Memorandum by the Home Office (MMC 60)
MODERNISING MEDICAL CAREERS—INTERNATIONAL
MEDICAL GRADUATES
SUMMARY
The Home Office welcomes this opportunity to
explain to the Committee its role in implementing Government policy
on ensuring self-sufficiency in the supply of doctors. We have
provided advice on, and implemented, changes to the immigration
rules to achieve Department of Health policy objectives. The two
key sets of immigration rules changes were laid before Parliament
in March 2006 and February 2008.
We believe that amending the immigration rules
is the right short-term solution to NHS workforce planning problems.
We know the Department of Health believes it urgently needs its
own sustainable solutions to workforce planning problems and has
acknowledged that a solution using immigration rules is only a
stop gap.
The Department of Health first approached the
Home Office in 2005 about using the immigration rules to close
down competition for training posts from International Medical
Graduates. We agreed to restrict the provisions of the Postgraduate
Doctors and Dentists category so that it would be open only to
those who had studied for their medical qualification in the UK
and that it would enable them only to complete their Foundation
Training. Those immigration rules took effect on 3 April 2006.
We were approached again in June 2006 with a
request to impose restrictions on the Highly Skilled Migrant Programme
(HSMP) and Tier 1 of the (then) forthcoming Points Based System
for controlling migration. This proposal is, of course, an exception
in the policy behind HSMP and Tier 1—to attract the brightest
and best by offering free access to the labour market.
Domestic Affairs Committee cleared the policy
in time for rules changes to be laid before Parliament on 6 February
2008. These changes will come into effect on 29 February in the
UK and 1 April in India. The restrictions imposed by these changes
will be extended to the rest of the world by the end of the summer
in line with the roll-out of the Points Based System.
SPECIFIC QUESTIONS
1. When the Home Office and Department of
Health ended permit-free training in March 2006, did the Home
Office anticipate that this would lead to a major increase in
the number of non-EEA doctors applying to the Highly Skilled Migrant
Programme?
We made the rules change in 2006 to implement
Department of Health policy. When the Department of Health first
approached us in 2005, it identified that continuing to allow
doctors to enter under the Highly Skilled Migrant Programme or
Tier 1 of the Points-Based System might undermine the effects
of restricting the Postgraduate Doctors and Dentists category.
We agreed with its analysis.
2. Can figures be provided for the number
of medical HSMP applicants from 2005-07?
It is hard to give precise numbers as HSMP migrants
are not required to declare their profession or say what they
intend to do when applying to enter or remain in the UK. We have
estimated the following for 2006 from management information:
— Around 8,000 HSMP approval letters
were granted to migrants applying from outside the UK, of which
fewer than 1,000 were granted to applicants self-reporting their
profession as doctors.
— Around 14,000 approval letters were
granted to migrants already in the UK switching into HSMP from
another category, of which around 7,500 were granted to applicants
self-reporting their profession as doctors.
— Around 14,000 approval letters were
granted to applicants seeking to extend their stay in the UK under
HSMP, of which we estimate, from a limited survey of cases, that
fewer than 8,000 were granted to doctors.
Source: Border and Immigration Agency local management
information. These figures are not provided under national statistics
protocols. All the figures are provisional and subject to change.
3. What options were considered for addressing
the problems caused by the increase in HSMP applicants?
The Department of Health was concerned that
the April 2006 changes had led to a displacement of migrants from
the Post Graduate Doctors and Dentists category into HSMP. We
provided advice on the immigration option of placing a condition
on the leave of HSMP migrants to prevent them from taking junior
doctor training posts.
4. Was the Home Office surprised that the
appeal against the DH guidance was upheld and the guidance declared
unlawful in November 2007?
The government's position is that we believe
the judgement was wrong, which is why the Department for Health
has appealed to the House of Lords.
5. In the light of the Court of Appeal decision,
is it clear how restrictions could be made legally?
Amendments to the immigration rules placing
conditions on leave granted under particular immigration categories
can be legally made under the power in section 3(1) of the Immigration
Act 1971. The Court of Appeal decision was in respect of the Department
of Health guidance. The Department of Health should be asked to
comment on the legality or otherwise of other options it has under
consideration.
6. Is it the case that the UK can restrict
applications if it decides to?
The Home Secretary has the power to place conditions
upon a migrant's leave which restricts that person's employment
or occupation in the UK. It is for the Department of Health to
comment on the legality of any levers they have to restrict applications
to specified posts in the NHS.
7. Are there any other plans for future restrictions
on the number of non-EEA doctor applicants from 2009 onwards?
What immigration options are available to limit the number of
applicants?
There are no plans for any further restrictions
being placed via the immigration rules. It is for the Department
of Health to comment on what they are doing to find a sustainable
way to ensure self-sufficiency in the supply of doctors.
8. Since it is the Government's long-standing
policy to make the UK more self-sufficient for its medical workforce,
do you agree it is necessary to restrict non-EEA applications?
This question should be addressed to the Department
of Health.
13 February 2008
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