…foreign doctors?

Nathalie Rothschild says that just because a handful of foreign doctors may have been involved in recent attempted terror attacks, that is no justification for imposing greater restrictions on the movement of medical professionals into Britain.

The vetting procedures for foreign doctors in the UK National Health Service (NHS) have come under scrutiny after eight medical professionals and students were arrested in connection with failed car bombings in London and Glasgow. Three of the suspects are doctors who were trained in India, Iraq and Jordan. This has prompted demands that the NHS review its checks on prospective employees born or trained abroad. It has been suggested that terrorist organisations could be recruiting doctors because they are from a trusted profession, and even that the NHS offers an open door to terrorism (1).

In fact, the criteria for employing foreign healthcare workers, especially from outside the European Economic Area (EEA), are far too stringent already. Not only does the UK need more foreigners to keep the NHS going, but medical professionals – and anyone else for that matter – should be free to live and work wherever they want. While some Western doctors take pride in being ‘borderless’, here in Britain foreign medical workers are being held back by stringent immigration policies and by having to jump through numerous bureaucratic hoops.

The NHS employs over one million people (2). There are 227,000 doctors on the General Medical Council register, and out of these 128,000 have been trained abroad. The BBC reports that 1,985 on the register are from Iraq and 184 are from Jordan (3). But so far, we only know that three out of the eight people arrested in connection with the recent attacks are doctors trained abroad. So should we really slam the door in the face of foreign NHS staff just because three out of 128,000 doctors trained abroad – that’s 0.00234 per cent – were potentially involved in terrorist activity? Such an overreaction would hurt thousands of entirely innocent people, and the NHS, too.

Doctors from overseas are required to undergo several NHS checks. Those who have qualified outside the EU have to pass a series of linguistic and clinical tests before they can register with the General Medical Council (GMC), the profession’s regulatory body. Under European legislation, doctors who gain their qualifications in countries within the EEA have a right to register in Britain and are exempt from the GMC’s tests (4).

Yet before they can even think about taking these tests, non-EEA health professionals face major obstacles in coming to Britain. And considering the government’s constant tightening of rules, reformulations of criteria and u-turns on immigration policies, it is understandable if those who have managed to come here feel there is little guarantee that they will be allowed to stay. Here are three examples of how New Labour is already making it difficult for foreign health workers to get jobs with the NHS.

Race and nationality trump merit

Since last year, International Medical Graduates (IMDGs) from outside the EEA wishing to work or train in the UK need a work permit from the Home Office. To obtain one, an employer must show that a genuine vacancy exists and that it cannot be filled by a doctor who is a UK or EEA national (5). So, qualified foreigners have to scrape for the NHS jobs that no UK or EEA national wants. As Dr Peter Trewby of the Royal College of Physicians said: ‘For the first time in the history of the NHS, we are going to say that race and country of origin are going to trump merit, and that is a very sad thing indeed.’ (6)

Income trumps skill

Four years ago, the government set up the Highly Skilled Migrant Programme (HSMP) to encourage experts and professionals to come to Britain to help make the British economy thrive. Around 20,000 individuals, including hundreds of scientists and doctors, applied. Successful candidates were promised permanent residency after four years. But in November 2006 the rules changed and a new points system was introduced (7). This puts greater emphasis on high earnings rather than work experience, disregards any previous UK work experience, and does not give priority points for GPs (8). Since the new rules apply retrospectively, an estimated 6,000 people who entered under the old criteria may have to leave the UK, including doctors. Hundreds of doctors, both foreign-born and British-born, protested against the change in the rules and warned that the government’s u-turn could have serious repercussions for Britain’s overstretched health system (9).

Stopping the ‘brain-drain’ trumps free movement

The Department of Health’s 2004 Code of Practice for the Recruitment of Health Care Professionals states that the 157 developing countries on the Organisation for Economic Cooperation and Development list of aid recipients should not be targeted for recruitment in the UK health sector (10). The countries include Afghanistan, Iran, Iraq and Pakistan. The DoH believes that medical students and doctors in such countries should stay put in order to help their own beleaguered populations.

In other words, best practice, as the DoH sees it, is to undermine freedom of movement to professionals for the developing world by holding back from them advertisements for jobs in Britain as a way of encouraging them to ‘stay at home’.

Well, at least this means the DoH will not run the risk of accidentally employing Ayman Al-Zawhiri, Osama Bin Laden’s second-in-command, and a doctor. Indeed, as terrorism expert Marc Sageman has shown, most of al-Qaeda’s leaders and operatives are well-educated, well-off, cosmopolitan and professional (11). So despite the dismay over the past couple of days over the ‘lifesavers turned killers’, and the shock that the NHS, Britain’s ‘greatest institution’, has ‘harboured terrorists’, it actually is not especially shocking that middle-class professionals may potentially have been involed in the London and Glasgow attempted attacks. Al-Qaeda is a middle-class phenomenon.

Tightening restrictions on the arrival of foreign health professionals in Britain will do nothing to stop terrorism. But it could lead to even more inhumane immigration policies, further deny employment opportunities and freedom of movement to people in the developing world, and intensify the shortage of qualified healthcare workers in the UK.

Nathalie Rothschild is commissioning editor at spiked.

Read on:

Who’s afraid of…

(1) NHS and an open door to terrorism, The Daily Mail, 4 July 2007

(2) See the NHS Employers website

(3) How doctors from abroad are vetted, BBC News, 3 July 2007

(4) How doctors from abroad are vetted, BBC News, 3 July 2007

(5) See the General Medical Council website

(6) See The new ‘colour bar’ in the NHS by Liz Frayn

(7) See ‘If I am sent back, I will be jobless’ by Emily Hill

(8) Doctors to fight ruling on Highly Skilled Migrant Programme that could spark NHS recruitment crisis, Personnel Today, 20 February 2007

(9) Doctors to fight ruling on Highly Skilled Migrant Programme that could spark NHS recruitment crisis, Personnel Today, 20 February 2007

(10) See the code of practice for the international recruitment of healthcare professionals (2004) and the list of developing countries not to be targeted when recruiting healthcare professionals.

(11) See Meet the al-Qaeda archetype, by Brendan O’Neill