Staffing the NHS properly requires more training - not endless immigration

By Lord Green of Deddington
Chairman of Migration Watch UK
Conservative Home, 10 June, 2018 

Pressure on the overall immigration target is rapidly growing, but the immediate issue is the cap on skilled workers, where the Prime Minister’s insistence leaves her looking increasingly isolated.

A bunch of MPs have written to Number Ten, and various cabinet ministers are said to support them. Sajid Javid said recently that he is taking a “fresh look” at he issue.

The immigration lobby are asking us to believe that raising (or even abolishing) the cap on skilled migration would solve so many problems at a stroke.

We could have all the doctors and nurses that we need, and industry could have all the skilled people that they demand. Problem solved. Really?

Is the Government unaware that nearly two thirds of the population wish to see a significant reduction in immigration? Have the Conservatives missed the fact that 84 per cent of their supporters take this view?

Perhaps the Remainers are in denial about the importance of immigration in the outcome of the EU referendum – and not because of a dodgy poster deliberately confusing asylum with immigration – but because of the massive impact that immigration is having on many parts of our country.

Only recently, a Demos poll found that 73 per cent of those samplied believed that immigration had made the communities where migrants had settled more divided, reaching 78 per cent in areas that have experienced large-scale migration in recent years.

Those who suggest that the public are becoming “more positive” about immigration overlook the fact that a major reason for this is that many believe that numbers are coming down or will reduce after Brexit – not job done, but job in hand.

Of course, if you ask the public whether they think that a particular category of skilled workers should be granted visas they will say yes – but that is subject to their overall concern about numbers.

Part of the immediate pressure is about medical staff. First, we should recognise that certain medical skills have already been identified by the Migration Advisory Committee (MAC ) as shortage occupations, which are not only granted visas, but are given clear preference over other applicants. Indeed, the government estimates that around one third of the 20,700 permits issued every year go to the NHS.

So what about other doctors? We already have one of the highest proportions of foreign-trained doctors in Europe – 29 per cent compared to less than 10 per cent for France and Germany, and about three per cent for The Netherlands. It has been obvious for decades that we have failed to train the staff that we need.

The real solution surely has to be to reduce this reliance on those trained overseas and to train our own.

The Royal College of Physicians have themselves noted that “The long term focus needs to be on developing the home grown health care work force” and in 2013 the MAC noted “the absence of a specific training pathway to produce middle grade doctors in the UK”. That is extraordinary.

As for nurses, the former chair of the MAC, Sir David Metcalf, said in 2016: “There is no good reason why the supply of nurses cannot be sourced domestically. There seems to be an automatic presumption that non EA skilled migration provides the health and care sector with a get out of jail free card.”

They also pointed out that in 2016 the shortage of nurses in England was closely linked to the decision to cut training places by almost a fifth between 2009 and 2013. Indeed, until 2014 over 30,000 UK applicants for nursing courses were turned away every year.

There is a wider question too. How can we justify taking health care staff from countries that need them far more than we do? According to the World Health Organisation, there is a shortage of literally millions doctors worldwide which is particularly acute in Sub-Sahara, Africa and South East Asia.

Indeed, we signed up to a declaration in Kampala in March 2008 which called on richer countries to “give high priority and adequate funding to train and recruit sufficient health personal from within their own country”.

So here we are again with the NHS management once again blaming immigration control for their failure to train British workers, indeed for turning them away in their thousands in past years. It is time that we had a different conversation.

For a start, any concessions should be time limited and should steadily diminish. Only if there is sustained pressure will employers be weaned away from taking the easy (and often more profitable) way out at the expense of opportunities for young British applicants.

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