It’s fine. I have a legitimate job offer. I’m a key worker. I’ve studied and trained in the UK I’ve been in the UK for close to a decade. I’m just here to visit and fix up my living arrangements before applying for my visa. I’m sure they’ll understand. That’s what I had thought. Until I found myself in detention at the UK border. Several months before, as I booked my flights in advance to get back to the UK to start a new medical job, I kept reassuring myself with similar thoughts. I tried to ignore the fact that the health board was taking forever to get my certificate of sponsorship issued; despite my regular reminders, and with few replies on their end. As the number of days to my flight and my new job decreased, the certificate of sponsorship was still nowhere in sight. The niggling worry at the back of my mind slowly grew. Flying without a work visa, I thought: I’ll just come in with a visitor’s visa first to sort out my living arrangements. I’m sure they’ll understand. I need to settle in so that I can start work the minute the visa is issued. The NHS as a civil service/public institution would not let me work without one, the border control would understand that. Instead they said I was at risk of starting work without a visa. I was detained at the border, with my mobile phone taken away from me for several hours. I was informed that I would be put on the next available plane back to my last port of call, which was a city in Europe and nowhere near my home country. I remember how completely surreal it felt, like a living nightmare. Thanks to friends who rallied support from MPs, DAUK, and my union the BMA, I was able to have the deportation order rescinded with extraordinary difficulty. Unfortunately not everyone is so lucky to be that well supported. As it is, being a NHS doctor is hard enough with the pressures currently on the system, let alone adding on the worry about your right to legally remain in a country. And the sad part is that I know I’m not the only one. I have other non-UK colleagues who speak of the pressure of waiting for visa extension decisions long after their current visa has expired. Of being unable to leave the country to visit their loved ones for fear of not being able to get back after. I’m sure many readers who are also overseas workers have their own experiences to share. The government repeatedly declares that they’re supporting and fixing the NHS. Do they forget, for instance, that approximately 25% of doctors working in NHS England are non-british nationals? Having the threat of detention and deportation over one’s head does little to help with making the UK an appealing country to come to work. I personally know of several excellent colleagues who previously had planned on working in the UK but feel it is no longer worth it and have returned home. If the UK government truly believes they are doing the right thing to address the workforce shortage in the NHS by attracting qualified healthcare professionals from overseas, then they need to sort out fundamental issues such as the visa application backlog, and making it easier to get indefinite leave to remain.

6 July 2022 

Dear Colleagues,

Certificate of Sponsorship (COS) crisis for doctors on non-permanent visa

We are alarmed to learn that many doctors currently on non-permanent visas are facing bureaucratic delays that could prevent them from starting new jobs in August 2022. This threatens them with homelessness and a lack of income. Aside from the human misery, injustice and suffering this is needlessly causing, this will impact badly on the NHS at a time of increasing crisis.

As you will be aware, a COS and BRP are vital piece of paperwork required for these doctors to obtain valid proof of employment, letting agreements, mortgages and future applications for permanent residence visas.

It is unacceptable that several of these doctors will end up homeless as letting agencies are not willing to renew rental contracts and lenders will refuse mortgages if their BRP expires in a few weeks time, while the jobs they have been accepted for will be left unfilled.

The combined delays at Health Education England and within the Home Office are leaving these doctors under extreme mental stress, as they have already given notice to previous employers, while new employers won’t allow them to start without a new BRP – which is impossible without a COS. Many have applied for a new BRP after receiving their COS but have not received it. We know of cases where doctors have emailed after 8 weeks and received generic replied stating that Ukrainians are being prioritised.

The COS crisis is making doctors feel demotivated and undervalued, despite their contributions to the NHS. Many have been required to cancel major life events such as marriage due to this bureaucracy.

We therefore ask if HEE, the Home Office and the Department of Health could advise Trusts to do the following:

1. Allow doctors on non-permanent visas in training posts to be issued with a temporary emergency BRP to allow them to take up their posts
2. Where possible, support accommodation of these doctors by either providing a letter they can give to their letting agencies or by being their guarantor to prevent them from becoming homeless

We also request that: 

1. Issuing of COS is expedited 
2. HEE demands the Home Office expedite the renewal or issuing of new BRPs

The NHS needs all the doctors and healthcare professionals it can get. Placing these doctors in this highly stressful situation is both needless, easily overcome, and harmful on several levels. It also threatens to worsen the current staffing issued within the NHS. We hope you will take all reasonable and immediate steps to overcome this and await your reply. 

Yours sincerely

Dr Pushpo Hossain – IMG Lead

Dr Ellen Welch – Co-Chair

Dr Matt Kneale – Co-Chair

Doctors’ Association UK

The Doctors’ Association UK is utterly appalled that up to 1000 newly qualified GPs face deportation despite having completed their GP training in the UK. See our press release.

Home Office rules state that foreign doctors must work under the skilled worker visa scheme for at least five years before they can apply for Indefinite Leave to Remain (ILR) and this timeframe covers most specialist medical training. But GPs usually gain their certificate of completion of training (CCT) after three years, leaving a two-year gap during which they must secure sponsorship if they want to stay in the country when their visas run out. This gap leaves several GPs in limbo with the threat of deportation hanging over them. The Sunday Mirror has now reported on this, quoting DAUK’s IMG Lead Dr Pushpo Hossain and co-Chair Ellen Welch, that up to 1000 newly qualified GPs face deportation despite having completed their GP training in the UK.

“This simply defies belief and demonstrates the siloed thinking that is present in government when it comes to NHS staffing. These doctors, who worked during the pandemic, are ideally placed to help address the problems faced by a dramatically understaffed GP service currently.”

The Royal College of General Practitioners said that overseas GPs in the UK are being threatened with deportation. Our co-chair Dr Ellen Welch appears on BBC Radio 5 live to talk about how DAUK is working to match GP practices who can sponsor visas with GPs who need it, which was mentioned in Pulse. Dr Ellen Welch, a GP and co-chair of DAUK, says that the GP workload is immense, but there aren’t enough doctors to deal with it. To threaten deportation to fully trained GPs is clearly unwise. The government’s narrative is false, the sensible step is to approve indefinite leave to remain for trained doctors in the UK so that the pressure on the workforce is removed.

“We are short of thousands of GPs in the U.K. and desperately need these doctors to stay and work in the NHS. If the government is serious about bolstering the workforce then they need to take immediate action to ensure these doctors are not deported and are granted indefinite leave to remain to use their skills within our crumbling health service.”

Tune into Dr Ellen Welch speaking to BBC Five Live here.

References:

1. https://www.pulsetoday.co.uk/news/education-and-training/overseas-gps-forced-to-leave-the-uk-as-practices-cannot-sponsor-them/
2. https://www.pulsetoday.co.uk/news/workforce/overseas-gps-threatened-with-deportation-after-qualifying-says-rcgp

Ministers are being urged to grant migrant NHS workers the indefinite right to remain as the health service braces for what could be one of the most difficult winters it has ever faced.

Cross-party MPs, along with medical bodies including the British Medical Association (BMA), have backed calls to change the law so that foreign health and social care staff are given the right to stay in the UK in honour of their commitment during the pandemic.

Liberal Democrat Christine Jardine, who is pushing the second reading of a private members’ bill that would make this happen, warned that failing to provide “certainty” to these healthcare workers would risk “fuelling the winter crisis with an exodus of staff”.

Dolin Bhagawati, interim co-chair of the Doctors’ Association UK, said it was “time the government assures [migrant NHS workers] that they will not be callously cast aside as a political inconvenience”.

“These are dedicated professionals who have performed heroic service over the last 18 months. Yet they live with the potential for deportation over their heads at any instant. The country they have sacrificed so much for should be welcoming them home,” he added.

Read the full article here

The role played by international staff in the NHS received widespread media coverage recently after current head of NHS Test and Trace Baroness Dido Harding said she wanted to make the NHS less reliant on foreign doctors and nurses if she became the next head of NHS England.

As a ‘foreign’ doctor myself, comments like this sadly echo the racist statements we are increasingly hearing from patients. These include things like: ‘I want to be seen by a white doctor’ or ‘Why don’t you go back to where you came from’.

At a time when abuse towards NHS staff is becoming the norm, and all areas of the service, especially primary care, face overwhelming demand, we need the next leader of the NHS to understand that the NHS relies on its workforce to function.

International staff

Almost 200 different nationalities are represented within the NHS in England. The majority of staff are British, but as of January 2020, 169,000 (13.8%) report a non-British nationality, with Indian, Filipino and Irish representing the highest numbers. Some 67,000 members of staff are nationals of other EU countries.

Despite being the biggest employer in the UK, the NHS doesn’t have enough staff to meet demand. According to recent data from NHS Digital, the NHS has a shortfall of 84,000 FTE staff, and this does not include primary care where we know there is a shortage of GPs, and is before absence figures for COVID-19 are factored in.

Since its inception in 1948, the NHS has been heavily dependent on overseas healthcare workers, demonstrating that ‘foreigners’ are not only important, but vital for the smooth functioning of NHS services.

COVID-19 pandemic

This is even more apparent as we emerge from the challenges of the last 18 months, where international healthcare workers have stood shoulder to shoulder with their British colleagues.

Last month, former health secretary Matt Hancock told the parliamentary inquiry into COVID-19 that 1,500 health and social care workers have died during the pandemic and we know that with those from a Black, Asian or ethnic minority background are at an increased risk.

‘Foreigner’ comments make international healthcare workers sound like a burden on the NHS and completely undermine their contributions. Not only do they offer their skills and experience as healthcare workers, but they pay the same amount of tax as any British worker without having any recourse to public funds.

After residing in the country for 5-6 years, they then have to pay over £2,000 to apply for Indefinite Leave to Remain. They are also frequently seen investing in property, shares and tourism.

In 2015, the coalition government introduced the Immigration Health Surcharge (IHS), an annual fee of £624 that migrants need to pay to use the NHS. For a family of four, this charge, along with visa fees can easily reach £10,000 a year – which for tax paying NHS staff is an extortionate amount of money to pay in order to access the very system they work within.

In October last year, after lobbying by the DAUK, the Prime Minister announced that international health and care staff and their dependents would be exempt from the IHS, in view of their efforts during the pandemic.

It is time we valued our migrant healthcare staff, which is why DAUK will be supporting the bill to grant indefinite leave to remain to overseas staff, like myself, who have given their all to the NHS during the pandemic.

The NHS relies on the goodwill of its workforce to stay afloat, and the next leader of the NHS, whoever that is, needs to take this onboard

• Dr Pushpo Hossain is junior clinical fellow, acute medicine and a committee member of the Doctors’ Association UK (DAUK)
• Read the article in full here

The UK Government has been urged to hand indefinite leave to remain to health and social care staff amid warnings of a “psychological and financial” burden on Britain’s key workers.

Liberal Democrat MP Christine Jardine is urging ministers to act and offer “security and reassurance” to those who put their lives on the line during the pandemic.

Speaking to The Scotsman, the Edinburgh West MP claimed failing to do so could see the heroes of the pandemic face expensive visa costs or even being deported.

Ms Jardine, who has tabled a Private Members’ Bill in a bid to see the ambition realised, said: “So many of us have so much to be thankful to our NHS and care workers for in this pandemic that it seems the most appropriate way of saying thank you, to say to those who are here on visas, and want to stay and contribute, yes of course you are welcome.

“When the pandemic was at its worst and the daily death toll was frightening, many of those at most risk in the NHS and care sector did not, at any time, shrink from the threat to their own wellbeing.

“Now that many of them who have lives here, make an invaluable contribution to our society and want to stay, it is surely unreasonable to ask them to come up with the expense of visa costs or face the threat of being deported.”

Earlier this year it was announced that NHS and social care staff would have their visas extended by one year, but Ms Jardine insisted this was not enough.

She explained: “They are here legally, have worked hard, saved lives and made an astonishing contribution to getting this country through the worst pandemic and economic crisis in recent history.

“Without them the burden on our NHS and care sectors would have been so much heavier for everyone.”

The UK employs 170,000 non-British individuals from more than 200 countries in the NHS, making up 14 per cent of all NHS staff.

One of these is Dr Krizun Loganathan, who worked in a busy intensive care unit during the first wave of the Covid pandemic.

Read the full article here.

The Doctors’ Association UK (DAUK) are supporting overseas doctors from COVID-19 red list countries who are unable to travel to the UK to complete an exam required to be eligible for medical training in the UK. 

The forthcoming exam -The Stage 2 Clinical Assessment run by the UK Foundation Programme Office* (UKFPO) overlooks current travel limitations enforced by the COVID-19 pandemic, which have left many overseas applicants unable to progress their applications for the Foundation Programme, to enable them to work in the UK. 

Passing the Clinical Assessment is mandatory for candidates who graduated before August 2019 and now wish to apply for a foundation doctor post. The second stage of this Assessment is a test of a doctor’s clinical skills by way of an Objective Structured Clinical Examination (OSCE)-style, face-to-face exam, due to take place on the 26-27^th May this year. 

Pandemic restrictions currently limit travel from countries in the Red List (including Pakistan, Philippines, Bangladesh, Kenya, Zimbabwe and most recently, India), meaning that candidates cannot travel from these countries to participate in the exam.

A candidate who wished to remain anonymous from one of the listed countries raised concerns with DAUK saying, “this directly goes against the UKFPO duty of fair treatment for all applicants and discriminates against those who are unable to travel due to extenuating circumstances.” “Prior correspondence reassured that no candidates would be disadvantaged for their circumstances. However, the UKFPO have indicated its intention to withdraw myself 

(and other applicants in red list countries) if we fail to attend the assessment in person in May, despite having paid the non-refundable assessment fee (£850) and already being allocated to a UK foundation post for August.”

This doctor and colleagues wrote an open letter to the UKFPO proposing reasonable adjustments to the examination, including rescheduling the date of the assessment and/or adapting the format for delivery via an online platform to enable participants from overseas to complete the assessment. These suggestions have been rejected.

Dr Jenny Vaughan, DAUK Chair:

“DAUK supports the adjustments proposed in the letter, to enable experienced international colleagues to join our NHS workforce. These candidates have already invested significantly in the process of coming the work in our system and many have served resignation notices in their current posts. Passing this exam is their key to taking up roles in the UK, and we urge the UKFPO to find solutions for these candidates, to enable them to contribute to an NHS that is much in need of their skills.”

Freya Rhodes, Medical Student Representative DAUK:

“This is huge concern for these qualified doctors who are ready to work in the UK. 1 in 7 NHS workers are from overseas and their vital contribution to the workforce must be recognised.”

“It is a very challenging time to be entering the NHS. Considering current workforce shortages and high levels of staff burnout, inadequate exam provision is an unnecessary obstacle. The UKFPO must make reasonable adjustments to ensure equal access to training and allow as many new doctors as possible to start work in August.”

CONTACT 

Press@dauk.org

FURTHER INFORMATION

*The UK Foundation Programme

-The UK Foundation Programme Office (UKFPO) manages the Foundation Programme – a two-year structured programme of workplace based training for junior doctors, that forms a bridge between medical school and higher specialty training, and allows trainees to practice as a fully registered doctor in the UK.

-The UKFPO is responsible for allocating places on the programme to all qualifying medical graduates in the UK. They also manage applications for non-UK graduates who are eligible to apply.

-The Clinical Assessment is a mandatory requirement for anyone who qualified from medical school on or before 4^th August 2019. This includes many overseas doctors who may have qualified before this date, and gained valuable experience practising as doctors elsewhere.

Recent government action

In 2019 the prime minister, Boris Johnson, announced a new “NHS visa” which would make it significantly easier for doctors and nurses from around the world to work in the UK. This visa would cost around £464, half the usual price, and would be guaranteed a decision within two weeks. This was established pre-pandemic, to mitigate any negative impact which Brexit would have in attracting overseas staff to the NHS, demonstrating how important migrant workers are for  the service.

Following this, in the peak of the first wave of the pandemic in 2020, the government announced that all non-European Union migrant workers in the health sector whose work visas were due to expire before 31 March 2021 would have them extended for another year with no fee.

This scheme has now been extended, to allow healthcare workers that fit the eligible profession criteria with visas due to expire between 1 April 2021 and 30 September 2021 to apply for a free one year extension. The scheme also allows dependent family members of healthcare workers, such as spouses or children under 18, to apply for the visa extension too.

The Private Member’s Bill

In November 2020, the Immigration (Health and Social Care Staff) Bill 2019-21 was put forward, which intends to offer migrant healthcare workers indefinite leave to remain. This is similar to the actions taken in countries such as France, where full citizenship is being granted to frontline migrant workers. The bill is supported by the Royal College of Physicians, the Royal College of Nursing, the Doctors Association UK, Independent Age and Unison, and MPs are thought to have received upwards of 7,400 letters of advocacy for the bill. 

However, the second reading of the bill was delayed in January 2021 due to the Commons’ COVID-19 safety rules. The Liberal Democrat MP Christine Jardine, who sponsored the bill, has since called on the government to consider debating the bill remotely due to the urgency of its nature, stating “I make no bones about the fact that I would like the government to recognise the contribution made by the NHS workers – the foreign nationals – who have done so much for this country in this crisis”.

The rest of this article can be read here.

London (CNN)Few would envy Britain’s embattled National Health Service (NHS) workers over the past year. One of the world’s worst Covid-19 tolls has meant grueling shifts, danger, and workplaces full of grief and trauma. But Charles Oti would swap places with them in a heartbeat. A microbiologist by training, Nigerian by birth, Oti has spent four years working for the NHS honing a specialism in infection control.Oti’s skills are in short supply and among the UK government’s highest priorities for recruitment. But instead of taking a position on the front line of the pandemic response, he has been prevented from working and threatened with deportation.

“I believe I have the skills to make a difference,” says Oti. “This has been so frustrating because I am being wasted.”The case represents a personal ordeal and a wider issue. At a time when Britain is heavily reliant on immigrants to staff its essential services, particularly in the NHS, many of these same workers are fighting for their right to remain in the country. 

Living in legal limbo 

Oti, 46, received a five-year residence permit when he arrived in the UK in 2013 with his partner, a European citizen.After a spell in the private sector, he took a job with the NHS in London in 2015 as a medical devices coordinator. His regular duties included contamination control and ensuring the safety of equipment such as X-ray machines and respirators.Better money was available in private enterprise but Oti says that public service suited him. He felt the job made more of a difference to the lives of patients and enjoyed the camaraderie within the NHS’s multinational workforce which was “like a family.” There, he says he formed close friendships that helped him adapt to a new country.

But Oti’s residence permit was revoked without his knowledge when his relationship ended, and after returning from a trip to Nigeria in 2017, he was detained at the border and ordered to leave Britain. Since then he has existed in a legal limbo. Several applications to remain have been denied. Oti was allowed to continue working until 2019, when the Home Office informed the NHS that his status was insecure and he was suspended without pay. “They tell you to stop working and it puts a person in a very difficult position,” says Oti. “You can’t afford to make a fresh application or to appeal if it fails. One can go destitute because of this, a lot of migrants do.”Oti has avoided this fate with help from his friends and new partner — a British citizen and NHS worker — who have supported him while he has been unable to work.

Tip of an iceberg

Oti’s case is far from unique, statistics show. An estimated 170,000 of the NHS workforce of 1.28 million are foreign nationals, many of whom have an insecure status. The Doctor’s Association UK (DAUK) group is campaigning for Indefinite Leave to Remain for all NHS workers and their families, writing an open letter to Prime Minister Boris Johnson that notes his own recent reliance on the service. “Charles Oti’s case represents precisely the reason DAUK have campaigned for NHS workers and dependents to be granted immediate Indefinite Leave to Remain,” Vice-Chair Dr. Dolin Bhagawati told CNN. “It beggars belief that the Home Office is not playing its part in the national effort to combat a pandemic that still affects the country.”Migrant rights campaigners believe the Home Office’s “Hostile Environment” policies, launched in 2012, are to blame. Those policies, aimed at deterring illegal immigration, introduced more stringent and frequent checks on immigration status that increased the difficulty of accessing services and left migrants more vulnerable. In the most notorious case of the “Windrush” generation, legal arrivals from the Commonwealth were cut off from housing, healthcare and banking services, and in some cases deported. The government has since apologized, commissioned an independent review, and established a compensation mechanism.

“The Home Office has a long history of treating migrants with disdain and cruelty,” says Minnie Rahman of the Joint Council for the Welfare of Immigrants (JCWI). “The Windrush Lessons Learned review showed how deeply the Home Office needs fundamental and meaningful reform, but the Government has so far failed to act.”The government has introduced free visa extensions for around 3,000 health and care workers, which unions have criticized as it excludes thousands more. Oti’s solicitors are now pursuing a judicial review of the case, which they say is his last hope. A crowdfunding appeal for his legal fees has raised around £2,700 ($3,700).For Oti, the pandemic has highlighted the need for people to work across boundaries as our fates are invariably connected. “When you walk into a hospital, the consultant who sees you might be a migrant, and the nurse supporting the consultant could be a migrant,” he says. “When something goes wrong (like the pandemic) it can affect everybody.”

Read the article in full here