International Doctors: Visas

Jim Shannon Excerpts

Wednesday 2nd November 2022 Westminster Hall

[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.

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[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.

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[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.