Examination of Witness (Questions 157-179)
MR ALASTAIR
HENDERSON AND
MS MANDY
THORN
3 FEBRUARY 2009
Q157 Chairman: Thank you also for coming
today to give evidence on the occasion when the journey in was
more difficult than it normally would be. Could I begin by asking
you, Mr Henderson, a question about the role of medical consultants
being included in the shortage occupation lists? Are hospitals
and NHS trusts satisfied that the shortage occupation list meets
their criteria and meets their requirements for recruitment of
specialist medical consultants?
Mr Henderson: Employers are broadly
satisfied with that. We have been improving and getting a much
more robust system for inputting into what the shortage list is.
Our organisation has been working very closely this time round
with the current review that is going on with the Workforce Review
Team to provide statistical evidence and Skills for Health as
the sector set of skills council. We are broadly satisfied therefore.
In medicine in the health service there has always been quite
a high percentage of doctors from non-EEA countries.
Q158 Chairman: Could you tell us
some figures as to how many are involved?
Mr Henderson: In terms of hospital
doctors it is around 31%, 27,000-28,000.
Q159 Chairman: Could you slow down
a little?
Mr Henderson: It is around 28,000
hospital doctors which is 31% of the totality of hospital doctors
who are non-EEA qualified. It ranges quite a lot: the consultants
themselves are lower, that is around 22%, but you get the group
of staff and associate specialist doctors, which are those doctors
who are not in training and not consultants, where it is much
higher, it is actually over 60% of those are non-EEA qualified.
With GPs the figure is a lot lower.
Q160 Chairman: You are going very
fast. The 60% figure relates to what?
Mr Henderson: The 60% relates
to Staff and Associate Specialist doctors which are those groups
of doctors who are not consultants and are not also doctors formally
in training.
Q161 Chairman: And GPs?
Mr Henderson: GPs is considerably
lower; that is 16.5%.
Q162 Chairman: So a third of all
the NHS consultants at the moment—
Mr Henderson: No, just under a
third of all NHS hospital doctors are non-EEA qualified. For consultants
themselves it is slightly lower, that is 22%.
Q163 Chairman: Why is there such
a shortage in the resident labour market?
Mr Henderson: There has been a
considerable increase in the number of doctors in training and
medical school places but historically, since the NHS began, we
have relied on overseas-trained doctors in the NHS. That has been
a traditional part of the health service since it began.
Q164 Ms Buck: I want to follow that
point up specifically and ask about trend analysis because it
is clearly a dramatic figure, but if it is broadly the same as
it was 10 years ago or 20 years ago then obviously it has different
implications for the area we are studying. I wonder if you are
able to answer that now or would perhaps tell the Committee at
another stage.
Mr Henderson: Certainly there
are the figures. It has not changed hugely, one way or the other,
over recent years, it is still around that figure. There will
be changes; part of the Government's changes last year which did
restrict the access of non-EEA doctors into training places will
make a difference and for the group that was very high, the staff
and associate specialist doctors, you would probably find that
the profile there of those non-EEA doctors are probably those
nearer retirement. There was a large group of doctors that came
in, particularly from the Indian subcontinent, that makes up those
numbers. So with both the increase in medical school places—and
that has been very substantial over the last 10 years—and
that aging demographic of that population, over time you will
see that change.
Q165 Ms Buck: That leads to my next
question. I know it was for fundamentally different reasons but
I was one of those MPs in Inner London that really got a lot of
grief two years ago with the crisis over the postgraduate medical
training access. I just wondered if you could tell us a little
bit more about the restriction on access, whether you welcome
it and what will be the impact? Will it have a positive impact
in terms of meeting the needs for UK-trained doctors going through
the system and are there any disadvantages?
Mr Henderson: As you know there
was a consultation about whether access to the formal training
grades by doctors from outside the EEA should be restricted. There
were some quite mixed views actually from NHS organisations. There
clearly was a recognition of the sense for the service to ensure
that UK graduates were getting employment and the wider economic
requirements of utilising the investment that has been put into
their training. Equally, there was a concern from some employers
to ensure that they did have the widest possible field to ensure
that they were getting the highest quality standards. I would
say it was fairly evenly balanced but the majority did favour
the restriction of access. In the noise that there was in the
system a couple of years ago there was possibly a difference and
the statement that UK doctors cannot get jobs is sometimes more
accurately that UK graduates cannot get jobs in the specialties
and the places they want. As a London MP that was a strong issue
there, but being able not to get a job in surgery at Guy's is
not the same as there not being medical posts available.
Q166 Chairman: There is no prospect
then of a whole lot of medical students going outside their hospital
saying "British jobs for British workers".
Mr Henderson: Absolutely not.
I did think that the group during the MTAS discussions, "Mothers
for Doctors" struck me as one of the most powerful and effective
lobby groups that I have come across for a long time. But certainly
that restriction and what that meant was that there were hospitals
in other parts of the country that actually really welcomed some
of the changes and have found it a lot easier to fill posts where
they were having difficulty. So in that way it has been popular,
but there do still remain some particular specialties where there
are difficulties and that is partly also about the choices that
doctors, graduates and medical students make. There are still
some specialties that are a lot less attractive.
Q167 Ms Buck: Following on from that,
does the restriction mean that there is a risk that you will end
up with less popular posts remaining unfilled because there is
not a call to train for them, or is that not possible?
Mr Henderson: In some ways it
is perhaps the opposite. One of the purposes of the new training
arrangements was that people did not mill around in what was called
the SHO, the senior house officer grade. It did give an opportunity
for people, if they did not get a job in the London teaching hospital
they wanted first time round they could keep hanging around until
they did or eventually gave up. Now that is not so much an option.
If people cannot do that they do have to make other choices about
other specialties so in some ways we ought to be able to move
people into the less attractive specialties, which I think is
a benefit.
Q168 Tom Brake: Just following on
that point are there any particular specialisms that the international
medical graduates used to go into where now we may have more difficulties
actually ensuring that those places are fully filled?
Mr Henderson: I do not know of
any particular evidence of a tailing-off of the interests of international
medical graduates in particular areas. For example, psychiatry
has been an area that has been quite hard to fill from UK graduates
but I do not think there is any particular tailing-off of the
interest from non-EEA graduates because they will clearly see
where the vacancies are and will apply if they are qualified there.
Q169 David Davies: I just wonder
if you can help me understand this. Either we are not training
enough British people to become doctors and are filling the service
with people from inside and outside the European Union, or we
are training about the right amount but the people from outside
the European Union are creating a surplus which means some British
people are not able to get jobs. Which of those two scenarios
is correct?
Mr Henderson: It is more the former.
Q170 David Davies: We do not train
enough people.
Mr Henderson: We have not been
self-sufficient in the training of doctors to meet the demand
but we have decided to rely on bringing people in—and there
are real advantages both to the service and to the doctors themselves
of bringing people in.
Q171 David Davies: We have been doing
that since the NHS was created roughly.
Mr Henderson: Yes.
Q172 David Davies: What checks do
we make? If somebody turns up here from a Third World country,
from somewhere in Africa, presents themselves as a doctor, what
checks do we make to ensure that their qualifications are as credible
as those of somebody who spent six years training in the United
Kingdom?
Mr Henderson: That is the responsibility
of the GMC, the General Medical Council. Nobody can practice as
a doctor in this country unless they are on the GMC register—it
is the same with nursing with the Nursing and Midwifery Council.
Q173 David Davies: Do they have to
do any tests to ensure that they are up to scratch when they come
here or are their qualifications sufficient?
Mr Henderson: The GMC has a very
rigorous process of testing for qualifications; there are various
tests and there are language tests as well—the PLAB is the
language test that doctors have to take.
Q174 David Davies: They do not simply
say "Okay, you are from a country where there may be problems
with corruption; we are quite happy to accept that you have done
that six years, that your degree is as good as a British degree",
they say "You will have to undertake some written tests to
ensure that you actually know what you are doing", because
there have been cases, have there not? There was one, funnily
enough, from America—which you would not necessarily expect—where
a doctor was not a doctor and yet his qualifications had been
taken at face value by the GMC, nobody had bothered to carry out
any checks as to whether he had been in the university or not;
does this happen now every single time? Do we check?
Mr Henderson: Broadly the service
has confidence that the GMC has good tests.
Q175 Mrs Dean: You talked about the
percentages of non-EEA trained doctors; do you have the figures
for the overall numbers of doctors now compared to, say, 10 years
ago?
Mr Henderson: Yes, indeed. Now
the number of overall hospital doctors is around 91,000 hospital
doctors and about 33,000 GPs. We have the figures for the last
10 years and there has been quite a considerable increase; I can
certainly send you those and what those were over the previous
10 years but there has been a steady increase of doctors.
Q176 Mrs Dean: There has been a steady
increase in the number of doctors being trained.
Mr Henderson: Yes. There have
been very substantially higher numbers coming out of medical school
and through training, so the numbers of UK-trained doctors has
grown very considerably.
Chairman: Mr Winnick has another quick
supplementary.
Q177 Mr Winnick: Just to confirm
the position in answer to a previous question, does not all the
evidence indicate that doctors who come in from the Indian subcontinent
and the rest and have to reach the standards of the BMA provide
no less an excellent service than British-born GPs?
Mr Henderson: Absolutely.
Q178 Mr Winnick: There is no doubt
about that.
Mr Henderson: There is no doubt
about that, no.
Q179 Patrick Mercer: Mr Henderson,
tier 1 of the points-based system awards points for age on a sliding
scale up to a maximum age of 31 years old. Given that doctors'
training typically lasts seven years are you concerned that this
is going to discriminate against doctors?
Mr Henderson: I know this is an
issue that the BMA has raised and I can understand that. It strikes
me though that certainly for doctors coming in there are likely
to be other factors in terms of earnings that may well give them
compensatory points there, and certainly of course there are other
doctors who can come in on tier 2 for specific posts where, without
a doubt, they will get the required number of points.
Chairman: We are now on to nurses and
Karen Buck will lead on that point.
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