The Human Side of the Immigration Policies in the NHS (15/05/18)

ICS Council Member, Dr. Shondipon Laha, looks at the human impact on overseas doctors who staff the NHS, and stresses the importance of a diverse representation on our professional bodies.

The Windrush debacle and the tier 2 visa caps preventing immigrant doctors alleviating pressures in the UK are part of a saga that’s been ongoing for decades. According to the British Association of Physicians of Indian Origin (BAPIO), there’s evidence suggesting that the GMC treats Black and Minority Ethnic (BME) doctors ‘differently and harshly’. A view reinforced recently by the treatment of Dr. Bawa-Garba.

The NHS has had several reviews of its BME groups. The 2014 review of London Trust boards and National Committees, the ‘Snowy White Peaks of the NHS’, demonstrated that, despite having  41% of all NHS staffing of BME origin, the number of BME staff at board level had declined by 8%, and chief executive and chairs by 2.5%, when compared to 2006. At a national level it was even worse. BME executives were absent from the Boards of NHS England, Monitor, Health Education England, and the Professional Standards Authority.

Out of curiosity I’ve looked at a few of the professional bodies that I am currently a member of, and BME representation is unsurprisingly underwhelming there too. Those that are present have had tremendous achievements in their careers prior to their appointment.

So my first question is whether this really matters?

It’s an uncomfortable thought to have as I’m a second generation immigrant, although this is the first time I’ve ever put that in writing. When people ask me where I’m from – I reply Manchester and watch the slow confusion as some try to identify the region of India that’s in. In my head I’m British and my family came from India.

My parents came in the 1960s as part of a need to staff the NHS. Initially this was only a temporary measure (sound familiar?), but they stayed to ensure their family had a good education. I grew up in south Manchester. My father working as a consultant geriatrician in a local hospital. I was the only Asian child at primary school so I made friends with those around me. I’ve had the same attitude towards other people ever since. There are many like me that this will resonate with. Our parents expected us to work hard and on the whole most of us have gone on to have productive, tax generating careers.

Throughout my life, I’ve never really considered the colour of my skin and I’ve just expected people to appraise me for what I do. My colleagues judge me on my successes, and my myriad of shortcomings. However, like many of my skin colour, I’ve noticed the occasional tendency for people to deal with me differently before they’ve heard my accent and seen my CV.

The different cultural expectations of staff from overseas can make adapting to life here a considerable strain. The rhetoric from the press, public and political establishment suggests that they’re here under forbearance; once they’ve completed their time they should return home. Don’t pass Go, and under no circumstances collect your £200. I suspect that history will repeat itself and most will provide us with hard working descendants who’ll eventually contribute to society. Isn’t it sad that skilled immigrants, who’ve demonstrated their ability to jump through the bureaucratic hoops, pass the right exams, speak in colloquial English and integrate their culture with ours, should be expected to leave their home in Britain?

Do our professional bodies represent their needs, or are they more concerned about the effect their absence would have on the service? The recent cross-party BMA letter to Sajid Javid is clearly all about service demand. But there’s a different issue, the human aspect; how we respect these individuals for the commitment they make. I don’t think it’s about the money but more about our attitude. Most are already accredited professionals in their own country and are here for aspirational reasons. People are people and while service provision is important, there doesn’t seem to be any consideration given to the consequences of decisions about service on the personal lives of those from overseas who provide it. For this reason, I think BME representation does matter.

The next question is whether the lack of BME representation is intentional? I suspect not. After all, if our masters are incapable of preparing for winter pressures despite their annual occurrence, it’s pretty unlikely they would be competent enough to do this deliberately. I suspect there are a variety of reasons why those of BME origin do not apply for these posts; they just want to get on with life and keep their heads below the parapet.

However, looking from the perspective of an ICS Council member, there are a significant number of BME members in the ICS yet only two from a BME background on the council, although you’ll have a BME ICS president this year. There’s no real reason for this and the ICS is there to represent its diverse membership. The council can’t fix it but the membership can…