Select Committee on Health Written Evidence

Memorandum by the Foreign and Commonwealth Office (MMC 59)


  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.


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

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