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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