International Doctors: Visas

Stephen Kinnock Excerpts

Wednesday 2nd November 2022 Westminster Hall

[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.

--- Later in debate ---

[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.

[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.