Health CommitteeWritten evidence from VSO UK (ETWP 70)

VSO and Health Workers

1. VSO is an international development agency with over 50 years of experience working in poor countries around the world. We take a unique approach to tackling global poverty, by placing committed volunteers with carefully selected partners—from grassroots groups to government ministries. Our 1,600 volunteers use their skills to improve the impact of aid efforts for poor and marginalised people. By working closely over time with partner organisations, they provide the right support to help ensure that local development efforts deliver greatest impact and value for money.

2. VSO recognises that the health crisis in many countries is one of the key barriers to development and to countries moving out of poverty. VSO is responding to this inquiry because:

VSO recruits UK-trained health professionals to volunteer overseas to train local health workers and strengthen local health systems. VSO would recommend that the Department of Health continue to view overseas volunteering placements as beneficial for professional development and that it supports efforts by trusts and other organisations to facilitate them.

Recent research by VSO concluded that developing countries can benefit from their health workers spending a period of time training in a foreign health system such as the NHS. The research concluded that the Medical Training Initiative (MTI) provided a suitable route to provide such training. VSO has a particular concern about the Government’s proposal to reduce the duration of a Tier 5 visa from 24 months to 12 months. This change would decrease the number of doctors willing to participate in the MTI, increasing staff costs for the NHS and potentially leading to further “brain drain” from developing countries. VSO has responded to the UK Borders Agency consultation (closed 17/09/2011; results not yet published). VSO would recommend that the Government retain the length of the Government Authorised Exchange category of the Tier 5 visa at 24 months, and not reduce it to 12 months.


3. Our short submission will focus on two aspects of the inquiry:

The impact of people retiring from, or otherwise leaving, healthcare professions; and

The place of overseas educated healthcare staff within the workforce.

The Impact of People Retiring from, or otherwise Leaving, Healthcare Professions

4. VSO currently has 120 UK-recruited health professionals, including 44 doctors, serving as overseas volunteers. The majority of returned volunteers agree that their VSO experience has provided a valuable learning opportunity and had improved their personal capacity, for example by making them more resilient, flexible, improving problem-solving skills, and improving their ability to work with and care for people from different backgrounds. A survey by the Chartered Management Institute1 showed that 94% of employers agree that long term overseas voluntary activity broadens skills and experience.

5. The Department of Health, through Primary Care Trusts and Hospital Trusts currently supports overseas volunteering by promoting opportunities, approving sabbaticals and guaranteeing jobs on return, and paying NI contributions for the duration of placements. VSO would recommend that the Department of Health continue to view overseas volunteering placements as beneficial for professional development and that it support efforts by trusts and other organisations to facilitate them.

The Place of Overseas Educated Healthcare Staff within the Workforce

About the Medical Training Initiative

6. The MTI is “a temporary scheme designed to enable a small number of international medical and dental graduates to enter the UK to experience training and development in the NHS for up to two years—before returning to their home country.” The latest figures VSO has been given (April 2011) show that there are 340 doctors working in 149 trusts across the UK through the MTI. The purpose of the scheme is to make use of spare training capacity in the NHS, while providing relevant work experience in the UK to doctors from low- or middle-income countries. The three largest countries of recruitment are Sri Lanka, India and Egypt. Participation in the MTI does not lead to settlement or a prospect of a career in the UK. At the end of the maximum period (two years), the individual is expected to return home.

Benefits of the MTI to the UK

7. The NHS’s reliance on locums to staff their hospitals has grown considerably in recent years. Utilising the International Medical Graduates (IMGs) recruited through the MTI saves trusts money. MTI doctors are paid the same as UK trainees and do not incur additional charges for the trust from locum agencies. Using the MTI also enables more efficient workforce planning by hospitals. It allows them to plan ahead for MTI positions instead of using last-minute locum appointments.

8. VSO is proud that the NHS is highly regarded internationally and seen as a place where the best medical graduates across the world want to receive education and training. IMGs who train in the UK return home with loyalties to the UK and links to NHS Trusts. These well-established training links give the UK additional influence internationally. The MTI also supports the UK’s international development objectives by facilitating the sharing of knowledge and best practice to strengthen developing country health systems.

Benefits of the MTI to sending countries

9. As training in some developing nations can be quite basic, the MTI provides overseas doctors access to a higher-quality structured training programme. Some countries, for example Sri Lanka, rely on it as their only route for advanced training. The MTI and other Tier 5 training schemes for health workers run by the medical royal colleges and other organisations represent the few remaining routes for overseas health workers to access training within the NHS.

10. The majority of health workers interviewed expressed their desire to come to the UK on a temporary basis to work or train in order to increase their skill levels. Many VSO volunteers, leaders of professional associations, and other stakeholders expressed the view that health workers with experience of working in the NHS were better placed to take up positions of responsibility within their home health system and brought back additional skills and expertise. The safeguards of the MTI ensure doctors do return to their home countries to practice and do not contribute to “brain drain”.

MTI Safeguards

11. The MTI scheme has robust safeguards to ensure the highest quality IMGs are working in the NHS. IMGs who come to the UK on the MTI must demonstrate a high level of English language and communication skills in order to be registered with the General Medical Council (GMC). The RCP and other royal colleges ensure candidates have excellent medical expertise by interviewing them in their home country before they are able to start working in the NHS.

12. There are also robust safeguards to ensure IMGs cannot prolong their stay in the UK. Tier 5 visas limit an individual’s stay to 24 months. At the end of this period the IMG cannot be employed legally and is required to leave the UK. There is no option for extension or switching of visa categories. Once the IMG returns home, they are not permitted to apply for another Tier 5 visa for five years.

Proposed changes to Tier 5 visas

13. The MTI is currently administered under Tier 5 of the “points-based system” of the UK’s immigration rules. It falls under the specific sub-category of a Government authorised exchange (GAE), which has the support of a Government department and an “overarching sponsor” who can manage the scheme. The Government has set a target to reduce immigration to the UK. As people who stay in the UK for 12 months or less are counted as “temporary visitors”, and are not regarded as immigrants, the UK Borders Agency (UKBA) is considering reducing the maximum length of stay under the Tier 5 visa from 24 to 12 months. VSO believes this change would jeopardise the MTI and push doctors from overseas into training opportunities in other countries that do not guarantee return to their home country. VSO would recommend that the Government retain the length of the Government Authorised Exchange category of the Tier 5 visa at 24 months, and not reduce it to 12 months.

December 2011

1 Valuing Volunteering, Chartered Management Institute, 2006

Prepared 22nd May 2012