Select Committee on Health Written Evidence

Memorandum by the Home Office (MMC 60)



  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.


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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