Thought of the week: NHS reforms and its impact on Indian doctors in UK

In 1963 the Conservative Health Minister Enoch Powell launched a campaign to recruit Indian doctors to save the NHS from an impending staffing crisis. Ironically, a few years later Powell warned Britain of the “rivers of blood” caused by the influx of foreign workers. By the mid-sixties more than 18,000 doctors had arrived in Britain. Most of them dreamt of working in advanced teaching hospitals. But there was a shock waiting for them.
They were shepherded to either crime and unemployment ridden inner city areas or the small rural communities, where English doctors were reluctant to go.

Last week, York Hospitals NHS Trust decided to cut 200 jobs over the coming year as part of plans to save seven million pounds. Two days earlier the Worcestershire Acute Hospitals NHS Trust had announced that 720 jobs were to be axed as it tries to save 30 million pounds.The University Hospital of North Staffordshire is cutting 1,000 jobs in the face of a 15.5 million pound debt, while Brighton and Sussex University Hospitals NHS Trust is also losing 325 posts as part of plans to save more than 10 million pounds over the next year.The Royal Free Hospital in Hampstead, north London, is cutting about 480 jobs under plans to save 25 million pounds in the next year, and the Mid Cheshire Hospitals NHS Trust said that it could be forced to cut 250 jobs to avoid going into debt.To save costs, some hospitals - such as those in Staffordshire - have resorted to outsourcing medical secretarial work to India. A similar pilot scheme at the Royal Cornwall Hospital (RCH) has been opposed by the local staff.As one of the cost-cutting schemes, hospital officials have proposed that consultants use a digital recorder to dictate notes that can be uploaded via the internet and sent to companies in India and elsewhere to be typed.A spokesman for RCH said: "We are reviewing ways to address a backlog of work that cannot be met, at the moment, by staff at the trust. We are considering companies who provide similar services for other NHS organisations and throughout any pilots they will be monitored and assessed on their speed of turnaround, accuracy, reliability and cost issues. We will then evaluate the outcomes."

Almost every day, several hospitals announce job cuts to meet budget deficits. In recent weeks, the overall job losses in the NHS are said to be nearly 7,000 in 22 trusts and hospitals in different parts of the country.The financial crunch further lessens the prospects of thousands of Indian doctors currently seeking employment in Britain. New work rules have compounded the situation for them as now they can no longer work as part of "permit free training", and need work permits.Britain's health authorities are faced with higher numbers of local medical graduates and many more from the expanded European Union who have the right to work in Britain. The situation makes it difficult for non-EU nationals - such as Indian doctors - to secure employment in the NHS.An association of doctors of Indian origin has scheduled a demonstration outside the Department of Health here April 21 to protest against the changes in work rules as applicable to Indian doctors.
Thousands of Indian and other foreign doctors are forced to live on the breadline in UK because they are lured from their home countries with promises of work, only to remain unemployed, poor and discriminated against a year after expensively gaining UK visas and pass grades in a key medical exam. The new survey, by the General Medical Council, UK’s lead medical body, comes a year after the British Medical Journal published data, case studies and statistics to warn overseas doctors—particularly from India—to eschew UK as they were at risk of remaining out of work for months on end. The GMC survey, which renews the warning, offers data to prove that less than half of those who passed Britain’s medical qualifications test, PLAB, in summer 2004 found work within six months. The survey found that a quarter of those who passed the PLAB or professional and linguistic assessment board, remained down and out in London and other British cities a year later. The survey warned that the situation was likely to worsen in 2006 with nearly 7,000 non-European doctors rushing to pass the PLAB in 2005, up nearly seven times from the 1,000 doctors who passed the test in 1998. The GMC, which administers the PLAB, admitted that the race to clear the exam, mostly amongst doctors from the sub-continent, was prompted by an attempt to recruit overseas, non-European doctors to plug gaps in National Health Service. The department of health said it was considering allowing overseas doctors to apply for jobs from their home countries, a longterm key request by British Indian doctors. Last February, the BMJ “warning to all junior overseas doctors” carried well-chosen words of advice from Peter Trewby, chair of the Royal College of Physicians’ working group on international medical graduates, with the stark facts about the life an Indian doctor could expect in the UK. Recounting the stark fact that a whopping 900, mainly Indian, applicants had attempted to secure the unglamorous post of “a preregistration house officer in Darlington”, Trewby declared the unsuccessful majority of applicants constituted a massive waste of human resource totaling 800 “doctor years”. Senior British Indian doctors told TOI that the faultline appeared to lie in the NHS’s attempt to recruit internationally from September 2001, with the aim of bringing in 1,000 senior doctors and thousands of nurses from overseas into the UK within four years. They said the UK’s policy of declaring healthcare a “skills shortage occupation” gave Indian doctors both the licence and hopes of securing jobs in Britain with the result that “over two-thirds of doctors registering to practise in the UK in 2003 were from overseas—the vast majority from non-European countries”. But the reality of life in UK for a newly-qualified Indian doctor now means queuing for free meals in temples and sleeping three to a room in squalid lodgings, the survey said. In response to the survey, Prasada Rao, BIDA chairman and a general practitioner, said the figures were “absolutely diabolical… unbelievable. These people have come to serve NHS and there is chaos, confusion and total lack of care. There is no co-ordination between the health department, home office and GMC. It is totally unacceptable.”"

Why are the Indian doctors forced to leave their home land and work in UK and Canada and the land of downunders Australia. Only because of poor work atmosphere at home,the meagre salaries , the focus on curative treatment and gross negligence of scientific research and lack of direction from the part of policy makers who are bend on bribery and corruption. Inspite of gross defecits of GP's and Physicians in the rural india where you are offered handsome salaries as per indian standards, almost all the doctors and consultants are crowded in cities there by decrasing the relative job deficit in cities amounting to low salaries and exploitations from the part of private hospitals who try to keep the salaries of thedoctors at the rock bottom. Service part of the profession is lost to big corporates who rule the health care and inluence the policy making to make inappropriate profit and loot both the health professionals as well as the patients.

What is now needed is developing a central INHS for india, Posting of fresh MBBS graduates in rural india with good salaries and limiting their work time, with a proper referral system, to abolish undue importance to superspecialists , reduce the duration of MBBS,MD and DM courses and the governmental assistance in recruitment of doctors to foreign countries especially to Australia and CANADA where the deficits of health professionals are increasing. Making compulsory insurance for the masses and restricting the private hopitals and setting a bench mark salary will defenitely solve the problem of employment among doctors. Setting up of newer and newer self financing colleges is ruining the whole scenario and needs immediate restrictions or else the same doom in UK is sure to fall on us too.

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