The wrong diagnosis

The ‘doctor-turned-terrorist’ has convinced many that it’s too easy for foreigners to join the NHS. In fact, it’s too hard.

Nathalie Rothschild

17th December 2008

Last summer, there were widespread calls for stricter vetting procedures for foreign medical staff in the UK following failed terrorist attacks in London and Glasgow. Eight of the men initially suspected of carrying out the attacks, outside the Tiger Tiger nightclub in London and at Glasgow airport, were medical professionals and students. Some commentators suggested that terrorist organisations could be recruiting doctors because they are from a trusted profession, and even that the British National Health Service (NHS) offers an open door to terrorism (1).

This week, the full details behind the events were established as the ‘car bomb trial’ came to an end. As it happens, just one NHS employee, the Iraqi-born Bilal Abdulla, was found guilty of conspiracy to murder by planning the car bomb attacks. His accomplice, Kafeel Ahmed, an engineer and PhD student from India, died from severe burns soon after the attack at Glasgow airport. Dr Mohammed Asha, a 28-year-old NHS neurologist from Jordan and a friend of Abdulla, was cleared of any involvement, but still remains in custody and potentially faces deportation after his highly-skilled migrant programme visa expired while he was on remand.

Writing in The Times (London), Andy Hayman, former assistant commissioner for special operations in the Metropolitan Police, says the outcome of the trial shows that the ‘threat is changing’, that the professional background of the terrorist plotters signifies a new face of terror, with radical suicide attackers clearly coming from diverse backgrounds (2). For our vetting-crazed government, the ‘diversifiction’ of the threat apparently warrants a corresponding diversification of monitoring foreigners. The prime minister’s office has confirmed that a review of NHS recruitment procedures was carried out after the attacks, and has resulted in measures to tighten the procedures (3).

This is a massive and dangerous overreaction. As figures showed at the time of the failed bombings, the NHS employs over one million people (4). In July 2007, there were 227,000 doctors on the General Medical Council register, and out of these 128,000 were trained abroad. The BBC reported that 1,985 on the register were from Iraq and 184 from Jordan (5).

It was known at the time that just three out of the eight people arrested in connection to the attacks were doctors trained abroad. That’s three out of 128,000 foreign-trained doctors – or 0.00234 per cent – suspected of being involved in terrorist activity. Many seemed to feel this warranted slamming the door in the face of all foreign NHS staff, even though it would hurt thousands of entirely innocent people – and the NHS itself.

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In truth, far from being too lax, the criteria for employing foreign healthcare workers, especially from outside the European Economic Area (EEA), were too stringent even before the June 2007 attacks. 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 (6).

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 2006, International Medical Graduates (IMGs) 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 British or EEA national (7). So, qualified foreigners have to scrape for the NHS jobs that no British or EEA national wants. As Dr Peter Trewby of the Royal College of Physicians has 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.’ (8)

Income trumps skill

Five 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 (9). This puts greater emphasis on high earnings rather than work experience, disregards any previous British work experience, and does not give priority points for GPs (10). Since the new rules apply retrospectively, an estimated 6,000 people who entered under the old criteria potentially faced having 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 (11).

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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 British health sector (12). 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 (13). So despite the dismay expressed by Hayman and others over the ‘lifesavers turned killers’, and the shock that the NHS, Britain’s ‘greatest institution’, has ‘harboured terrorists’, it is not especially shocking that middle-class professionals were involved in the London and Glasgow incidents. Al-Qaeda is a middle-class phenomenon.

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.

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.