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.

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A year ago today, we lost the first of too many healthcare workers to covid as Dr Adil El Tayar and Dr Habib Zaidi passed away. Since their tragic deaths, hundreds of NHS workers have died from covid.

The full extent of the devastation that has been wrought on the NHS workforce by covid is yet to be established. Even the figure of 883 NHS staff covid deaths only records those who died between March 2020 and December 2020 and does not include the many more who have tragically died during the second wave.

We do not yet have data on some other major effects of this pandemic on the NHS workforce, such as the impact of long covid; the toll on mental health of witnessing death on an unprecedented scale; the trauma of treating colleagues and watching them die. This trauma is multiplied in those cases when, only weeks ago, those colleagues were standing shoulder-to-shoulder with us in the pandemic response.

The families of those who have died need to have answers regarding the circumstances, both ethically and legally. An inquiry is needed as soon as possible. However, the need for honesty and openness appears incompatible with recent public pronouncements, such as denials of problems with PPE. These responses seem more concerned with disingenuous denials and spinning of facts rather than a true desire to learn and not repeat mistakes in the future.

Early in the pandemic it was clear that, in the UK, those from BAME communities were at greater risk of dying from covid. Yet a report by Public Health England, published in early June 2020, on the disproportionate effects of covid on black, Asian and minority ethnic people, was criticised for leaving out submissions from third party organisations, which included claims of “structural racism”. The third party submissions were later published, in mid-June 2020, but only after an outcry from opposition parties, the Royal College of Physicians Edinburgh, the Doctors’ Association UK and the Muslim Council of Britain, among others.

One section of the report stated that “…the pandemic exposed and exacerbated longstanding inequalities affecting BAME communities. Action is needed to change the structural and societal environments. There is a legal duty and moral responsibility to reduce inequalities.” The implication of the initial attempts to withhold this information was to summarily dismiss or to attempt to spin potential systemic and structural influences that may predispose mortality.

These actions deeply affected ethnic minority families in mourningas well as the memory of the NHS co-workers who are no longer with us. The government had discarded their sacrifice, despite pressure from groups like the The Doctors’ Association UK making efforts to point out the harm of these actions .

While the government repeated the phrase “follow the science” with a religious zeal, it was striking that they ignored years of evidence with regard to health inequality in the UK. Part of the PHE report showed that the pandemic exposed and exacerbated longstanding inequalities affecting BAME communities. Some of these inequalities arise from the “hostile environment policy” that has been in place over the last decade. Research has shown the deleterious effects of this policy on health, which will have been exacerbated during the pandemic.

Sections of the BAME report stated: “Lack of trust of NHS services and healthcare treatment resulted in their reluctance to seek care in a timely basis and late presentation with disease.” Even before the coronavirus crisis, this was evident and something I had seen personally. It has now been dramatically exacerbated in the era of covid and failure to acknowledge the harmful health impacts and disenfranchisement of the hostile environment is killing people. However, to acknowledge this requires introspection and a willingness to accept responsibility for actions past. Such willingness appears distant at best.

The institutional failure to safeguard the lives of BAME NHS workers has been duplicated in both political and medical sectors. When it became clear that so many of the early healthcare worker deaths were from a BAME background, the response from NHS England was to institute mandatory risk assessments in June 2020. However, the feeling of frontline staff is that these have largely been a paper exercise with no follow through and many BAME workers feeling exploited and at risk.

More recently the strategy has evolved to include heavy spin employed to deny the problems that frontline NHS staff have faced, as demonstrated by health secretary Matt Hancock. An egregious example was his claim that “there was no national shortage of PPE”, which in a demonstration of Nixonian doublespeak seemed to hinge on the definition of “national.”

While undoubtedly a media team congratulated themselves on this insulting view of the past, we remembered cherished colleagues like Dr Peter Tun, who treated covid patients at the Royal Berkshire Hospital in Reading. He pleaded for vital PPE supplies three weeks before dying from the disease last April. Andrew Ekene Nwankwo, a nurse at Broomfield Hospital in Chelmsford, also died of covid after desperately trying to buy his own PPE online.

We are not imagining the mourning of colleagues who had treated covid patients with inadequate PPE. They are not only numbers, but people we miss deeply. This disregard for the experience of shell-shocked NHS staff to save political face is beneath contempt. March 2020 was a month of chaos, with frontline NHS staff screaming at the government that they felt like “cannon fodder” while having to work without PPE.

Politicians and their support structures do not normally have to face fatal consequences of the decisions they have made. However, in this pandemic they have been laid bare as every decision that has been made had a fatal consequence. Every £1billion spent on unusable PPE is money not spent protecting frontline staff. Every £1billion that did not result in a workable Test and Trace programme was money not spent on ensuring lower patient numbers in our overloaded hospitals over the last year. These are very real consequences that must be faced up to. Blame must not be the aim but all those who have been involved must bear responsibility for decisions that led to avoidable deaths. Running from that responsibility disrespects the memory of our colleagues that passed away and the thousands that continue to mourn for their loved ones who have died over the last year.

The time for empty talk and rhetoric is over. The tactic of hiding from the truth is not an option. After the shocking revelations of poor care at Mid Staffordshire Hospital in 2009, Robert Francis QC concluded his inquiry with the words that “there lurks within the system an institutional instinct which, under pressure, will prefer concealment, formulaic responses and avoidance of public criticism” and “an institutional culture which ascribed more weight to positive information about the service than to information capable of implying cause for concern”. Several years later he appears, sadly, to have perfectly described the attitude of the political establishment with regards to deaths from coronavirus, especially those of healthcare workers; once heroes to be applauded, yet now treated as a mere inconvenience.

Their memory deserves more.

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In London we’re at where we were in the first wave and it’s going to get much worse over the next few weeks. A lot of places are cancelling planned care and surgeries to free up staff and beds for Covid patients.

The number of people in hospital with Covid-19 has surpassed the April peak in England, according to official data that emerged as the UK government prepared to decide whether to tighten restrictions on millions of Britons. 

The high volumes are in part because of a deeper understanding by clinicians of how to treat the disease, according to NHS officials. Far more are surviving than earlier in the pandemic, but they may require weeks on a hospital ward to recover fully, doctors noted.

NHS leaders have warned that hospital capacity is at breaking point. “People are incredibly worried about what is to come. We’re in the eye of the storm, and the storm means something big and destructive — it’s a hugely challenging time,” said Saffron Cordery, deputy chief executive of NHS Providers, which represents leaders across the health service. 

NHS leaders have spent months pressing the health service to make up lost ground by performing surgery and procedures delayed during the pandemic, with significant success. 

However, Dolin Bhagawati, a London neurosurgeon who speaks for the Doctors’ Association UK, said rising Covid-19 admissions would have an inevitable impact on other services. “In London we’re at where we were in the first wave and it’s going to get much worse over the next few weeks,” he said. “A lot of places are cancelling planned care and surgeries to free up staff and beds for Covid patients.”

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The Doctors’ Association said that some doctors are still waiting for biometric residency permits, which would allow them to start work.

In Leicester respiratory specialist Dr Ahmad Ussaid is sitting idle because of these delays, it said. Even an intervention by a local MP has failed to speed up the issuing of the permit.

Other doctors remain out of pocket because a promised refund of the health entry tax – the immigration health surcharge – has not arrived, the association said.

Neurosurgeon Dr Dolin Bhagawati said:

These prolonged and ongoing bureaucratic delays are simply unconscionable. We have trained doctors in this country who are ready and willing to help combat the pandemic but unable to work due to the Home Office not doing its job and supplying appropriate documentation.

Promises made by the Prime Minister and the cabinet regarding refunding the IHS to NHS staff continue to remain unfulfilled. How can the NHS attract the best and brightest to the UK if the world sees a government unable to fulfil straightforward promises?

Unfortunately, the immigration rhetoric and policies of the recent past has led to many of our valued colleagues feeling crestfallen, unappreciated, and exploited. This country must reward those that come to its aid in its time of greatest need.

We call on the government to do its job to allow the NHS to do its part in leading the country through this national emergency.

“We have trained doctors in this country who are ready and willing to help combat the pandemic but unable to work due to the Home Office not doing its job and supplying appropriate documentation,” he continued.

“Meanwhile promises made by the prime minister and the cabinet regarding refunding the immigration health surcharge to NHS staff continue to remain unfulfilled. How can the NHS attract the best and brightest to the UK if the world sees a government unable to fulfil straightforward promises?

“Unfortunately, the immigration rhetoric and policies of the recent past has led to many of our valued colleagues feeling crestfallen, unappreciated, and exploited. This country must reward those that come to its aid in its time of greatest need.”

Qualified doctors in the UK are being blocked from working due to Home Office delays, at a time when the NHS is under increasing pressure due to surging numbers of coronavirus cases.

Home secretary Priti Patel has been urged to act after it emerged delays in issuing Biometric Residence Permits (BRP), which prove a visa holder’s right to work in the UK, are preventing frontline doctors from working in hospitals to combat the pandemic.

In one case, a respiratory specialist doctor with an approved visa who is currently in Leicester, a city hit particularly hard by Covid-19, is unable to start work due to an ongoing delay providing him with a BRP.

Despite multiple contacts by email and telephone as well as intervention by his MP, Dr Ahmad Ussaid is unable to start work, depriving him of an income and the NHS of a skilled doctor when the health service is being increasingly stretched.  

Boris Johnson removed the NHS migrant surcharge – a £624-a-year fee which is levied on most UK via applications – for health and care workers in May after he came under intense pressure over the “immorality” of the policy. Staff were told they could apply for reimbursements of the charge backdated to March 2020.

However, seven months later, many doctors are still waiting for their refunds and have been given no clear reason for the delay, while others have been refused as they have paid from bank accounts from their country of origin which have been closed on arrival to the UK, according to DAUK. 

A letter to Ms Patel from Doctors’ Association UK (DAUK) on Wednesday stated that delays in providing BRPs were preventing frontline doctors from working in NHS hospitals to combat the pandemic due to a “bureaucratic hindrance”, depriving the health service of skilled doctors “when the country needs them most”.

It called for a fast-track system to be introduced to ensure BRPs are issued without delay for all approved visas for international medical graduates, to make sure the NHS has the “highest number of trained personnel on the frontline during the escalating pandemic”. 

The letter also raises concern about delays in refunding the immigration health surcharge, which DAUK said “smacked of reluctance” to implement the government pledge.

“It is known that Bame NHS staff are at increased risk of dying from Covid-19 yet they are still stepping up to treat the sick during this time of emergency,” states the letter.

“If these staff members are willing to step forward and help the nation, the nation must respond in kind. Failure to do so is simply not in keeping with accepted British values.”

Dr Dolin Bhagawati, a neurosurgeon working in London and editorial lead for DAUK, said the “prolonged” and ongoing bureaucratic delays were “simply unconscionable”.

“We have trained doctors in this country who are ready and willing to help combat the pandemic but unable to work due to the Home Office not doing its job and supplying appropriate documentation,” he continued.

“Meanwhile promises made by the prime minister and the cabinet regarding refunding the immigration health surcharge to NHS staff continue to remain unfulfilled. How can the NHS attract the best and brightest to the UK if the world sees a government unable to fulfil straightforward promises?

“Unfortunately, the immigration rhetoric and policies of the recent past has led to many of our valued colleagues feeling crestfallen, unappreciated, and exploited. This country must reward those that come to its aid in its time of greatest need.”

Read the full article here.

The Department of Health has said that the scheme to fund fees incurred by NHS staff in privately run hospital car parks — first introduced as the UK lockdown began on March 25 — cannot “continue indefinitely”, and that workers will have to begin to pay for parking again in all but “certain circumstances”.

No certain timeline for the changes has been given.

The move has prompted an angry backlash.

Dr Dolin Bhagawati ,from grassroots medic campaign group Doctors’ Association UK (DAUK), told the Standard: “The Doctors’ Association UK are appalled by the decision to charge NHS staff for parking at their place of work. Such actions demonstrate a casual amnesia by the Government to the commitment and sacrifice of NHS staff.

“The combination of this decision, refusal to countenance pay rises for NHS staff, and the Prime Minister’s comments blaming care homes for Covid-19 deaths shows breathtaking disregard and derision for our NHS and care staff.

“We would strongly urge the reconsideration of this decision.”

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