Memorandum by the Foreign and Commonwealth
Office (MMC 59)
MODERNISING MEDICAL CAREERSINTERNATIONAL
MEDICAL GRADUATES
The FCO is grateful to have this opportunity
to explain to the Committee its role in the formulation of Government
policy affecting training opportunities available to non-EEA doctors
in the NHS.
The FCO recognises that there is a tension between
a desire for self-sufficiency in the supply of doctors and an
open door policy for foreign doctors. Efforts to resolve this
have been underway for about two years. Principally an issue for
the Department of Health and the Home Office to resolve, FCO ministers
and officials have always appreciated the difficulties with which
these other Departments have faced. FCO involvement and interest
has been confined to advising these Departments on the foreign
policy implications of the various policy options under consideration.
For many years the NHS has relied on foreign
doctors to fill vacancies and they made, and continue to make,
a very valuable contribution to the NHS. Many of these doctors
come from South Asia, in particular from India. The Government
of India follows this issue closely. Announcements of the introduction
of measures that limit access to training slots in the NHS for
non-EEA doctors need, therefore, to be handled carefully and sensitively.
We have a strong bilateral relationship with
India, exemplified by the recent UK-India Summit where discussion
between the two Prime Ministers covered a wide range of issues
and reinforced the depth of our strategic partnership. Migration
is an issue that constantly features high on the Indian agenda.
We have been keen to ensure therefore that details of any changes
to the immigration rules are communicated clearly and in advance
to the Governments of those countries concerned.
The FCO would also have a more general concern
over any change to the Immigration Rules that excluded doctors
from Tier 1 of the new Points-Based System (PBS) for managed migration
(which will replace the Highly Skilled Migrant Programme). The
PBS is the mechanism through which we will attract the migrants
our economy needs. Tier 1, for highly skilled migrants, will uniquely
allow all those whose qualifications meet certain standards to
enter the UK without a job offer. It is aimed at the brightest
and best. Measures that significantly limit one highly skilled
sector would run counter to the essence of Tier 1 and could set
an unwelcome precedent. However, the FCO recognises that, given
the argument for self-sufficiency in the supply of doctors in
the UK, some such changes may now be justified.
SPECIFIC QUESTIONS
Was the FCO consulted by the Department of Health
(DH) or Home Office on the decision to end permit-free training
in March 2006?
According to the records we have found, we were
informed before the decision was implemented, but we were not
consulted on the decision to end permit-free training.
Was the FCO involved in subsequent attempts to
limit the entry of non-EEA doctors such as the use of the DH guidance?
Our involvement has been limited. Our role has
been to inform the Government debate of the foreign policy implications
of any proposed changes.
Of the various options considered, the use of
the DH guidance would have been our preference because it would
not have automatically blocked off speciality training slots to
all non-EEA doctors. It would also have not required a change
to the Immigration Rules. We understand that the DH is appealing
against the judgement of the courts that the use of the guidance
was illegal.
Does the FCO have any arrangements with non-EEA
countries (eg India) regarding access to UK medical training places
for their citizens?
We understand that a number of non-EEA countries
have arrangements with the Royal Colleges to provide medical training
and there have been some preliminary discussions to consider how
HMG might offer specialist medical training overseas, but the
FCO has had no significant involvement in this.
Does the FCO know the number of non-EEA doctors
who return to their country of origin after completing medical
training in the UK?
Specialist training within the NHS is valued
highly by many doctors, especially those from South Asia for whom
comparable training opportunities do not exist. For these doctors,
specialist training in the NHS is a vital part of their career
and many do return to their country of origin after completing
their training to use their new skills. We do not have details
of the numbers involved.
Does the FCO have a view on what the Government
should do in future to limit non-EEA applicants to UK medical
training places, notably, once the cohort who came to the UK with
an expectation of training have passed through the system?
We have accepted the need for temporary changes
to the Immigration Rules to limit access by non-EEA applicants
to UK medical training places, provided that they are prospective
and not retrospective in application, and limited to addressing
the immediate difficulties. It will be for the Department of Health
to find a longer term solution to the workforce planning problems
that it faces.
Does the FCO have a view on the best way or providing
training for non-EEA doctors who wish to return to their country
of origin?
As we have said above, training in the NHS is
highly valued. In order to avoid disrupting relations with key
emerging economies and to continue making a contribution to improving
the quality of health services in the developing world we believe
it will be important to retain some degree of access to speciality
training in the UK. There is also a place for training in countries
of origin. We should consider options to help finance these, but
this would be outside FCO's area of expertise.
What would be the consequence for UK/Indian relations
of stopping non-EEA doctors from applying for medical training?
The implementation of measures to prevent access
to specialist training by non-EEA doctors would not be welcomed
by the Indian Government or medical bodies. As we have said above,
in recent years this issue has been top of their agenda in discussions
on migration and restrictions on access would be very likely to
create difficulties for our wider bilateral relationship.
India is also a priority market for trade in
pharmaceutical and medical devices. This trade could be affected
if we prevent non-EEA doctors from applying for medical training
slots in the UK.
February 2008
|