Day Two of our series on the 70th anniversary of Scotland's NHS
ONE of the best advantages of working in the NHS is the variety of people of differing backgrounds you get to work with. The diversity of our staff is something to be proud of and celebrated.
Yet in recent months Westminster has shown a complete disregard for the contribution of healthcare workers from overseas. Under the gloom and threat of a “hostile environment”, doctors, nurses and other healthcare professionals are reconsidering the decision to live in our beautiful country and work in our fantastic health service.
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The damage caused by decisions taken elsewhere in the UK on Scotland’s health service in regard to foreign policy are already apparent – Brexit is affecting the long-standing relationship we have with Europe. Nursing and Midwifery Council figures earlier this year saw a sharp drop in the number of nurses from Europe coming to work in the UK, while the same report showed a leap in those leaving the NHS. Some 3000 fewer nurses from the European Economic Area work in the NHS compared to last year.
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It has been strongly inferred that using the residency status of EU migrants as a bargaining tool in the early stages of the Brexit negotiations has been largely to blame for this.
More recently, the fallout from the Windrush scandal, coupled with stories of doctors and nurses from outside the EU being denied Tier 2 visas (despite shortages of medical staff across the UK), has further eroded trust in Westminster and thrown light on the failings of Theresa May’s Home Office stewardship.
Relying on Whitehall to set and approve immigration figures for Scotland undermines devolution and the “goodwill” agreement between parliaments. The bizarre situation wherein we have sole responsibility over some policy domains such as job creation, but not the levers to ensure those posts are filled, implies that Scotland simply isn’t capable of determining these key policies.
The opposite is true. Holyrood produced the paper Scotland’s Population Needs and Migration Policy in early 2018, but it has largely fallen on deaf ears. Acknowledging the significant financial contribution of economic migrants (£34,400 per migrant to GDP, and £10,400 per migrant in additional government revenue), and the challenges faced by many rural communities in Scotland, it called for the novel solution of a Scottish visa to help fill essential jobs. Those rural communities are among those who were covered by the Highland and Islands Medical Service, a state-supplemented healthcare system implemented in 1913 that was the progenitor of the National Health Service; they are also the same communities most vulnerable to shifts in immigration trends.
At present, EU nationals account for 5% of the total number of employed adults in Scotland, and this figure rises to 5.8% of the total number of doctors working in NHS Scotland. Some 4% of nurses and midwives are non-UK EEA-qualified nationals, and those from outside the EU take the total number of non-UK nationals delivering care to more than 10%.
In spite of this, those coming to work in our NHS, particularly from outwith the EU, face serious barriers. Applications for a Tier 2 visa – a visa for skilled workers, allocated against a monthly UK-wide quotient – are notoriously challenging. Many non-UK qualified doctors taking up service provision posts such as clinical fellowships (jobs designed for service delivery rather than training) have to jump through hurdle after hurdle, at a significant financial cost.
The variability of this system, essentially a limited supply-and-demand system, was highlighted when the salary threshold temporarily jumped to £55,000 in December 2017 due to unprecedented demand (the average salary of a clinical fellow doctor is around £40-45,000 depending on experience). This resulted in desperately needed doctors being denied visas. This doesn’t even begin to address the challenges nursing staff would face trying to obtain a visa, with the starting salary for a Band 5 (staff) nurse in Scotland set at £21,909.
The immigration system as a whole needs reworked, but a temporary, much-needed exemption for healthcare staff should be undertaken as a priority, until Scotland is in a position to set its own immigration policy. Until then, we must abide by the rules of Westminster, and our EU colleagues will need to pay £65 for settled status unless they have indefinite leave to remain in the UK.
Scotland cannot mitigate every cut and cost thrown at us by Westminster, but I would urge Nicola Sturgeon to stay true to her promise last year to pay for the settled status of every EU national working in our public services – to do so makes an important and bold statement about the welcoming and inclusive country we aspire to be.
Marc Aitken is a junior doctor in Glasgow and a member of NHSforYES
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