Goodbye Doctor

The NHS will no longer employ doctors from overseas. Too many British doctors have been trained, which has lead to a high demand for places.
Since the NHS has been sustained for so long by migrant workers, clearly there are moral debates to be had: Do we owe anything to overseas doctors who have worked here before? There are also administrative issues too: Where does this leave the Highly Skilled Migrants Programme? However, there are also second order issues, the problems we may not feel for a generation to come.
It is often said that the UK, above other countries, enjoys a good reputation around the world. We are said to enjoy “good links” with other countries, especially the Commonwealth, made up for the most part of former colonies. We know that these good links are embodied not just in formal institutions, aid, and preferential trade agreements, but on the personal level too. Our large immigrant population, with family back in India or South Africa or wherever, form a multitude of individual ties which together forge a strong, enmeshed bond between to countries. We have an army of millions of people around the world, who have worked in the UK at some point in our lives. They are a million secret agents, sleeper cells in their own communities, who will stand up and defend our interests and our reputation when required. This latest decision by the Home Office is the first step in the disbanding of that multicultural regiment, and it will hurt us in the long run. It is another steo away from an open, Internationalist approach that has stood is in such good stead for so long. Let us hope these measures are not extended to other professions too.

11 Replies to “Goodbye Doctor”

  1. Rob, what has happened to you?
    You claim to have British interests at heart, but yet here you are effectively advocating the disemployment of British people, in favour of people from other countries. Do you really think this is a good way to improve relations between British and immigrant populations in this country? You are certainly, in this post and the last, alienating me from the notion of multi-culturalism.
    If the moral imperative is upon us as you argue, why should it not also be upon those in other countries, to stand up for us where relevant because it is morally correct in terms of the issue at stake, not just because we scratched someone’s back? This kind of cynical currying of favour overseas is utterly disingenuous, manipulative and immoral.
    And your invokation of the fear of some unspecified foreign threat to try to support your argument, well that’s worthy of the type of tactics our government has used to curtail our civil liberties. If one buys this part of your argument, one is essentially endorsing an attempt at world-domination by stealth. In the first place, I think this is terribly naiive, and in the second place, I think it’s rather morally dubious, and non-egalitarian to boot.
    There is absolutely nothing wrong with the fact that we, as a country, have a greater duty to employ our own citizens than those of other countries where possible. Every country has this duty, it’s perfectly reasonable.
    I presume you do not wish to see the NHS destroyed, or our country bankrupted out of some sense of duty towards people who have already benefitted plenty from the uk, and who, let’s face it, already have their own country anyway? So the gravy train has ended for these people. I hate to say it, but shit happens, Rob. Life is like that. Since when was it encumbent upon us to mitigate against changes in economic and labour-market situations for the sake of foreign citizens?
    If multi-culturalism comes to mean putting those of every nation ahead of British citizens, and to hell with the health service, to hell with the economy, to hell with people who call it their home, then I for one do not want it.

  2. It’s a myth that the NHS is “sustained by migrant workers”. Migrant workers are employed in the NHS and home grown nurses and doctors (who train and qualify at huge expense to the UK taxpayer) then leave to work elswhere because there are no jobs here. British medical treaining is among the best in the world, meaning we are swapping the best staff for the mediocre. Meanwhile, the (disproprtionatley large and poor) families of those migrant workers put far more pressure on the NHS than is relieved by employing them in the first place, so we are playing a perpetual game of diminishing returns.
    “If multi-culturalism comes to mean putting those of every nation ahead of British citizens”.
    It always has meant just that, I’m glad that others are starting to see it

  3. Clarice, I’m certainly not advocating the disemployment of british people in favour of foreigners in the way you suggest, or that our domestic employment policy should take into account foreign interests. I am merely saying that the old system, whereby we filled the spare slots in the NHS with foreign doctors, had positive cultural benefits. These are now being lost, undeniably.
    (To be clear, the fault here doesn’t lie with the Home Office. I see why they have taken the decision. Instead it lies with the Department of Heath, which completely mismanaged the doctor training programme – “the greatest disaster for medical training in a generation” says the article linked to above – and resulted in a glut of doctors).
    The paragraph about the sleeper cells is not as clear as it should be. When I say “in their communities” I mean in India, South Africa or whatever. I am not saying that foreigners in Britain, suddenly unemployed, will rise up and destroy us… I’m saying that they will be on our side, culturally and economically speaking, and if this leads to any kind of dominance it will be in our favour.
    Your “you scratch my back” suggestion betrays a worrying lack of some je ne sais quoi. The relationships I am talking about are not simply business relationships (e.g. “you employed me, so I’ll stick up for your trade agreement”). The ties I am talking about are those of friendship and family. If you genuinely like Britain, and if you genuinely understand Britain, then that is surely of benefit to everyone. Your analysis seems to ignore the possibility that foreigners can really be friends, and you read my post in terms of fear of some mercenary Other. Foreigners aren’t like that.
    On a separate point, there is also a distinction between foreign workers who are already here and working in the system, and those who have now lost the chance to come in the future. For the former group, I am merely lamenting the loss of cultural ties that will result from their absence. For the latter group: I do think there is some real obligation them. Do other organisations indulge in summary sackings based on nationality? Why should the NHS?
    And the idea that foreigner workers in the NHS were on some kind of gravy train is pretty offensive. They worked crippling hours in order to shore up the system. To suck them in and spit them out seems pretty harsh. But hey, why should we care what happens to anyone else? After all, they’re not one of us, are they? So fuck ’em..?

  4. Its often said that the NHS is actually our National Religion. MK asks when someone is no longer foreign. Perhaps “when they’ve worked in the NHS” might be an appropriate answer? 😉

  5. Interesting reactions here. I read the comments on the Times article too, and found it ironic that the comments lamenting the quality of English spoken by foreign doctors were inevitably riddled with spelling errors and atrocious grammar.
    It is worth examining what it means to belong in a country and what threshold one passes to become British. Obviously not all foreign doctors working in the NHS decide to naturalise or apply for indefinite leave to remain. But what of those who do? Or what of those who, as Rob mentions, are already in the system on the Highly Skilled Migrant Programme? They may have passed the Home Office’s tests, but will they ever be accepted by their communities?
    I think it’s worth meditating on what criteria migrants have to pass to enter the country. Try taking the eligibility test for Highly Skilled Migrant Programme:
    and the Citizenship test:
    to get a sense of what is required.
    I completely agree with what Rob has said about the current difficulties not being the fault of the Home Office. Immigration serves many positive purposes, and governments worldwide are very aware of this. But I suppose it’s easier to blame the Home Office, or blame immigrants, than lay the blame on people who should have seen this crisis coming.

  6. “They worked crippling hours in order to shore up the system”.
    They have to because the system is overloaded with migrants……..
    “I am merely saying that the old system, whereby we filled the spare slots in the NHS with foreign doctors, had positive cultural benefits. These are now being lost, undeniably”.
    Western medicine is applied science, and science doesn’t have a culture except it’s own. And what exactly are the cutural benefits anyway – doctors that can barely speak english ? Medics that refuse to wash their hands/perform abortions/consult male/female patients, or treat “western diseases” like alcoholism ? Cultrural diversity just adds cost and complexity to public services which more than eclipse any abstract notions of “enrichement”

  7. Culture generally, not the culture within medicine and the NHS.
    And you should know that the phenomenon of doctors breaking the hypocratic oath over stuff like abortions is not limited to foreigners.
    Indeed, I would suggest that the very nature of medicine, applied science and all that, means that those of other religions and cultures who are doctors are going to be more open to our culture than their countrymen back hope. Multiculturalism is about change for both the cultures that mix. It is also undeniable that the people that come here are changed by their experience. That’s the fluip side of multiculturalism. So the hand-washing charge is a cheap shot.

  8. As I’m sitting here flitting between checking the score between Arsenal and Blackburn and reading this, I am reminded how many football analogies one can make in the context of politics.
    I support Arsenal. To my mind (and most neutrals) Arsenal play the most entertaining, skilled and attractive football in the English Premier League. They have been criticised in recent years for their squad being made up primarily of foreign born players. Arsene Wenger’s argument has always been – I will buy the best players for my team – regardless of their passport. Arsenal FC, contrary to popular belief, do have their own training academy where they are teaching the players of tomorrow. When these players mature, if they are good enough, they will play for Arsenal FC (at least until they’re 27 when they’ll be sold to Barcelona / Real Madrid / AC Milan for a tidy profit…). Surely the point is – when the home-grown talent isn’t there, you shop elsewhere and everyone benefits. However, this shouldn’t be an argument to willfully accept that British kids leaving school just aren’t good enough. Why are they not good enough? And when they are good enough, and have trained for several years to the detriment of their bank account to the tune of tens of thousands, it is horifically remiss of those who actively encouraged them to train, to turn round and tell them there are no jobs. My girlfriend, as you know, is a secondary school teacher in Scotland. She is one of the fortunate 47% of qualified teachers in this country to be in full time employment (as a teacher). This is a common story across the board. Higher Education establishments are knowingly taking on too many students because bums on seats means more money. This needs to be addresses. However, in the meantime, the Government has a responsibility to its citizens to prioritise them (if all else is equal) over those from foreign countries. Surely you’re not arguing for the opposite?

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