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Reconsider immigration cap plans to avoid damaging NHS: BMA

`UK relies outside EU doctors to fully staff NHS’

10th November 2010: The British Medical Association — standing up for doctors — has warned that rushed plans to cap immigration must be reconsidered to avoid damaging the NHS.
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According to an article carried by the BMA, the Commons home affairs select committee on 3rd November 2010 published a report expressing concerns that the cap has been hurried through, without enough consideration of how it will work.

Responding to the report, BMA international committee chair Terry John said: ‘The government needs to rethink its plans to introduce an annual cap on immigration to take into account the impact these changes will have on the NHS.’

‘The UK relies on doctors from outside the EU to fully staff the NHS. The interim cap on skilled migration has already made it more difficult for employers to secure sufficient sponsorship certificates to meet their workforce needs. The imposition of a permanent cap is likely to make the problem worse.’

The article adds: The committee’s report also says the plan could affect the recruitment of talented professionals to public services.

Select committee chair Keith Vaz said: ‘Successive governments have enacted changes to the immigration system with almost immediate effect, bypassing parliamentary conventions.’

The report says the cap would affect less than 20 per cent of immigrants and argues that this may lead the government to look at restricting other routes, such as those open to international students.

International students account for 25 per cent of long-term immigration each year.

Dr John said: ‘We are particularly concerned that international graduates from UK medical schools may be unable to continue training.

‘It is estimated that around 500 international medical students graduate from UK medical schools each year. These doctors are already factored into workforce planning and it would be a huge loss to the NHS if they were not able to work in the UK.’

The level of the non-European Economic Area economic migrant cap has not yet been set but will be announced at the end of this year.

The BMA memorandum of evidence to Home Affairs Committee inquiry on cap on non-EU migration dated 23 September 2010 says: `The BMA is an independent trade union and voluntary professional association which represents doctors from all branches of medicine throughout the UK. It has a membership of over 141,000 doctors.

`This response will highlight the BMA’s position in relation to the cap on non-EU economic migration. There are three principle areas of interest to the BMA:

`The impact of the proposed cap on international doctors who have qualified in the UK and are working in the NHS; the impact of the cap on international doctors who are not UK qualified but have already committed themselves to working in the NHS; and the impact of the cap on the ability of employers to recruit additional staff from overseas when it has not been possible to fill vacant posts using the resident workforce

`In submitting this evidence the BMA would like to reaffirm its support for the long-term aim of self-sufficiency in NHS medical staffing but in doing so would highlight that workforce gaps remain in certain regions of the UK and within particular medical specialties. These gaps necessitate that employers remain able to recruit doctors from outside of the European Union (EU) if the resident workforce cannot produce suitable candidates for specific vacancies.

`The BMA does not support unfettered migration of doctors to the UK but believes that a system in which employers are able to recruit doctors from outside the EEA to fill vacant posts must remain in place for those situations where suitable applicants cannot be found from within the resident workforce.

`The interim cap on skilled migration and the forthcoming permanent cap are the latest in a series of measures which have affected international doctors and the career opportunities available to them in the UK. These measures include the end of permit-free training, Tier 1 (General) restrictions preventing employment as a doctor in training and changes to the points requirements that applicants must meet in order to secure a Tier 1 (General) visa. Whilst measures to ensure that UK-trained doctors are not being displaced have been necessary and welcome, there remains a need to allow sufficient flexibility to allow for recruitment from outside the EU if posts remain unfilled.

`As with so many of the immigration rule changes of recent years, the true impact of the cap on non-EU economic migration is unlikely to be completely clear until after the policy becomes fully operational. The interim cap on skilled migration has already created a number of problems; not least employers’ difficulties in securing sufficient certificates of sponsorship to meet workforce needs and doctors who are already working in the NHS facing delays and uncertainty due to their employers being unable to issue them with certificates of sponsorship to extend their leave. The imposition of a more rigorous, permanent cap is likely to exacerbate this problem further.

`Of particular concern to the BMA is the impact of the cap on international graduates of UK medical schools. The current route for such doctors involves them completing the two-year Foundation Programme under Tier 4, taking up specialty training posts under Tier 1 (Post-Study Work) for two years and eventually switching to Tier 1 (General). The BMA is apprehensive that the inclusion of in-country applications in the migration cap may lead to some UK-trained doctors being unable to secure a Tier 1 (General) visa to continue their training despite having completed a number of years of postgraduate medical training and being part-way to achieving specialist status. The number of doctors this could potentially impact is hard to gauge although it is estimated that about 500 medical school graduates per annum are from outside the EU. These doctors have been factored into future workforce planning for the NHS.

`Furthermore, the BMA is uneasy that the cap has the potential to impact non-UK qualified doctors who are already working in the NHS under Tier 1 (General) or Tier 2 visas and may lead to employers losing members of their existing workforce. Whilst we acknowledge that the cap on migration is being implemented to reduce net migration levels, it has the potential to drive out existing NHS workers as opposed to simply restricting the flow of additional workers into the UK. This could result in existing NHS doctors being forced to return to their country of origin due to not being able to secure extensions to their leave and employers having reduced options to try and source replacements. Ultimately the medical workforce could be diminished and this poses significant implications to the delivery of care to patients.

`Whilst the Government might ultimately achieve its policy objective to reduce net migration by capping non-EU economic migration, it will have been accomplished not only by preventing additional migrants from entering the UK but also by thwarting migrants from obtaining further leave to remain in the UK. The BMA recognises that it is unavoidable that the policy of capping migration will have a detrimental impact on some but as far as possible, a scenario must be avoided where the NHS is unable to retain staff from outside of the EU due to a lack of visa availability.

`In addition to concerns relating to the potential impact of the migration cap on existing NHS employees, the BMA remains concerned that the cap will prevent or unnecessarily delay future recruitment from outside of the EU even when exhaustive attempts to recruit from the resident workforce have been unsuccessful.

`Much of the rhetoric about immigration has focused on the pressures that increased migration has placed on public services including the health service, housing and schools. The debate frequently fails to acknowledge the significant impact that highly skilled migrants such as doctors have played, and continue to play, in delivering and sustaining public services such as the NHS. The strong economic rationale for justifying the cap on skilled migration ignores the potential negative repercussions of the cap on public service delivery with employers facing increasing barriers to retaining and recruiting the staff they need.

`The anticipated consequences of capping skilled migration cannot be oversimplified by emphasising reduced stress on public services and increased job opportunities and career prospects for resident workers. It must be subjected to more rigorous scrutiny and measures must be taken to ensure that public service delivery is not compromised as a result of the migration cap.

`The pooling system for Tier 1 visas appears to be a workable proposal provided that its structure allows for the identification and prioritisation of individuals with the most sought-after skills at that time. As with other facets of the PBS the pooling system must not be predicated on purely economic or business- related criteria but must allow for the identification of skills vital to the public sector.

`The BMA has concerns related to the proposed ‘first come first served’ method of allocating Tier 2 visas and believes that if the allocation of Tier 2 visas is not managed effectively then employers could face significant delays in recruiting staff to the detriment of NHS service delivery. For example, a yearly allocation of Tier 2 visas could pose practical problems for employers if the annual allocation is used up many months before the 12 month timeframe expires but workforce gaps persist. This scenario would leave employers having to wait months for the next year’s allocation to become available. A more practical solution would be monthly allocations of certificates of sponsorship to reduce the potential for employers to face lengthy delays in obtaining a certificate of sponsorship.

`In addition to monthly allocations being a more practical option, consideration must be given to those times of year when visas are more frequently required within particular sectors. For example, demand for certificates of sponsorship for Tier 2 visas for doctors is likely to be highest from June until September to allow for recruitment to specialty training.

`The BMA has significant concerns in respect of the auction system for skilled migrants under Tier 2 which has been proffered as an option within the UK Border Agency’s consultation ‘Limits on non-EU economic migration’. The concept of organisations bidding for visas with those prepared to pay the largest sums securing the visas at the expense of less wealthy organisations does not constitute an appropriate use of public funds. At a time when huge cuts are being made in public sector budgets, forcing organisations to use much-needed resources as part of a bidding war for staff does not seem apt. Such a practice might be more acceptable within the private sector where companies will often commit significant resources to attracting the right individuals to work for them, but within the public sector this option appears dubious and impractical.

Merging the Resident Labour Market Test with the Shortage Occupation List
16. The BMA believes that the proposed merger of the Resident Labour Market Test (RLMT) with the Shortage Occupation List has several worrying implications not least the potential for regional shortages to be ignored and potentially exacerbated. The RLMT currently provides a valid route for employers to recruit staff from outside the UK when the resident workforce can’t fill vacancies. Merging the RLMT route and shortage occupation list would only allow for recruitment to take place if there is a national shortage in that occupation and the job has been extensively advertised and no one suitable has applied from the resident workforce. Ultimately, this would mean that regional shortages would be ignored and employers would be unable to recruit on this basis alone. The RLMT in its current form has been widely used by employers and merging it with the shortage occupation list is likely to exacerbate shortages that exist in certain regions of the country.

`It is the BMA’s view that any merging of the RLMT with the Shortage Occupation List must involve a review of how shortage occupations are identified and whether any allowances can be made for regional shortages in particular professions/ medical specialties or in situations where an individual employer is suffering significant staff shortages.

`In principle, the BMA supports the concept of upskilling the resident workforce to reduce the demand for skilled migration. In practice this will be difficult to achieve in respect of the medical profession due to the length of training required to become a doctor and the intellectual ability needed to take up a medical degree.

`In relation to medical vacancies there remains a need to ensure that posts in less popular medical specialties and in less popular regions of the country are made as attractive as possible to generate greater interest from the resident population. This is likely to take time and investment but is not necessarily a process that requires any significant upskilling of the resident medical workforce outside of the existing training structures in place.

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