychiatry. Without the help of these medical professionals a lot of NHS services would struggle to give effective care to their patients.”

She said the figures reflected the truth that for numerous years the NHS actively encouraged overseas doctors to move to the Uk.

The spokeswoman added that doctors had been subject to stringent criteria set by the GMC and that if they were from outside the European Economic Area they had to get extra language exams to guarantee that they spoke English to a excellent normal.

Although the figures assist illustrate the contribution of migrants, they do not paint the whole picture, as several will have taken British nationality since arriving.

Nationality statistics of NHS staff have by no means been published but figures on the place doctors competent are produced offered by the Standard Health care Council, which include GPs in its information.

Mirroring the HSCIC statistics, India is the 2nd most widespread nation of qualification soon after Britain, in accordance to the council, which says 25,122 doctors registered in the United kingdom had been qualified in the world’s 2nd most populous nation.

The HSCIC figures are provisional as of September final year. The nationalities of 136,624 workers were not recorded and, due to use of distinct employees record systems, information was not accessible from two NHS trusts, Moorfields Eye Hospital NHS basis believe in and Chesterfield Royal Hospital basis trust.

Figures demonstrate extent of NHS reliance on foreign nationals