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

full article by Alicia Clegg in the FT

At the start of the pandemic, trainee GP Kaveri Jalundhwala was working on a hospital placement. By the end of March, she had become infected with Covid-19, which then developed into long Covid and forced her to pause her training. With stories emerging of how healthcare workers in makeshift masks and gowns — and sometimes no protection at all — were paying for failures to provide adequate personal protective equipment (PPE) with their health, Jalundhwala looked for a way to support her colleagues.  She joined Doctors’ Association UK (DAUK), a grassroots lobbying group. And rather than “just get angry at home”, Jalundhwala got involved with their “Protect the frontline” campaign. Its aims include to inform the public about conditions in the fight against Covid and press the government to give healthcare workers appropriate PPE and support.

The DAUK grew from doctors joining together to support a junior paediatrician, Hadiza Bawa-Garba. In 2015, Bawa-Garba was convicted of manslaughter by gross negligence after the death of six-year-old patient and was then struck off by the General Medical Council. But many medical professionals did not see a doctor who had failed, rather an overstretched colleague who was put in an unsafe situation and scapegoated. “Any one of us could be Bawa-Garba,” says Jalundhwala. It often feels that doctors are “a faceless number on a rota where [our] individual voice does not matter to the people who make decisions,” she adds. Bawa-Garba has since returned to medical practice, while the DAUK developed its “Learn not blame” campaign to improve the culture of the NHS so it can learn from mistakes “in a constructive and fair manner”.

When the pandemic hit, DAUK started its “Protect the frontline” campaign. As part of this, it broke the story of NHS staff being warned not to discuss PPE problems on social media or speak to the press. It also created an app that enables doctors and GPs to report on PPE supplies. In April 2020, DAUK also led calls for an independent public inquiry into healthcare worker deaths and PPE supplies, with its petition gathering more than 100,000 signatures. When this received no formal response from government, DAUK started legal proceedings with the Good Law Project.

“When something needs doing, we do not sit on it,” says Pushpo Hossain, who joined DAUK to amplify the voice of doctors working in the UK who qualified abroad.

In May, when a DAUK member heard about a plan to upload all NHS patients’ medical records to a central database that could be shared with third parties, the organisation joined forces with Foxglove, a digital rights campaign group, to help force a delay. “In less than a week we had decided to take legal action [later paused],” says Rosie Shire, a GP who led DAUK’s response to the plans. The scheme has now been postponed to allow time for more consultation with no new date for implementation.

Read the full piece by following the above link

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

DAUK’s Dr Ellen Welch talks about what the day meant, how it is to become an annual event and it’s main aims.

Read more here.

Having worked under extreme pressure for the last year, should the Government’s pay rise for NHS staff not recognise this?

See the interview here

Medics fear another Covid-19 spike as many revellers snubbed masks, social distancing and the rule of six as they enjoyed new freedoms outdoors on a sunny FA Cup semi-final Saturday

Revellers toasted the first weekend of freedom in months by downing six million pints of beer today in a sun-soaked splurge of socialising.

Drinkers formed queues outside beer gardens, with many staying on to watch the FA Cup semi-final between Chelsea and Manchester City on jumbo outdoor screens.

High streets were busy too, and Joshua Bamfield of the Centre for Retail Research estimated 18.4million shoppers would spend £1.6billion in stores this weekend.

Dr Pushpo Hossain of the Doctors’ Association UK committee, said the packed pub gardens were “very scary”.

She said any new spike could prove too much for medics who have been exhausted by the the pandemic and demoralised by a paltry pay proposal.

Dr Hossain said: “The government has broken our morale with the one per cent. If a third wave hits we won’t be fit enough to deliver a service. We are burnt out.”

Dr Pushpo Hossain

Read the full article here

The volume of patients, the complexity of illnesses, and the unrelenting nature of the covid pandemic are having a huge impact on morale among our junior doctors, many of whom are experiencing their first winter in the NHS, write Nikki Nabavi and Clara Munro

A winter surge in hospital admissions is not unfamiliar. However, Public Health England’s annual flu and covid reports1 show that the current pressure on hospitals is not comparable to the usual winter influx. The difference in healthcare staff’s morale between the start of the pandemic and now is palpable, not least among those who are experiencing their first winter in post.

The nervous energy that characterised last spring has been replaced by chronic exhaustion. Natalie Ashburner, vice chair of the Doctors’ Association UK, says that doctors feel “battered by the unrelenting experience of caring for those with the virus.” And the idea of “just a bad day on call” is replayed without any opportunity for recovery.

Pushpo Hossain, a junior doctor in London, says, “When you are doing everything you can and you reach the ceiling day after day, morale falters.”

Alone

One major difference is that, during the first wave, doctors weren’t also providing routine care. This has now changed, and in addition there are long backlogs of patients, some of whom have had their treatment delayed for over eight months. It’s created an additional pressure on the NHS that wasn’t there during the first wave.

The Faculty of Intensive Care Medicine surveyed its members in November 2020, before the peak of the second wave, and reported that only 18% of respondents agreed that staffing levels in intensive care units were adequate.2At the peak of the second wave in January, junior doctors and medical students were being asked to volunteer in intensive care, sometimes through call-outs on social media.3

The BMJ heard concerns about staffing levels from several junior doctors around the country. “Staff are constantly having to isolate, which leaves us so understaffed,” says Amelia Seifalian, a foundation doctor in Watford. “Often at 9 pm we are asked on our hospital’s foundation year 1s’ WhatsApp group if anyone can go in and cover a night shift, as they are short of around four doctors.

“These shortages mean that juniors are left with more responsibility than usual, and things that you would usually ask your senior house officer for support on or double check with them, you are unable to, which makes us feel less confident.”

In a 2019 study published in the Journal of the Royal College of Physicians, 66.4% of doctors reported “feeling part of a team” as being the most important factor affecting their morale.4 Bethan Markall, a junior doctor based in Birmingham, told The BMJ that rota gaps also affected doctors’ sense of team support and camaraderie: “Juniors no longer have a team—it’s not unusual to work four different shifts, each with completely different teams.” This leads to a lack of team identity and reduced support.

Markall adds, “First year foundation programme teaching has only been online, meaning we have had less of a chance to meet our cohort or socialise with them, which can be quite isolating.”

This trend of isolation is highlighted by the stark contrast between the culture of free team meals and social support, as seen during the first wave of the pandemic, and the new socially distanced canteen booths that Seifalian describes, allowing for little to no mealtime debriefs with colleagues after difficult days. She emphasises the importance of reflections with colleagues. “I don’t want to talk about it to my family or housemates,” she says. “I don’t want to share the burden.”

Infantilised and ignored

Morale may be further eroded by feeling “infantilised” by colleagues. Freddie Stourton, a foundation doctor in the south of England, says that it can feel frustrating and exhausting to be thrown in at the deep end and then be “told off” for things that are out of your control. Senior staff can expect juniors to be familiar with their surroundings or a ward’s logistical practices, even though they are sometimes working with completely different teams on different shifts. Some reported being shouted at for “standing in the wrong place” five minutes after arriving at a new ward and while trying to help a patient.

While all doctors will be familiar with the “bad shift,” those who spoke to The BMJ said that the covid pandemic had brought an increasing frequency of these shifts among junior staff who lack the experience to contextualise these encounters.

The Doctors’ Association UK is among those who have called for greater provision of accessible mental health services for doctors. A spokesperson told The BMJ, “We have grave concerns about the effect that this pandemic is having on the mental health of NHS workers. We urgently need more specialist mental health services that are well funded, adequately resourced, and accessible to those who need them.”

The BMA, meanwhile, has called for medical staff to be prioritised for covid-19 vaccination to help reduce the absences that are leaving rotas short5 and subsequently affecting junior doctors’ ability to attend vaccination appointments themselves, while changes to shift patterns and night shifts6 make this challenging.

Stourton says that, in some ways, the shunting of junior doctors reflects an attitude that’s persisted throughout the recruitment process: doctors who have undergone years of training being “treated like numbers on a page, with patchy communication and changes in the process with little or no notice.”

Partha Kar, consultant in diabetes and endocrinology and a BMJ columnist, says that “what junior doctors have taken on in this pandemic has been nothing short of astonishing. Stepping into areas way outside their comfort zone, with specialties not being a barrier or given a second thought—their desire and determination to help without any hesitation has been fabulous to see and be part of, as well as inspiring.”

He concludes, “The least as seniors we can do is to find some time, if possible, to have a kind or caring word, or even a simple thank you, for their efforts in these extraordinary times.”

Read the article in the bmj

‘As the government faces mounting criticism that well-connected people made millions out of Britain’s PPE crisis, Panorama investigates who won out.’

‘More than £12 billion was spent in the first six months of the pandemic on contracts to provide personal protective equipment.’

‘Reporter Richard Bilton meets one man who made £40 million on a deal and speaks to others who felt ignored in favour of less experienced suppliers. As the government refuses to reveal the full details of all its so-called VIP deals, the programme reveals the high-profile connections to one lucrative contract.’

Watch the full programme here

“The NHS could not function without its foreign born workers. Around 169,000 people, or 13% of the workforce was born outside of the UK.”

Radio 4 interviewed DAUK’s Dr Pushpo Hossain on NHS Overseas Workers Day last Friday:

Would you like to continue working in the nhs?

“I really love working for the NHS and I would like to call it my home. But unfortunately it is our fate as an international health care worker, we are on temporary visas and cannot obtain permanent residency…we have to be on temporary visas for five years before we can apply for the Indefinite Leave to Remain, which also comes with an exuberant fee of around £3000 per applicant.”

Will your salary be affected by this proposed 1% pay increase? 

“To be honest, it feels very, very insulting…for some of us [the 1% pay increase does not even cover] the £3000 that is required for the Indefinite Leave to Remain application. So how are we being recognized? How is this being fair to all these international health care workers…we have put our lives on the line and is this how they want to reward us?”

Today marks the first ever Overseas NHS Workers Day, organised by Dr Pushpo Hossain, of the Doctors’ Association UK, and supported by the Unison trade union and a number of other organisations.

Almost 14 per cent of NHS staff identify as non-British, with nearly 200 different nationalities represented within our health service. Among NHS doctors, 30 per cent were born overseas. The international medical community has formed a massive and crucial part of the NHS frontline, with members risking their lives to look after patients with Covid-19.

As an overseas NHS worker myself, I have felt the impact of being alone during a pandemic, more than 5,000 miles from home and family. I’m delighted by an initiative which celebrates the contribution of the international medical community during this crisis, and raises awareness of some of the issues international staff face.

Chief among these issues is immigration status. Indefinite leave to remain (ILR) or permanent residency is currently awarded to those with Tier 2 visas who have lived in the UK for a qualifying period of five years. I’m originally from Kerala, India, where I was born into a family of doctors who inspired me to gain international experience within the NHS after completing medical school in India. I will only be eligible for ILR in 2023, which as a frontline worker, adds an extra layer of stress to be uncertain about my fate in this country.

Many of my NHS colleagues have faced delays in obtaining a Biometric Residency Permit, without which we cannot rent accommodation, apply for a training post, enrol our children in school, apply for a driving licence, or even open a bank account. It’s not unusual for DAUK to be contacted by doctors unable to travel home to see dying relatives because of delays receiving this permit.

I’m currently a trainee in psychiatry in the Oxford Deanery. Being an international doctor in training on a Tier 2 visa is not straightforward. To apply for any out of programme experience, research, or training, brings with it mountains more bureaucracy. I truly believe that international minds could devote more energy towards boosting clinical innovation within the NHS if we didn’t have to worry endlessly about our expiring visas, and research repeatedly shows the material and psychological benefits of gaining permanent residency.

The NHS has significant staffing and retention issues, with more than 88,000 vacancies in England alone; vacancy rates are approaching 10 per cent in some areas. Visa challenges and uncertainties contribute to these issues and have a drastic impact on the attractiveness of working as a doctor in the UK.

Progress of sorts has been made – for example exempting international NHS staff from the immigration health surcharge, which was a huge financial burden for doctors waiting to start work or renewing their visa. This came as a huge relief. 

The government has also introduced ILR for the dependents of staff who die during the pandemic while caring for Covid-19 patients, though not for staff who survive. I feel this is morally reprehensible and not in line with British values of fairness and respect. 

I can truthfully say that not once did I think of stepping back from the frontline. The call of duty has driven me to give the best to my patients. This is a spirit that all doctors and other NHS staff share. But we expect this to be recognised, and our hope is that us “Covid Soldiers” will be rewarded with ILR, showing that we are valued, and our sacrifices appreciated.

I would like to proudly call the UK my “home away from home”.

Dr Alex Vallakalil is a trainee psychiatrist and part of the Doctors’ Association UK

Read the original article here: https://www.independent.co.uk/voices/nhs-covid-nurses-immigration-doctors-b1812892.html