Student Visas - Home Affairs Committee Contents


Written evidence submitted by NHS Employers (SV32)

EXECUTIVE SUMMARY

We fully support the drive for successful implementation of a managed migration strategy which enhances the ability of healthcare providers to deliver high quality patient care.

It is important that any changes to the immigration system do not deter healthcare professionals who are considering the UK as a place to come and practice. Global competition for people with these skills is increasing. These people are essential to the continued provision of health services as demand from patients continues to increase.

NHS Employers' recommendations

  • Overseas doctors who train as medical students in the UK should retain Tier 4 status to undertake their two-year foundation training programme after receiving an undergraduate medical degree.
  • Courses that are undertaken at below degree level should be removed from Tier 4, as long as nursing is classified as degree or equivalent during the transition of nurse education in England to an all degree profession.
  • A solution should be found to retain the flexibility which has allowed and encouraged individuals to base themselves in the UK to undertake advanced health research and drive innovation in the field.
  • If the post-study route is curbed, it is essential that an alternative method is identified to enable the movement from highly skilled education to highly skilled employment in the UK so that valuable healthcare professionals trained by the NHS are not lost from the UK. An alternative to the post-study work visa would be a suitable period of time at the end of the Tier 4 student visa to allow the opportunity to secure employment and move into another immigration category. Employers have suggested that, in most cases, a suitable period of time for trained healthcare professionals would be six months.

BACKGROUND

1.  NHS Employers represents NHS trusts in England on workforce issues and helps employers to ensure the NHS is a place where people want to work. NHS Employers is part of the NHS Confederation.

2.  Our role is to provide employers with practical advice and information on changes on the recruitment and training of the workforce in order to improve the quality of patient care. We work with employers to facilitate networking opportunities and ensure their views are represented at the highest levels as key policies are developed and decisions taken.

3.  NHS Employers is at the heart of the discussions on the immigration system because the migration of individuals to the UK health system forms an important supply route of skilled and highly skilled professionals to support the delivery of health services to patients. Our work on immigration focuses on:

  • ensuring a system exists to provide employers with the ability to recruit the right numbers of appropriately skilled healthcare professionals to meet demand and patients' needs;
  • ensuring that employers are proactive in working to reduce the risk of employing illegal workers in the health sector; and[18]
  • ensuring the immigration system does not disadvantage developing nations in producing a clinical workforce to support their local health needs.

4.  We fully support the drive for successful implementation of a managed migration strategy which enhances the ability of healthcare providers to deliver high quality patient care and we welcome the Home Affairs Committee's involvement at this critical stage. We are pleased to have the opportunity to submit evidence to this inquiry.

THE NHS AND TIER 4

5.  The NHS is not only a major employer of migrant labour but also trains the future generation of healthcare workers. Individual health sector employers share the responsibility to deliver education and training with academic institutions. Employers are responsible for delivering the practical "hands on" education and training which comprises a significant proportion of undergraduate healthcare courses. The practical learning for which employers are responsible can be as much as 50% of some clinical professional undergraduate courses, such as nursing.

6.  Overseas doctors who train as medical students in the UK currently hold Tier 4 status to undertake their two-year foundation training programme after receiving an undergraduate medical degree.

Should the cuts be limited to certain types of courses?

7.  We believe the focus should be on the type of qualification gained upon completion of the course. To ensure this entry route is used to provide international students with a high level educational qualification, our view is that courses that are undertaken at below degree level could be removed from this route.

8.  We would caveat this statement with the need to ensure that nursing is classified as degree or equivalent during the transition of nurse education in England to an all degree profession, due to its status with the professional regulator, the Nursing and Midwifery Council. All new entrants to nursing courses will be studying at degree level by 2013.

The impact different levels of cuts might have on the health sector

9.  Currently the majority of individuals in the NHS who hold a Tier 4 visa are undertaking foundation medical training although there are other clinical professional trainees in pharmacy and nursing amongst others. Individuals choose the UK as their destination to train as undergraduates and continue training in their field of practice whilst in employment. These highly skilled professionals are critical in providing health sector employers with the ability to meet the rising level of patient demand.

The impact, if any, that reductions in student visas might have on the UK's standing in the world

10.  Increased global competition for skilled healthcare professionals must be recognised when reviewing this tier and others within the points-based system.

11.  During 2010, the Canadian Government waived the need to have an employment offer for many clinical occupations. The long-term implications of reducing educational, training and employment opportunities in the UK must not be under estimated when re-designing the UK system within the context of an increasingly competitive global market for clinical skills.

12.  Protecting the international reputation of the UK education and health sectors is also of primary importance to NHS Employers and providers of healthcare. It is notable that the Australian health service launched in 2010 a specific marketing campaign seeking medical staff and qualified nurses alongside their existing long-running campaigns to attract healthcare professionals to support their activities in the regions.

Will cuts in student visas have any effect on the decisions of highly qualified graduates to conduct research or take up teaching posts in the UK

13.  Our immigration system has traditionally allowed and encouraged individuals to base themselves in the UK to undertake advanced health research and drive innovation in the field. This has placed the UK as a leading force in these areas. This not only enhances our international reputation and attracts additional funds to support the developments but also provides the UK population with access to leading edge services and interventions.

14.  There is little evidence to submit to the Commiittee in this area but we can refer to the previous changes to the permit-free element of the immigration system in 2007, pre-points-based system. The closure of one route of the system brought about an immediate reduction in applications from overseas doctors. This change in policy co-incided with changes in the medical training system and other health policy initiatives and therefore cannot be viewed in isolation. It met the immediate desired objective, to curb an over-subscribed market. However, as a result of definite and strong messages around the availablility of opportunities in the UK, individuals sought opportunities elsewhere and many NHS organisations found they had gaps in the workforce.[19]

15.  Changes to immigration systems in other developed nations have protected the flexibility in the system to ensure those seeking to enter higher levels of study or research can obtain access.

Should the post study route be continued?

16.  It is critical that any decision on the continued existence or eligibility criteria for the Tier 1, post-study work visa should be taken within the context of changes to the Tier 1 and Tier 2 (General) parts of the system.

17.  In health, this route is used to support a range of clinical professionals in the transition from undergraduate study to employment which includes continued training, often in occupations in which the UK has a skills shortage. For example, overseas students completing medical, dentistry, pharmacy and other health care professional courses enter this route.

18.  There are approximately 500 medical trainees per annum eligible for this route. Other professional groups are not counted centrally but will not exceed 500.

19.  Though these numbers may appear small, these healthcare professionals are essential to the continued provision of health services to patients. Employers in the NHS have invested time and resources to support the training of these people with a view to this leading to employment at the end of the course in most cases, and it is important that health services see the benefit from this investment.

20.  Employers can see the value in removing this route to curb proven abuse within the system. However it is essential that an alternative method is identified to enable the movement from highly skilled education to highly skilled employment in the UK so that valuable healthcare professionals trained by the NHS are not lost from the UK.

21.  An alternative to the post-study work visa would be a suitable period of time at the end of the Tier 4 student visa to allow the opportunity to secure employment and move into another immigration category. Employers have suggested that in most cases a suitable period of time for trained healthcare professionals would be six months.

January 2011



18   As an example of the practical support we provide, NHS Employers has produced a set of six Employment Check Standards, including the right to work check standard, to assist with pre and post employment checking systems. Back

19   NHS Employers published two guides Managing gaps in medical staff cover and Working and training in the NHS to support employers and individuals which are available on the NHS Employers website. Back


 
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© Parliamentary copyright 2011
Prepared 25 March 2011