Select Committee on Health Written Evidence

Memorandum by Dr Graham Winyard (MMC 53)


  I am writing as a recently retired Postgraduate Dean to urge you and your committee to include full consideration of the issue of medical immigration in your deliberations on MMC. This year, for the first time ever, we face the likelihood of substantial unemployment among UK medical graduates, with a worse situation predicted for 2008. This is being widely attributed to the chaos around the MTAS/MMC collapse, as reflected in your Committee's intended focus on:

    "The extent to which MMC has taken account of the supply and demand of junior doctors and the number of international medical graduates eligible for training in the UK;".

  However the planning of the supply and demand of junior doctors and the management of medical immigration are important issues in their own right whose mis-management would have resulted in the current problems even if MTAS/MMC had not been introduced.

  In essence what has happened is that ten years ago this Government decided to expand medical school output specifically so that the NHS would be less dependent on overseas doctors. It invested heavily including establishing four new medical schools, and those extra doctors are now ready to begin specialist training to become consultants or GPs. Until this year, providing they were willing to be flexible about their choice of speciality and geography, UK graduates could expect to access such training without too much difficulty. Now, as a direct result of the failure by Government to tailor its broad immigration policy to reflect its own intentions with regard to medicine, not only are 1,200 UK graduates unable to progress their careers this year, but next year, by the same Department of Health estimates, only one in three will obtain suitable NHS posts. This scale of loss completely negates the carefully planned medical school expansion.

  I raised the issue in September in an article in the British Medical Journal[2] but the basic facts are not in dispute being confirmed by the Tooke report and by the Department of Health's own analysis in its recent consultation document on the eligibility of doctors from outside the EEA to compete for specialist training in 2008. However the impact that this will have on the careers of thousands of young doctors, and on the attractiveness of medicine as a career, seem to be going largely un-noticed. It makes no sense at all to train thousands of extra doctors simply to make many of them unemployed at a stage when they are still too junior to work usefully in the NHS. Nor can it be good for long term recruitment to medicine for it to become a career with a built-in cull after seven years of training and thousands of pounds worth of debt.

  This seems to be a real case of the right hand not knowing what the left hand is doing across Government. The simple approach that could have prevented all the above problems would have been to modify the terms of the Home Office Highly Skilled Migrants Programme to exclude eligibility for postgraduate training in medicine. However I understand that it was not possible to reach agreement with the Treasury and the Home Office. Instead the Department of Health has had to attempt to introduce unilateral guidance to achieve the same ends. This has already been subject to prolonged legal challenge (not yet concluded) during which thousands of extra doctors from outside the EEA entered this year's competition pool creating the unemployment levels highlighted above. But the fact that policy coherence seems to depend on the outcome of an Appeal Court hearing surely shows that something has gone seriously wrong here.

  I do hope that your committee will be able to look into this. The pros and cons of detailed career structures and recruitment processes which will form much of your committee's MMC deliberations become irrelevant if we cannot get the basics of managing supply and demand right.

  I would of course be happy to amplify any of these arguments if that would help the committee.

Dr Graham Winyard CBE FRCP FPHM

Retired Postgraduate Dean

November 2007

2   BMJ/22 September 2007/Volume 335. 593 Back

previous page contents next page

House of Commons home page Parliament home page House of Lords home page search page enquiries index

© Parliamentary copyright 2008
Prepared 8 May 2008