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Matt Warman (Boston and Skegness) (Con)
I beg to move,
That this House has considered visas for international doctors.
It is a pleasure to serve under your chairmanship, Mr Stringer.
This is a debate about doctors, but I want to begin with the story of a hypothetical patient. Let us call her Marjorie and say that she lives in Skegness. She is in her 80s or thereabouts. She is registered with a local GP practice, and she has a trainee doctor as her GP. They have a really good relationship and know each other well. They have the continuity of care that means that Marjorie’s needs are looked after. For a couple of years, Marjorie has gone back and forth to her doctor with little ailments, as people often do. In her final consultation, her doctor mentions that she will be moving on relatively soon.
Thereafter, Marjorie finds herself with another GP, and the continuity of care is broken. Marjorie struggles to get the type of relationship that she built up over the past few years, and she finds herself bouncing in and out of hospital. She is fine, but not as well as she would be if her care had been provided by a doctor who was able to make sure that they knew each other well. The reason for the break in continuity of care is that the doctor she had in training was an international medical graduate who was being trained at the surgery in Skegness. Unfortunately, for a whole host of reasons, the surgery was not registered to take international medical graduates once they had qualified, and it was not what is called a sponsoring practice—it was not able to say that it would sponsor the visa for that doctor.
The reason I make that point in such a way is because the people who are suffering as a result of the approach we currently take to visas—on one level, they are doctors who are dealing with the immensely stressful visa process—are ultimately patients, who should be our priority. The doctor I mentioned is one of 40% of trainee GPs who come from abroad. While they are training, their visas are sponsored by Health Education England.
Margaret Ferrier (Rutherglen and Hamilton West) (Ind)
A result of the difficulties around trainee GP visas is that many IMGs feel that they have no choice but to take on other roles within the NHS, or they leave the NHS altogether. Many may even return home. Does the hon. Member agree that this is yet another area where the Home Office must look at the bigger picture, rather than trying to plug gaps on an ad hoc basis?
Matt Warman
Ultimately, this is where we need joined-up government, whereby the Home Office and the Department of Health and Social Care deliver on the same priorities, and I really do think that they can.
As I say, 40% of trainee GPs come from abroad. In the final months before they qualify as GPs, the last thing they should be doing is dealing with the stress of a potential visa application and considering whether the practice where they might want to apply for a job is registered on the programme, and whether they can reasonably jump through the Home Office hoops at that precise moment. We are increasing stress for doctors, and we are increasing the risks for patients at the same time.
The hon. Lady alluded to figures from the Royal College of General Practitioners which show that some 30% of GP trainees are considering not working as GPs when they qualify for these visa-related reasons, and some 17% think they might have to leave the UK either temporarily or, at worst, permanently. That is some 1,200 doctors who are considering not working in the health service as a result of this system. In Lincolnshire alone, a third of practices have thought about registering as a visa-sponsoring practice, but just one in 10 have actually done it. We are really limiting the options for GP trainees and for the health service.
This is a political choice, and it reveals an inequality between different sorts of doctors. It will probably take a hospital doctor five years to qualify. After those five years, they will qualify for indefinite leave to remain in a much easier way. Because GP trainees take just three years to complete their programme, they need to go through this visa process, because three years is not five years, and the Home Office has decided that five years is what is required.
There are other associated problems. When it comes to applying for a visa, the GP practice that needs to register will consider whether that process is worth while. It may, in theory, be worth while in advance, and some practices do register in advance, but many do not. They then find themselves confronted with a brilliant candidate, and they try to register, but with the best will in the world, the timescales are very tight for doctors to apply for visas when they have a job offer from a practice that is already registered. There are lots of things to line up, and it is stressful for practices and for doctors. Even if there were no backlog in the Home Office, it would be a very tight timescale.
Mrs Pauline Latham (Mid Derbyshire) (Con)
I thank my hon. Friend for giving way and congratulate him on securing this important debate. I have recently returned from an International Development Committee visit to Jordan, where I spoke to a number of highly educated Jordanians, as well as Syrian refugees. Some of the Jordanians were already doctors and nurses, and the Syrian refugees in the camps in Jordan cannot get an education beyond the age of 18 but wish to become doctors, engineers and so on. They speak amazing English and would love to train here in the UK.
At the moment, Germany is hoovering up a huge number of these doctors and people who would like to study to become doctors, to satisfy the demands of its health service. Does my hon. Friend agree that it would be helpful for the Minister to consider opening up more visa routes for brilliant young medical students from countries such as Jordan that have long been strong international partners of the UK, in order to ease some of the workforce pressures on our NHS? It is important that we increase the numbers, and that would be one way of doing it.
Matt Warman
I absolutely agree with my hon. Friend that increasing all those routes is hugely important. Of course, we would all like to see more doctors trained in this country, and the Government have gone some way towards doing that, but where people want to work abroad, Britain should be as attractive a place as we can be. That is why, on the GP point specifically, the Government should be removing every single barrier in that visa process.
The most straightforward thing we could do, which would remove the need for a practice to register as a visa-sponsoring practice, is simply to say that when a GP qualifies in this country, they get the indefinite leave to remain that other doctors get. These are people in whom the UK has already invested. They are already here; they already have a visa. The extension of that visa into another form seems simply to be a bureaucratic hoop that we are putting in their way as doctors and in the way of GP practices. We are putting extra bureaucracy into a system, while on the other hand the Government say, “We desperately need people to come to this country to work in the NHS, and we will try to do everything we can.” The health service does hugely good work to try to recruit such people and specifically encourages them to train as GPs, but then we put an additional barrier in their way.
The response from the Government in the past has been, “Actually, the visa process registration is not terribly onerous and GP practices can do it.” They point to the numbers that have and do, which is fine as far as it goes, but it does not answer the question of why we put a barrier in the way in the first place. It should not be a cost of doing business when we say that we really want to make it as easy as possible.
Equally, it should not be a reasonable thing to put different sorts of doctors on different sorts of levels. It is not reasonable to say to people that, just as they have gone through the most stressful part of qualifying with exams, they should also be thinking about their immigration status. That calls into question their probity when we have things such as the General Medical Council making sure that they are upstanding members of our communities, and many of them have tens of thousands of patients to testify to that.
I do not think it really washes when the Government say that we need to put barriers in place, and I do not think that the Department of Health, where the Minister was previously a Minister of State, would agree, in an ideal world, with the Home Office stance. We could work together across Government to try to secure a sensible outcome.
I have talked about GPs, but there are broader issues around visas for doctors, many of which come back to the Home Office backlogs that I know my right hon. Friend the Minister is working really hard to address. There is a good argument for simply scrapping visa fees altogether for people coming to work in the health service. That is an argument for another day, but when it comes to GPs I think that lowering the five-year limit for indefinite leave to remain to three years is the neatest way to address the issue.
On the broader issues, ultimately this comes back to how many doctors we are training in the UK. We all want, as I said to my hon. Friend the Member for Mid Derbyshire (Mrs Latham), to see more people trained in this country. That is what we are doing and that is what the Government continue to pursue, but until we reach that moment—the NHS has never reached entire self-sufficiency in the UK—we should make it as easy as possible for doctors, dentists, nurses, people working in social care, and all those who work in different parts of the health service, to come to the UK. It is not primarily a question about backlogs; it is a question about process. At the moment there is a degree of bureaucracy that simply does not need to exist.
Steve Brine (Winchester) (Con)
It is great to hear my hon. Friend making such an eloquent case, as always—more so than I can. The issue matters for all the reasons he has set out, but would he agree that because of the retention challenge in the health service, the more we pour in at the top is sometimes, in part at least, offset by those who go out at the bottom? There is a wider picture here to do with pension pots—the whole retention piece is part of the wider jigsaw, which I appreciate is not the remit of this Minister, but perhaps was in his previous job.
Matt Warman
I thank my hon. Friend for that intervention. It is always tempting to ask the Minister to go and have a word with his former self, but we cannot do that. I think he has read the last couple of points that I want to make.
There are a number of relatively low-hanging pieces of fruit that the NHS has repeatedly asked for. I want to thank the RCGP, the British Medical Association, the radiologists, the British Dental Association, and also groups such as EveryDoctor, which have helped me with this debate and have identified the fact, as my hon. Friend implied, that there are a small number of things that could and should be sorted as quickly as possible. Busting the barriers around pensions and the bureaucracy around visas are things that would make a real difference to recruitment and retention across the health service. There are plenty of things that are difficult when it comes to addressing the NHS’s challenges, particularly as we approach winter. On the narrow point of GP provision, we have a visa process that puts pressure on, in particular, small GP practices, where the added burden of registering as a visa sponsoring practice is even greater now as they are under such huge pressure. It is also a burden on GPs at what is a particularly stressful point in their careers.
I know the Minister will make entirely legitimate points around putting a process in place, but the reality is that there is a political choice to be made to ease some of those burdens. There is a powerful, compelling case to be made for doing a small number of easy things that could address the GP crisis in particular, which, as my hon. Friend the Member for Winchester (Steve Brine) alluded to, is acute.
I appeal to the Minister and the Government to work as closely as they can with the Department of Health and Social Care to understand these challenges and see what can be done, and I urge my right hon. Friend to take seriously the suggestion that if someone qualifies as a medical doctor in this country, and in particular as a GP, they should have indefinite leave to remain. At the moment, it effectively comes with that if they qualify in a hospital but not in general practice. That is an inequality that the Minister can look to fix, and I hope he will do so as soon as is practicable.
Jim Shannon (Strangford) (DUP)
I thank you for allowing me to participate in the debate, Mr Stringer. I thank the hon. Member for Boston and Skegness (Matt Warman) for bringing this matter to light. It is good to see the Minister in his place—a return to duty in his ministerial role—and I am confident that, like the rest of us, he will be keen to address the key issues of the debate and why this issue is so important. I wish him well in this new role and look forward to his response to our questions.
The issue of visas is always a difficult one. I am incredibly aware of the need to protect our country and ensure that only those who have a desire to enjoy British life and to enhance it should be given visas. I understand the system of immigration and agree that it should be rigorously implemented. However, within that, we very much need to have the appropriate systems for the appropriate types of visa. That is why I believe that changes need to be made, as outlined by the hon. Member. Talented and skilled doctors want to come here and contribute to our society but unfortunately, due to the visa system, they are not always able to do so. For me, the issue is: how can we help them to help us in the United Kingdom of Great Britain and Northern Ireland?
Margaret Ferrier
As the hon. Member for Boston and Skegness (Matt Warman) said, a difficulty that many international medical graduates face is that many GP practices do not have a visa sponsorship licence in place, making it harder to meet the requirements before the student’s studies end. Does the hon. Member share my concerns about the general level of the Home Office backlog and the associated impact on IMGs?
Jim Shannon
I agree with the hon. Lady. I hope that through today’s debate and contributions, this issue can be addressed. Again, we look to the Minister to give us some help, direction or support in how we can go through the vigorous bureaucracy that is clearly there. People with talent and skills want to come here; it is about how we can make that happen.
I have raised immigration on multiple occasions with Home Office Ministers—in particular, with regard to visas for those working on fishing boats in my constituency and the skilled work done by Filipino fishermen. The previous Minister was most helpful. That work is undoubtedly skilled, but it is under the pay threshold, so visa requirements sometimes restrict that opportunity.
Junior doctors, nurses and others do work that is not highly paid but highly skilled and necessary. That is why there must be time-sensitive application systems for those vital jobs and staff members. We need flexibility in the system. I say this again because it is important: those highly skilled and highly talented people who wish to come here will add to society and enable us to fill some of the vacancies.
I cannot speak for the United Kingdom mainland, but I can certainly speak with some knowledge of Northern Ireland. I am my party’s health spokesperson, and the research we did for this debate shows that 6,613 vacancies are listed for the five trusts in Northern Ireland. I know that they are not entirely for medical staff, but it is clear that we are desperately in need of staff, and there are many opportunities for doctors.
In my constituency and neighbouring constituencies, we are having problems in relation to GPs. I absolutely agree that there is a need for restrictive immigration, but we must not cut off our nose to spite our face. I am sure those numbers are replicated throughout the entire UK; perhaps the Minister will give us some figures for GP vacancies. I know that the Government have set out a strategy for employing and recruiting more GPs—that is good news.
During the Brexit discussions, we were told that there would be distinct differences between the visa systems. That is as it should be. The hon. Member for Boston and Skegness said that the system needs to be altered to meet the need, and that is what we need to do today.
The hon. Gentleman mentioned GPs, and we are of the same mindset. In a neighbouring constituency, a GP surgery, which is 10 minutes from my office, is set to close down because there are not enough GPs. In response, the GPs in my area have issued a moratorium on joining or leaving local practices. In other words, they will not take any more patients, and in some cases they are directing patients who live outside the area—that was okay a few years ago—to go elsewhere.
The trust is hopeful that it will get more GPs to take over the practice, but the fact is that we simply do not have enough GPs. That puts more pressure on the existing ones, which leads to more burnout, and the vicious cycle continues. GPs are under incredible pressure. Patients want to meet their GP; they want face-to-face appointments. That has been lost to them over the past two and a half years due to covid, but they are trying hard to get back in the queue.
The hon. Gentleman said that 40% of all GP trainees are international medical graduates—the hon. Member for Rutherglen and Hamilton West (Margaret Ferrier) referred to that—but they have difficulties obtaining visas. I do not have the exact numbers for Northern Ireland, but I do know that we cannot afford the loss of any more GPs. I therefore add my voice to those of others in the Chamber requesting that a special dispensation be granted not simply to allow those trainees to stay but to enable us to recruit further.
If there a block of trainee GPs who have almost completed their degrees and courses and are ready to come here, let us encourage them to do so. The question is not why it cannot happen, but how we can make it happen. The thought of training GPs to understand how we do medicine and run our practices, only for them to leave—not because they want to but because the system is not working for them—is madness. That needs to be addressed through this debate.
Recently, medical professionals outlined to me that the mental health and self- esteem of our medical community are at an all-time low because the staff are simply burned out. I have met many nurses, GPs and surgeons who are absolutely exhausted with the work they do. For those who are on call and have a duty rota to complete, being sent an SOS text to cover shifts is no longer exceptional; it is standard. That tells us that the GPs need to be employed and some of the pressure taken off.
We need to change the way that things are done, by giving GPs more admin support and funding for on-site nutritionists, physios and mental health teams, which we need within all health clinics. In my constituency, they are trying to do that regularly, and it should help to diagnose early, whether the problem is diabetes, arthritis or dementia. Whatever the issue, doing that correctly in GP surgeries is the way forward.
It is impossible to imagine that things can go on much longer the way they have for the past two and a half to three years throughout the United Kingdom of Great Britain and Northern Ireland. We need change, flexibility and help, Minister. We do not want to put all the pressure on the Minister, but in this case there are ways forward. The hon. Member for Boston and Skegness has outlined them, as have I and others. We look forward to a successful conclusion to this debate, with a way forward from which we can all benefit across this great United Kingdom of Great Britain and Northern Ireland.
Stuart C. McDonald (Cumbernauld, Kilsyth and Kirkintilloch East) (SNP)
It is good to see you in the Chair, Mr Stringer. I also start by welcoming the Minister to his place. I wish him good luck; he probably needs it, as much as any Minister in Government, because his is an incredibly challenging post. We will, of course, have significant political differences on this topic, but it is an important issue, so if there is an opportunity for constructive and positive engagement, I am up for that, wherever possible. I thank the hon. Member for Boston and Skegness (Matt Warman) not just for securing the debate but, as ever, for his expert introduction to the topic and advocacy.
Moving to the subject at hand, like other Members I will start by recognising the extraordinary contribution of non-UK nationals to all parts of our NHS. I suspect everybody in the room has benefited from that, never more so than in recent times. GP practice is no different, and nationals of other countries will continue to play an important part, both now and in the future. As the hon. Member for Boston and Skegness alluded to, figures suggest that 47% of new GP trainees in England in 2020-21 were international medical graduates.
Another important context for this debate is the extraordinary pressure that our NHS is under, particularly in the light of covid, but also for all sorts of other reasons, which we could perhaps touch on in another debate. High vacancy rates are among them. As has been mentioned, challenges in recruitment and retention affect GP practices as well as everywhere else.
Against that background, the hon. Member identified what at first seems to be a technical problem in the operation of the immigration system, but one which, when examined, is significant. A failure to solve it leads to some absurd and harmful consequences. As he pointed out, the pain will ultimately be felt by patients. He explained that the three-year GP training regime for IMGs leaves them, on completion, two years short of being able to apply for settlement. That is unlike other specialisms, which have longer training periods.
That requires IMGs to find a GP practice that has become a tier 2 sponsor, which is not easy. The hon. Member for Rutherglen and Hamilton West (Margaret Ferrier) alluded to statistics highlighting that, with half of all IMGs having struggled with the visa process, 30% having considered moving away from GP practice and 17% thinking about leaving the United Kingdom.
The Minister’s predecessors appeared to dig their heels in and say, “We just need more GP practices to become tier 2 sponsors.” I agree with the hon. Member for Boston and Skegness that that prioritises Home Office bureaucracy above the health service. Ultimately, it is the wrong answer for patients who are struggling to access a GP. We are going to lose skilled and dedicated GPs as a result.
There is one issue where I do have some sympathy for the Minister’s predecessors, and that is the rejection of the idea that a route to settlement should simply be shorter. Settlement is an important and significant thing. There are aspects of that where I am open to persuasion on the case to shorten routes generally and in some specific cases, for example, family members. However, an argument to shorten the route to settlement simply because a training course lasts a certain time is perhaps not the most persuasive. It is not one that I am closed to, but it is not one that I immediately find the most persuasive.
However, the Home Office should be pragmatic about other possible solutions that have been put forward. Its current insistence that 8,166 GP practices right across the UK should just invest time—and over £4 million—in becoming tier 2 sponsors on the off chance that they might want to recruit an IMG is simply not realistic. The £4 million in fees from those GP practices would go to the Home Office—I wonder if that has something to do with its intransigence at the moment.
The alternative approach of a practice only becoming a sponsor once it has already had an application for an IMG is also far from ideal. The delay that that causes is bad for all affected, and the pressure on IMGs to find a tier 2 sponsor to satisfy immigration requirements prior to their existing visa expiring means that they cannot wait. As evidence given to the Health and Social Care Committee earlier this year highlighted, newly qualified GPs have received removal letters from the Home Office soon after their qualification. That is absurd, because we not only need them but have spent tens of thousands of pounds on training them to do a job that we urgently need them to do. I hope good sense will prevail over the Home Office’s current intransigence.
I now turn the other solutions, which I think are perfectly reasonable, that the Royal College of General Practitioners has put forward. The first solution is to create a new post-medical training visa that works in the same way as a graduate visa. The second is to create umbrella bodies that could operate as a sort of super-sponsor. That could be the NHS or whichever training body had already sponsored the first three years of the IMG’s presence here. Who knows—it could be the Royal College of General Practitioners itself. I do not have the answer as to which option would be best, but any of them would clearly be better than the absurd situation we find ourselves in.
Steve Brine
I have a suggestion, at least for England: the primary care networks or the new integrated care boards could quite easily act as an umbrella sponsor, thereby taking the bureaucracy away from the practices, which is part of their purpose.
Stuart C. McDonald
That is a valid proposition, and we could do the same with health boards in Scotland. If we knock our heads together, we can come up with a way to fix this. It just requires a little bit of pragmatism.
There is a second issue I wanted to raise—when I saw the motion for this debate, I wondered if the hon. Member for Boston and Skegness would raise it. That issue relates to recent reports from the BBC flagging complaints of poor treatment and conditions for international doctors in private hospitals, as well as highly questionable recruitment practices. I will touch upon it briefly because it has not been raised, although it is important to draw it to the House’s attention and to see if the Minister will investigate and respond. There were reports from 11 October suggesting that doctors from some of the world’s poorest countries were being recruited, by Nuffield Health in particular, to work in private hospitals under conditions prohibited in the NHS. There are reports of doctors being on call 24 hours a day for a week at a time, not being able to leave the hospital grounds and, unsurprisingly, suffering from extreme tiredness, putting both patients and doctors at risk.
Nuffield Health denies those allegations, but a British Medical Association and Doctors’ Association UK questionnaire of 188 resident medical officers adds some credence to the claims. It shows that 81% of respondents were recruited from Nigeria, and most complained of extreme working hours and unfair salary deductions. The conclusion of the Doctors’ Association UK was that we now have a two-tier system: one for the NHS and one for other international recruits in the private sector. I ask the Minister to look into that.
That issue highlighted to me another fundamental problem with how the immigration system operates. We have all sorts of checks and regulations that focus on ensuring that people who come to work here abide by their visa conditions, and they include the doctors we have been talking about—the IMGs—where the Home Office is on their case as soon as they have qualified to see what they are doing next. However, little or no checks are done to protect people who come here. That is not just in the NHS and with doctors; I have been firing off parliamentary questions and freedom of information requests in relation to the agricultural sector. That is a sector wide open to exploitation, but as far as I can see there is no concerted effort to protect people from that exploitation.
As the Minister will appreciate, Nigeria is a red-list country for recruitment. According to both the World Health Organisation and the Government, that is not where we should be finding doctors.
Jim Shannon
Does the hon. Member agree that, when it comes to the criteria used, one thing we should perhaps be seeking from the Minister is an assurance that greater weight will be given to the skills that people have, as opposed to the money they could earn?
Stuart C. McDonald
That is absolutely fair. The point I am making is that we should also consider—and in fairness, we do—where it is that we are recruiting from. We do not want to leave some of the poorer countries in the world without the skills they need.
Nigeria is a red-list country, but the report highlighted that both the General Medical Council and the British Council are involved in establishing and overseeing a professional and linguistic assessment board test in Lagos. I encourage the Minister to look into those reports. I appreciate that he might not be able to tell us about them today.
Various broader issues have been raised, including visa fees, pensions and so on. We could talk about the impact of free movement and how that has mired certain services, including GP practices, in red tape and bureaucracy, but we will keep that discussion for another day.
I again congratulate the hon. Member for Boston and Skegness on securing the debate. Throwing out skilled and desperately needed GPs in whom we have invested tens of thousands of pounds in training is utterly absurd. The hon. Member for Strangford (Jim Shannon) put it very nicely, as he always does. The question is how we can help them to help us. There are pragmatic solutions available. This is an early test for the Minister on whether he will be a pragmatist or take what I would characterise as the more dogmatic approach of the previous Home Office regime. I very much hope it is the former and that he is a pragmatist.
Stephen Kinnock (Aberavon) (Lab)
It is a pleasure to serve under your chairship, Mr Stringer. I thank the hon. Member for Boston and Skegness (Matt Warman) for securing this important debate. His speech was an excellent example of a constructive critique of where his own party is on the issue, and he put forward some practical and thoughtful ideas. I hope the Minister has taken note. I suspect there is more chance he will take note of the hon. Member’s comments than he will of mine, but we never know. This debate is a great example of the cross-party discussion that we can have in this place.
Let me start by setting out the Labour party’s position on work-based migration in Britain, as it is important to set the context before drilling down into the specifics of the issue we are discussing today. In a nutshell, we support the points-based immigration system for migrant workers; it was of course the Labour Government in 2008 that introduced that system for immigration from outside the European Union. We are clear that there will be no return to the European Union’s freedom of movement. We want to build on and improve the points-based system currently in place. It is a very blunt, one-dimensional instrument that could be significantly improved.
Our long-term ambition is to make sure that every employer across the private and public sectors is recruiting and training more home-grown talent to fill vacancies before looking overseas, but we recognise that simply turning off the tap of labour from other countries without having the appropriate workforce structures, plans, training, skills and productivity strategies in place, our private sector and our public services will deteriorate, our businesses will struggle to meet the Labour party’s ambitions to make, buy and sell more in Britain, and we potentially risk jobs disappearing overseas.
We cannot have a situation like the one we have had in the farming sector over the past year, where 30,000 pigs were slaughtered and £60 million-worth of crops were burned. Indeed, we cannot have a situation in the NHS where we are short of doctors, all because our immigration system puts up red tape and barriers that prevent, or at least severely discourage and disincentivise, doctors who have come to the UK from overseas to do their three years of general practitioner training from staying on to fill critical vacancies in the job market. That is utterly counterproductive, not least because 47% of new trainees in England in 2020-21 were international medical graduates. Labour’s shadow Health Secretary, my hon. Friend the Member for Ilford North (Wes Streeting), has been clear that it is madness for the NHS to lose GPs whom the British taxpayer has paid to train.
Successive Conservative Governments have already cut 4,700 GPs over the last decade, meaning that patients are finding it next to impossible to get an appointment. There is a chronic lack of doctors, nurses and healthcare staff in the NHS. Staff shortages are reaching dangerous levels, when the need for NHS treatment is incredibly high, with huge backlogs and millions of people forced to wait for treatment. Patients are finding it impossible to get a GP appointment in many cases, and GPs are leaving the health service at an alarming rate. Last year, one in six people who tried to speak to a nurse or GP were unable to get an appointment at all. The hurdles placed in front of international medical graduates are a barrier to our NHS filling vacancies and providing the medical care that the British public deserve.
A survey by the Royal College of General Practitioners found that around 30% of all IMG trainees consider not working as an NHS GP because of all the difficulties and red tape with the visa process. The first of those difficulties is that IMG GPs are not eligible to apply for permission to stay permanently until two years after completing their training. GP training takes three years to complete, and it is only after five years that IMGs can apply for indefinite leave to remain, in line with wider UK visa rules. That problem is unique to general practice: other medical specialty training takes a minimum of five years to complete.
The second difficulty is that international GPs must find employment with a GP practice with a visa sponsor licence before their existing visa expires in order to be eligible for a visa that allows them to stay and work as a GP after their training, and ultimately apply for permission to stay permanently. However, practical and bureaucratic obstacles can make that extremely difficult, because GP practices may struggle with the costs and bureaucracy associated with obtaining a licence to sponsor a foreign worker. The Royal College of General Practitioners warns that the cumulative effect of visa difficulties on IMGs is that some are
“feeling forced to take roles elsewhere in the NHS and others considering leaving the NHS, and in some cases the UK, altogether.”
The Government have so far been utterly intransigent on the issue of IMGs, and on tweaking the visa system to remove the red tape. Labour would look closely at the issue as part of our wider improvements to the points-based system. Those improvements would involve the Government working hand in hand with employers, trade unions and other key stakeholders to ensure that we have a properly planned, sector-by-sector approach, with a proper strategy that works for businesses, workers, the public sector, customers and patients alike. As part of that, we will review the length of work visas, processing times and the existing path to citizenship to ensure that they are all working for our economy and for the public.
Labour already has a long-term workforce plan for the NHS. That involves doubling the number of medical school places, which in turn will deliver more home-grown GPs. At the heart of the plan is the doubling of medical school places—an increase of 7,500—which means we will double the number of doctors trained in a year. Our shadow Health Secretary will also produce long-term workforce plans for the NHS for the next five, 10 and 15 years, which will ensure that we always have the NHS staff we need to get patients treated on time. The plans will not only provide good jobs for British workers and fill shortages in our NHS, but prevent us from having to do dirty deals, as mentioned earlier, with some of the poorest countries in the world—those on the WHO red list—and from recruiting medical professionals from impoverished communities that desperately need that medical knowledge locally. That is exactly what the British Government have done recently with Nepal.
In the short term, Labour has consistently pushed for a fix to punitive doctors’ pension rules. The fix would do away with the cap above which NHS workers incur additional tax burdens. That would support short-term recruitment and prevent the exodus of workers. The Government are yet to deliver on that.
The Labour party is committed to making the points-based system work, and to our NHS workforce plan. The current system is simply not fit for purpose, and at this time of crisis we risk losing newly qualified GPs because of unnecessary red tape. The Conservatives have broken promise after promise on GPs. Their 2019 manifesto promised to deliver 6,000 more GPs by 2024-25. The former Health Secretary, the right hon. Member for Bromsgrove (Sajid Javid), admitted that the Government are not on track to deliver that.
In contrast, the next Labour Government will put patients first, ensuring that they are able to get a face-to-face appointment when they want one, bringing back the family doctor to deliver continuity of care and implementing our workforce plans. The current Government are out of ideas, and we need practical solutions.
Steve Brine
It is interesting that the hon. Gentleman mentioned continuity of care, because he will be aware that that came up yesterday during Health questions. Would the Opposition introduce direct management of lists back into the GP contract from when it is next renegotiated? That is how we achieve continuity of care.
Stephen Kinnock
The key piece of our plan is to cancel non-dom status, which is estimated to generate approximately £3.2 billion for the Exchequer, and to use that money to invest in more GPs, doctors and nurses—indeed, doubling the numbers. We can have the best plans and legislation in the world, but we need the resources to deliver them. That is how we will pay for our plans and generate the kind of care that we need for our public. It is time for that Labour Government, so that we can clear the backlogs holding our country back, which we see right across Government, and get Britain’s public services back on track.
The Minister for Immigration (Robert Jenrick)
It is a pleasure to serve under your chairmanship, Mr Stringer. I thank my hon. Friend the Member for Boston and Skegness (Matt Warman) for securing this important debate, and all Members who have contributed. The Government recognise the vital contribution that doctors and other health and care professionals make to the United Kingdom and our NHS. Of course, Dr Rachel Warman is my favourite doctor, and she has no doubt helped to inform the quality of my hon. Friend’s remarks.
By happy coincidence, I am both the Minister for Immigration and formerly the Minister responsible for the NHS and the recruitment of doctors domestically and internationally, so I understand and appreciate the importance of the issues raised. This is clearly a timely debate, because the NHS faces a significant workforce challenge. About 10% of the roles in the NHS are vacant, and a larger number are vacant in social care. We all need to be focused on creative ways to resolve the challenge, including, as has been said, on retaining more of our existing GPs and other health and social care professionals.
Last month, the former Health Secretary, my right hon. Friend the Member for Suffolk Coastal (Dr Coffey), and I announced changes to the pension provision for doctors to encourage more of them to stay in the NHS for longer, to work longer hours and not to resort to private practice as quickly as some are doing. Those changes will make a difference, although I appreciate that the BMA and a number of organisations wish the Government to go further.
We are keen to recruit and train more GPs and doctors in the UK. Persuasive arguments have been made for raising the cap on medical school places, including by the hon. Member for Aberavon (Stephen Kinnock). That is an important debate to have, and one that I am sure will find favour with the new Chancellor, who has raised the matter many times in the past. In the interim, it is clear that we will need to rely on more international recruitment of doctors and nurses. That is exactly what the NHS is doing at the moment. For example, as a result of significant retention issues the Government are succeeding in recruiting a large number of nurses internationally. We need to make that process as simple and efficient as possible for the benefit of the NHS and trusts that are undertaking that recruitment exercise, but also for patients.
Hon. Members will be aware that in 2020 the Government delivered and built on the commitment in our manifesto to introduce a route that made it quicker, easier and cheaper for qualified medical professionals to come and work in the UK. That was the health and care visa, which provides a significantly reduced visa fee and a dedicated Home Office team to process the applications. A number of Members understandably referred to Home Office backlogs, which do exist in some areas; most vividly, in the last week, we have had a national conversation about the backlog of asylum cases.
Applicants for the health and care visa get a gold-plated service. Health and care visas provide cheaper fees and quicker processing, and the aim is to process applications within three weeks. Understandably, there has been an impact on processing times this year, primarily because the Department chose to redeploy so many of its professionals to work on the Homes for Ukraine scheme and other refugee and resettlement schemes, but it is our intention to get back as swiftly as possible to the service standard. In fact, we have set a target of reaching that by the end of the year and continuing to meet it into next year while continuing to manage the very large number of individuals coming from Afghanistan, Ukraine and other parts of the world that are in distress.
Jim Shannon
I recently chaired an event in Portcullis House on a completely different matter. When I came out, the people taking over the room were getting ready to give a presentation about how Ukrainians with medical skills could help the UK. I am not sure who the sponsor was, but I will try to find out, and the Minister’s staff might do the same. It took place at 2 pm in room Q in PCH. I had to go to another event, so I could not stay, but it seems that there are a number of Ukrainians here who have medical skills that could be used in the NHS. That is just a thought.
Robert Jenrick
Of course, adults who come to the UK on the Homes for Ukraine scheme have the right to work, and we actively encourage them to do so while they are here. There has also been an exercise across Government, which I have not been personally involved in, to help them to find equivalent professional qualifications while they are here, and to break down any barriers. I would be happy to look into whether there are remaining issues for doctors and nurses from Ukraine while they live here on the three-year visas that we are granting.
Some 30,700 nurses and 14,900 doctors obtained a health and care visa up to the end of August this year. In total, including care workers and other professionals, 96,000 such visas have been issued—a very significant number, which accounts for 52% of all skilled worker visas that have been issued to people taking up work in the health sector. I would like to think that that innovation has been a success, but we take seriously the legitimate concerns that have been raised in the debate and that we have heard from royal colleges and others. Let me now turn to some of those concerns and what we might be able to do to assist.
As my hon. Friend the Member for Boston and Skegness said, the Royal College of General Practitioners has made a number of suggestions. We believe that the best way to increase the number of international GPs taking up places in the UK is for GP practices to register as Home Office-approved sponsors. The Government have run a number of engagement events that aim to explain the sponsorship process. Sponsorship is not supposed to be onerous, and the Home Office believes that it is not as onerous as some people clearly perceive it to be. Over 48,000 organisations are licensed sponsors of skilled workers, and many are high-pressure, small organisations, such as GP practices. However, there is clearly an issue—whether in reality or in perception—so I have two proposals to answer the concerns raised by my hon. Friend.
First, I am prepared to consider other sponsorship arrangements suggested by the sector, provided that they are consistent with the sponsorship system and that the sponsor can continue to discharge the important duties of a sponsor, which enables us to ensure that the overall system is robust and defensible. In principle, the sponsor could be an appropriate national body, such as Health Education England. It has not approached us to ask to be such a body, but I would be open to considering that. As my hon. Friend the Member for Winchester (Steve Brine) suggested, the sponsor could be an integrated care board in England or an appropriate body in Scotland, Wales or Northern Ireland, or it could be a royal college. I will therefore ask my officials to work with the sector to see whether there is a way forward to create umbrella bodies, if there is mutual support on both sides, with the caveat that any umbrella body would need to discharge the required duties in law to ensure the robustness of the system.
Secondly, in the interim my officials would be happy to run further engagement events with the sector to talk them through how straightforward they believe it is to be a sponsor. I encourage anyone listening to the debate to get in touch with the Home Office if they would like us to host an event in their area or with their part of the health sector. I have asked my officials to organise at least one such event in the weeks ahead. We will take account of any feedback that we receive at these events, and if it is true that the system is simply too complex and burdensome, I have asked them to report back to me with that feedback and we will take it into consideration.
The shadow Minister—the hon. Member for Aberavon —and others, including my hon. Friend the Member for Boston and Skegness, raised the fundamental question of whether five years is the right length of time to demonstrate an individual’s commitment to the UK. That is a profound question, and it is important that we approach it fairly, rather than hiving out individual sectors, however important they might be for our economy or our public services. Although I am sympathetic to the arguments around granting GPs settlement on completion of their training, my view today is that it is better to stick to five years because that has been, by the long-standing convention of this Government and their predecessors, considered the right length of time for an individual to demonstrate sufficient commitment to the United Kingdom to obtain indefinite leave to remain. We should value indefinite leave to remain, because it is an important and significant moment for anyone committing to life in our country.
Stephen Kinnock
I thank the Minister for setting out that clear position, but does he agree that the nature of that kind of commitment—the three years, and the type of work that somebody studying to be a general practitioner is looking into and wants to do—is in itself a demonstration of something extra in terms of commitment to the United Kingdom? It is not as if they are coming here to work for a foreign company. Should such people not be given some kind of exceptional treatment because of the nature of the work? That is an open question.
Robert Jenrick
The hon. Gentleman makes a valid point. Of course, one could apply that to a number of other regulated professions, whether that be lawyers, nurses or others making significant contributions to the United Kingdom. It is an important step to obtain indefinite leave to remain, and not one that we should give away lightly. Asking an individual to spend five years here in order to demonstrate that level of commitment to the UK feels to me about the right length of time, but I am open and interested to hear other contributions on that point. At the moment we do not have plans to reduce the length of time that skilled workers would need to complete in the UK in order to apply for settlement.
The SNP spokesperson, the hon. Member for Cumbernauld, Kilsyth and Kirkintilloch East (Stuart C. McDonald), raised a number of cases that I am aware of from my former role at the Department of Health and Social Care about allegations of the mistreatment of foreign workers—including doctors and nurses—coming to the UK. That is something we take seriously, and the Department of Health and Social Care and NHS England are investigating. If I receive further information from the Ministers in the Department of Health and Social Care, I will be happy to write to the hon. Gentleman.
On the broader question of the ethics of recruiting healthcare professionals internationally, the NHS takes that responsibility seriously. We have ethical guidelines nationally that are set by NHS England and individual trusts in England—that may well be the case in Scotland as well—and of course we take heed of the red lists, which give a strong indication of countries from which we should not be recruiting healthcare professionals because they clearly need them to satisfy their own healthcare requirements. The NHS proactively works with countries that have an excess of doctors and nurses, or that train individuals specifically for export. In fact, one of the last meetings I had as Health Minister was with the Chief Minister of the state of Kerala, which specifically trains nurses to be exported to other countries around the world.
That sort of arrangement is sensible and defensible by the UK, although it is not a sustainable answer in the very long term because we live in a globally ageing society; there will be competition from other states to recruit professionals. That is one of the many reasons we should be training more doctors and nurses in the UK and considering measures such as raising the cap on medical school places, if we are able to do so. That, of course, is a matter for the Treasury and the Department of Health and Social Care, not my Department. It is worth saying that it is an extremely expensive measure over time, and that the Opposition’s proposal would cost several billion pounds to deliver. That is not to say that it is not an important step, but it is worth bearing in mind the significant outlay.
Steve Brine
The Minister is responding very clearly to the points raised. What we really need is an independent health workforce assessment, supported by the Treasury. He will be aware that that was called for by some Members who are no longer on the Back Benches. Dare I say that he could encourage that through his good offices, because only once we have the answer will we get to a better place. If we ask the NHS what we need it will answer with what we can afford. Those are not the same questions.
Robert Jenrick
For a long time I have believed that one of the virtues of a national health service is that it should be able to plan for its workforce needs long into the future. My hon. Friend raises the specific campaign of our right hon. Friend the Member for South West Surrey (Jeremy Hunt), when he was Chair of the Health and Social Care Committee. I am sure that he will consider that carefully now that he has his hands on the controls as Chancellor of the Exchequer.
Stephen Kinnock
The Minister rightly mentions value for money. The British taxpayer pays for the training of international medical graduates in this country. Will the Government consider doing a value-for-money assessment of what the British taxpayer pays for people who train to be GPs but end up leaving our system all together because of all the visa issues? Is that not a waste of taxpayers’ money?
Robert Jenrick
The hon. Gentleman raises an important point. It really is a matter for the Department of Health and Social Care. I do not want to stray too far into policy questions that are rightly its domain, but clearly the UK benefits from retaining as many doctors who train here as possible. Staying will not always be the intention of those coming to the UK—many clearly want to make use of our world-class medical education and then return to their country of origin, or other countries that, for lifestyle reasons, they want to live in—but we benefit from encouraging more to stay.
Stuart C. McDonald
I have one final thought. I appreciate that the Minister will go away and task officials with looking at a possible umbrella sponsor—that is very positive news. The other issue is the length of visa for IMGs. From the Health and Social Care Committee inquiry, it appeared that there is a severe pressure between finishing up and being able to find a job. Extending the grace period a little might allow more people to stay.
Robert Jenrick
I will happily add that to the list of homework for my officials after the debate.
I thank my hon. Friend the Member for Boston and Skegness for securing this important debate, and the many colleagues on both sides of the House who have attended to register their interest in the topic. I assure them all that we will reflect carefully on the points raised, and in particular that I will task my Home Office officials to work with stakeholders in the sector to give greater consideration to the central question of whether there is a simpler way in which GP practices can apply for relevant visas. If that can be delivered by appropriate umbrella bodies, we would be pleased to see whether it can be taken forward.
Matt Warman
We are all hugely grateful for the fantastic work that doctors do for us all, as the Minister alluded to. I do not just say that because I am married to one, although it brings it home—literally. In the course of the debate, the Home Office has been accused of intransigence. Within days of his arrival, the Minister has demonstrated more progress on this important issue in the commitment that he has made to us today than we have seen in some years. He is the human embodiment of cross-Government working in the sense that he brings together the Department of Health and the Home Office remits. We could all learn from the value of cross-Government working. I am immensely grateful to all Members who have brought the issue to life, and I look forward to continuing to work with the Minister on the outcome of the review, which will make a real difference to our constituents, and to doctors up and down the country.
Question put and agreed to.
Resolved,
That this House has considered visas for international doctors.