EXPAT DOCTORS GET JUSTICE IN UK
Natteri Adigal

Merinews, India
Nov 15 2007

Fortunately, the Court of Appeal has disapproved of the British
government’s discrimination against international medical graduates.

Medicos in India will have to learn to live with Munnabhais. So why
would Indian docs in UK return home?

LORD JUSTICE Sedley, Lord Justice Maurice Kay and Lord Justice Rimer
have unanimously disapproved of British government’s discrimination
against international medical graduates for filling "training grade"
posts. Constituting the Court of Appeal in London, they termed as
unlawful the guidance issued by the department of health, which dealt
with doctors holding visas issued under the ‘Highly Skilled Migrant
Programme’. The ruling came on an appeal preferred by Bapio Action
Limited, a limited company set up specifically to look into legal
avenues for overcoming unfair treatment of doctors from the Indian
subcontinent. The British Association of Physicians of Indian Origin
(BAPIO), set up in 1998 and representing 25,000 doctors working with
the National Health Service, had earlier failed to obtain in the High
Court in December 2006 a decree against retrospective changes announced
by immigration minister Liam Byrne in conditions for permanent resident
status of expatriates.

Up to 8,000 non-European doctors, mostly from India and to some extent
from Pakistan, who had come to the UK on visas issued under the ‘Highly
Skilled Migrant Programme’ (HSMP) stand to benefit immensely from the
landmark ruling of Nov 9. They will now have to be treated on an equal
basis with any UK or EU national for career and training jobs by NHS
hospital trustees. In fact, as HSMP is the immigration category for
"entry to the UK for successful people with sought-after skills",
the visas granted to them did imply that they could expect such
treatment. Most of the affected medicos had sold family property or
taken huge loans in order to relocate to Britain under the programme,
which offered permanent residential status in the UK after 4 years. A
Pakistani medico, Dr Imran Yousaf, whose getting to the ‘Promised Land’
had bankrupted his family, even hanged himself, when he realised
he could not extend his visa in order to get a job because of the
arbitrary change in the rule.

Dr Satheesh Mathew, vice-chairman of BAPIO was understandably
delighted at the ruling: "This is a landmark victory for international
medical graduates as the courts have found not only that the Home
Office did not carry out a Race Impact Assessment but also the DoH
gave incorrect guidance to NHS employers on the way these doctors
are to be treated." BAPIO’s corporate advisor Dr Buddhdev Pandya,
who had been instrumental in setting up Bapio Action Limited, was
"overjoyed" by the ruling. Dr Raman Lakshman, another vice chairman
of Bapio responsible for policy issues, said, "We are absolutely
delighted. This is a truly happy Diwali for thousands of doctors who
have been through 18 months of unimaginable stress.

Doctors on the HSMP came to the UK on the understanding they are
required here and will be treated fairly. This judgment means that
these international medical graduates can expect to be treated on
merit for the 2008 recruitment process and onwards." Dr. Ramesh Mehta,
secretary, Bapio, hailed the move, "For the first time, a clear message
has been sent out that promises made to international medical graduates
must be kept."

With the changed immigration rules in 2006, many of the doctors could
not complete their NHS training in the absence of work permits. In
2007, the NHS did suspend the introduction of the new rules favouring
UK and EU candidates until the dispute could be resolved in the courts.

Several influential lobbies have bitterly criticised the court
ruling. Medical editor Rebecca Smith of ‘The Daily Telegraph’,
which led a campaign for better treatment of the 30,000 junior
doctors, headlined the ruling sarcastically, "Priority for UK medics
is unlawful!" She says that the DoH guidance that training posts
should be offered to overseas applicants only if no UK or EU doctor
was suitable made abundant sense. The British taxpayer incurs around
£250,000 to put a junior doctor through medical school; these junior
doctors could miss out on training posts to doctors from overseas.

She is concerned that British junior doctors will now face even tougher
competition for posts next year, with three candidates expected for
every job.

During the recent round of recruitment under the Medical Training
Application Service (MTAS), many Indian doctors gained employment.

Several British doctors, who were unsuccessful, had to leave the
country for jobs in Australia, Canada and the US. The inability of
British doctors to find fitting jobs in the NHS has understandably
led to a public uproar. Prime Minister Gordon Brown, in an attempt
to garner popularity for his "New Labour" Party, has been promising
"British jobs for British workers." Although termed unrealistic by
the opposition Conservative party on the ground that it went against
the European Union law, such populism in a democratic country cannot
be wished away. The Conservatives have worse reputation when it comes
to dealing with immigrants.

Lord Ara Darzi, an eminent surgeon appointed as under secretary by
Brown in June 2007 to give new direction and consumer orientation
to DoH under the "New Labour" policies, said in ‘The Independent’:
"We have a responsibility to ensure qualified British doctors are able
to gain employment and this is something the government are looking
at carefully." He was replying to a specific poser in the public QA
forum of the newspaper: "Why are medical jobs being given to those
from overseas when there are qualified British doctors who are unable
to gain employment?" Interestingly, the questioner, worried about
his prospects with NHS, was a British medical student of South Asian
origin. Even Lord Darzi is an expatriate Iraqi of Armenian origin,
who had originally migrated to Ireland.

Reacting to the ruling, a DoH spokesperson lamented, "It means we
no longer have the option of issuing the guidance for 2008, on which
we were consulting that prioritizes UK medical school graduates for
specialty training posts." The DoH told the court that the issue had
never been, and is not, whether the overseas doctors could continue
to work as NHS doctors. However, the legitimate concern of the Home
Office and DoH was this: Should the taxpayer be investing in training
these doctors instead of home-grown medical graduates?

The British Medical Association (BMA), which has thousands of Indian
and Pakistani doctors as members extended full support to the plea
of BAPIO. Dr Ram Moorthy, chairman of BMA Junior Doctors Committee,
acknowledged the strong support enjoyed by overseas doctors in
the body: "BMA has never wavered from the view that international
doctors should be able to compete for training posts alongside
their UK colleagues." Dr Terry John, chairman of BMA’s international
committee, declares, "Long-term, the UK should be able to produce
its own medical workforce. Managing medical immigration in the future
will be necessary. However, the thousands of overseas junior doctors
currently providing essential services in UK hospitals must not
be scapegoated for the government’s poor workforce planning. They
came to the UK in good faith and the honest expectation of training
opportunities in the NHS."

In 2006, the number of applications from overseas doctors for
inclusion under HSMP was just over 40,000, out of which some 55
per cent received a positive reply. With the striking down of the
discriminatory guideline, international doctors will be allowed to
compete with UK and EU doctors without any discrimination for training
and jobs.

Several companies in India specializing in emigration services –
a big chunk of them fly- by-night operators, have hyped BAPIO’s
victory as indicative of brightening the employment prospects of
thousands of other Indian professionals, like techies, engineers,
accountants and management professionals. These outfits see their own
profits soaring because of the sympathetic stand taken by the court
in case of doctors. Quite many of them have already started luring
aspiring emigrants to rush in, to exploit the opportunity. However,
the situation is not as optimistic as being hyped. Highly skilled
professionals must be quite cautious in rushing to these agencies,
lest they should meet the fate of Dr Imran Yousaf.

First of all, the favourable ruling that BAPIO has received is
limited to the adverse effects of retrospective imposition of
conditionalites. It only reverses the changes for persons who
have already got HSMP visas. The court was only faulting the lack
of consultation with HSMP visa-holders beforehand and absence
of a systematic racial impact assessment. As this amounted to
arbitrariness that could be interpreted as racial discrimination
in some international forum, it had the potential to embarrass the
country. Secondly, it is only in the medical profession that there is
a significant proportion of "specialty training jobs" where a doctor
goes for advanced qualification, while continuing in the job. The
amendment that limits the period of leave and the new extension rules
introduced by the Home Office, therefore, are not of significance
to others. Most importantly, resentment among locals has been the
least in the field of healthcare as everyone realises the benefits
of retaining high-calibre medical professionals within the country.

Even in the case of doctors, BAPIO’s victory at the Court of Appeal
does not spell any tremendous new opportunity to Indian medicos. In no
way does it open the floodgates or make things easier for them to get
into the greener pasture, because it only reverses the retrospective
action.

There are many more counts that make the prospects of Indian medicos
quite bleak. One, with numerous overseas doctors clearing statutory
tests like PLAB test, there has been an exponential growth in the
supply pool. Two, there have been multi-million pound investments
in medical schools, which have started turning out more graduates,
including foreign students, than be accommodated in NHS jobs
or training. Three, with the induction of several east European
countries into the EU, doctors from these countries are posing a
formidable competition.

It is of course good news that, thanks to the fight put up by BAPIO,
thousands of Indian doctors will be in a position to earn millions
of British pounds. They will become many times richer than they would
have, had they remained in India. Part of the money could come in handy
for securing a brighter future for several members of their family
back home. But, the fact that BAPIO had put up such a tough fight,
involving huge sums of money, to secure the rights of its members to
remain in UK is indicative of something disturbing.

The shameful truth is that these doctors do not want to return
because of the miserable conditions obtaining in India (and
Pakistan). With the field getting competitive, only the best and
brightest of Indian doctors will have any significant scope in the
NHS in future. Unfortunately, others will necessarily have to put
up with upstart politicians like Health Minister Anbumani, who has
been making life miserable for AIIMS doctors. Sincere doctors and
medical professors will have to continue to tolerate Munnabhais
stealing the limelight and getting awards. Corrupt bureaucrats in
health departments will continue to corner whatever meagre funds are
set aside for healthcare.

According to a FICCI study, India had some 600,000 doctors in 2005.

The country has to have at least 1.2 million doctors by 2012 if the
standards of healthcare prevailing currently are not to go down.

There is an illusion that medical colleges are sprouting everywhere in
great numbers. But, the addition every year is under 22,000, although
official estimates say 30,000 doctors pass out of the country’s
medical colleges every year. A doctor in a government hospital in
India starts his career with a salary of Rs 15,000 per month. He/she
can expect to get as much as £2,000 (over Rs 160,000) if he lands
a job with the NHS. With the new non-discrimination regime, he/she
can obtain specialised training to handle highly expensive equipment,
which is beyond the reach of 90 per cent of the doctors in India. Can
you blame them if they bet their shirts not to return home?

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