Overseas NHS staff

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Allo V Psycho
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Overseas NHS staff

Post by Allo V Psycho » Mon Jun 21, 2021 3:09 pm

Grauniad article

https://www.theguardian.com/commentisfr ... hs-england

While I don't think Harding is remotely suitable to run the NHS, I think the policy is a wee bit more nuanced than the article suggests. She (apparently) isn't suggesting getting rid of current international staff but rather training more UK staff, and this may well be a good thing. The UK has traditionally not bothered to rain enough doctors (I won't consider nurses here).

It has been reckoned cheaper to allow other countries to train expensive doctors, and then have them practice medicine in the UK. Of almost 17,000 doctors joining the NHS in 2019, more than 9,000 were non-UK trained. Non-UK trained doctors often face significant challenges working in the NHS, since they have trained in very different health care systems, and the NHS are not good at helping them work effectively. And there are still shortages - the NHS spends almost £1billion a year on locum services, and it is increasingly difficult to staff certain specialties and geographic areas. There is a good argument for increasing the number of UK trained doctors.

There are a number of interesting schemes afoot - HCPMed in Scotland is recruiting currently working health care professionals to train part time while still working at their original jobs. But an expansion of UK medical schools would almost certainly be valuable, including setting them up in deprived areas, and using them to widen participation. And the cost would be about the same order of magnitude as the current locum spend.

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Fishnut
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Re: Overseas NHS staff

Post by Fishnut » Mon Jun 21, 2021 8:53 pm

Allo V Psycho wrote:
Mon Jun 21, 2021 3:09 pm
It has been reckoned cheaper to allow other countries to train expensive doctors, and then have them practice medicine in the UK.
It feels like a continuation of our colonial approach to the world - others bear the costs and we reap the benefits. I'm being rather flippant and ignoring the agency of the doctors and nurses who choose to come to the UK to work, but the reliance on people from overseas to support so many facets of our society is increasingly noticeable in the wake of brexit. Is the UK unusual in this?
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Re: Overseas NHS staff

Post by Herainestold » Mon Jun 21, 2021 9:13 pm

Why not train British BAME and POC people in these medical specialties? That would increase diversity and stop the colonialist raiding of developing countries talent.
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Re: Overseas NHS staff

Post by bolo » Mon Jun 21, 2021 9:38 pm

Fishnut wrote:
Mon Jun 21, 2021 8:53 pm
Is the UK unusual in this?
The U.S. numbers are less extreme but still substantial. I believe about 25% of U.S. doctors are foreign-trained.

I'm all in favor of more opportunities for medical training within Britain and within the United States, but I object to the idea that hiring immigrants is "colonialist raiding". As Fishnut said, all those foreign-trained doctors have agency and chose to immigrate, often at some personal cost, presumably because they think their lives will be better as a result.

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Re: Overseas NHS staff

Post by secret squirrel » Tue Jun 22, 2021 2:34 am

bolo wrote:
Mon Jun 21, 2021 9:38 pm
Fishnut wrote:
Mon Jun 21, 2021 8:53 pm
Is the UK unusual in this?
The U.S. numbers are less extreme but still substantial. I believe about 25% of U.S. doctors are foreign-trained.

I'm all in favor of more opportunities for medical training within Britain and within the United States, but I object to the idea that hiring immigrants is "colonialist raiding". As Fishnut said, all those foreign-trained doctors have agency and chose to immigrate, often at some personal cost, presumably because they think their lives will be better as a result.
People thinking their lives would be better in developed countries is not independent of colonialism. It's not as direct as the old style of swanning into someone's country and taking their stuff at gunpoint, but the overt violence of previous decades has set up a state of affairs where resources, human and otherwise, flow 'naturally' from the poor to the rich.

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Re: Overseas NHS staff

Post by Woodchopper » Tue Jun 22, 2021 7:27 am

bolo wrote:
Mon Jun 21, 2021 9:38 pm
Fishnut wrote:
Mon Jun 21, 2021 8:53 pm
Is the UK unusual in this?
The U.S. numbers are less extreme but still substantial. I believe about 25% of U.S. doctors are foreign-trained.

I'm all in favor of more opportunities for medical training within Britain and within the United States, but I object to the idea that hiring immigrants is "colonialist raiding". As Fishnut said, all those foreign-trained doctors have agency and chose to immigrate, often at some personal cost, presumably because they think their lives will be better as a result.
An important reason for people wanting to work in the UK or US is the ability to send money back home. At a global level, remittances are worth far more than flows of development aid, and are probably more effective.

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Re: Overseas NHS staff

Post by Woodchopper » Tue Jun 22, 2021 7:28 am

secret squirrel wrote:
Tue Jun 22, 2021 2:34 am
bolo wrote:
Mon Jun 21, 2021 9:38 pm
Fishnut wrote:
Mon Jun 21, 2021 8:53 pm
Is the UK unusual in this?
The U.S. numbers are less extreme but still substantial. I believe about 25% of U.S. doctors are foreign-trained.

I'm all in favor of more opportunities for medical training within Britain and within the United States, but I object to the idea that hiring immigrants is "colonialist raiding". As Fishnut said, all those foreign-trained doctors have agency and chose to immigrate, often at some personal cost, presumably because they think their lives will be better as a result.
People thinking their lives would be better in developed countries is not independent of colonialism. It's not as direct as the old style of swanning into someone's country and taking their stuff at gunpoint, but the overt violence of previous decades has set up a state of affairs where resources, human and otherwise, flow 'naturally' from the poor to the rich.
Yes, the UK etc gain enormously from the talents of the people who choose to work there.

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Re: Overseas NHS staff

Post by Imrael » Tue Jun 22, 2021 10:18 am

I have seen some over-the-top condemnation of this, and I do remember discussions of the issues we cause to health services in poorer countries by importing doctors. And not necessarily very much poorer countries either.

The trouble is that assuming the worst about motivation of the current administration is only sensible.

Allo V Psycho
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Re: Overseas NHS staff

Post by Allo V Psycho » Tue Jun 22, 2021 11:33 am

Herainestold wrote:
Mon Jun 21, 2021 9:13 pm
Why not train British BAME and POC people in these medical specialties? That would increase diversity and stop the colonialist raiding of developing countries talent.

Medical students graduating in 2021 (i.e. entered medical school mostly in 2014 and 2015): Asian 29.5% Black British 4.6%
"People from Asian ethnic groups made up the second largest percentage of the population (at 7.5%), followed by Black ethnic groups (at 3.3%), Mixed/Multiple ethnic groups (at 2.2%) and Other ethnic groups (at 1.0%)"
Source: 2011 census (last available) https://www.ethnicity-facts-figures.ser ... les/latest

So what you suggest is already in place, and the Asian community, academically talented and socially ambitious as it is, is already well represented in medical schools. What is needed to increase the number of doctors markedly. The UK averages 2.8 doctors per 1000 people, making it the lowest ranked OECD country (22nd) apart from Poland and Slovenia. Germany has over 5/1000.

Source: https://www.bmj.com/content/357/bmj.j2940 (2017)

It has not been common practice in the UK to train medical students for particular specialties: rather, the task has been to produce the undifferentiated junior doctor - the iatroblast, as it were. Even new programmes such as HCP-Med and ScotGEM, while aimed to encourage GP careers, still lead to a general medical qualification, and graduates can enter any field of medicine.

https://www.ed.ac.uk/medicine-vet-medic ... fessionals

https://www.st-andrews.ac.uk/subjects/m ... .en.118111

It is perhaps of significance that both these valuable initiatives have emerged from Scotland.

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Re: Overseas NHS staff

Post by Bird on a Fire » Tue Jun 22, 2021 12:32 pm

Woodchopper wrote:
Tue Jun 22, 2021 7:28 am
secret squirrel wrote:
Tue Jun 22, 2021 2:34 am
bolo wrote:
Mon Jun 21, 2021 9:38 pm

The U.S. numbers are less extreme but still substantial. I believe about 25% of U.S. doctors are foreign-trained.

I'm all in favor of more opportunities for medical training within Britain and within the United States, but I object to the idea that hiring immigrants is "colonialist raiding". As Fishnut said, all those foreign-trained doctors have agency and chose to immigrate, often at some personal cost, presumably because they think their lives will be better as a result.
People thinking their lives would be better in developed countries is not independent of colonialism. It's not as direct as the old style of swanning into someone's country and taking their stuff at gunpoint, but the overt violence of previous decades has set up a state of affairs where resources, human and otherwise, flow 'naturally' from the poor to the rich.
Yes, the UK etc gain enormously from the talents of the people who choose to work there.
And in many cases, such as the one of NHS doctors and nurses, those jobs are only available in the UK because of a deliberate strategy of not training enough UK students, and instead pursuing the cheaper option of hiring people trained at other countries', or their own personal, expense.

It's one of those cases where being a richer country (and thus able to offer higher salaries) enables it to take the cheaper option.

I'd argue that morally the UK ought to be exporting qualified medical professionals, not importing them from less well-served places.
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Allo V Psycho
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Re: Overseas NHS staff

Post by Allo V Psycho » Tue Jun 22, 2021 12:45 pm

Bird on a Fire wrote:
Tue Jun 22, 2021 12:32 pm
Woodchopper wrote:
Tue Jun 22, 2021 7:28 am
secret squirrel wrote:
Tue Jun 22, 2021 2:34 am


People thinking their lives would be better in developed countries is not independent of colonialism. It's not as direct as the old style of swanning into someone's country and taking their stuff at gunpoint, but the overt violence of previous decades has set up a state of affairs where resources, human and otherwise, flow 'naturally' from the poor to the rich.
Yes, the UK etc gain enormously from the talents of the people who choose to work there.
And in many cases, such as the one of NHS doctors and nurses, those jobs are only available in the UK because of a deliberate strategy of not training enough UK students, and instead pursuing the cheaper option of hiring people trained at other countries', or their own personal, expense.

It's one of those cases where being a richer country (and thus able to offer higher salaries) enables it to take the cheaper option.

I'd argue that morally the UK ought to be exporting qualified medical professionals, not importing them from less well-served places.
Medical student places were cut in 2012 by, oh, let me see, the Cameron-Clegg administration. Hard not to think of it as a money saving device, on the assumption that imported doctors would make up the numbers.

Herainestold
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Re: Overseas NHS staff

Post by Herainestold » Wed Jun 23, 2021 6:25 pm

Allo V Psycho wrote:
Tue Jun 22, 2021 11:33 am
Herainestold wrote:
Mon Jun 21, 2021 9:13 pm
Why not train British BAME and POC people in these medical specialties? That would increase diversity and stop the colonialist raiding of developing countries talent.

Medical students graduating in 2021 (i.e. entered medical school mostly in 2014 and 2015): Asian 29.5% Black British 4.6%
"People from Asian ethnic groups made up the second largest percentage of the population (at 7.5%), followed by Black ethnic groups (at 3.3%), Mixed/Multiple ethnic groups (at 2.2%) and Other ethnic groups (at 1.0%)"
Source: 2011 census (last available) https://www.ethnicity-facts-figures.ser ... les/latest

So what you suggest is already in place, and the Asian community, academically talented and socially ambitious as it is, is already well represented in medical schools. What is needed to increase the number of doctors markedly. The UK averages 2.8 doctors per 1000 people, making it the lowest ranked OECD country (22nd) apart from Poland and Slovenia. Germany has over 5/1000.

Source: https://www.bmj.com/content/357/bmj.j2940 (2017)

It has not been common practice in the UK to train medical students for particular specialties: rather, the task has been to produce the undifferentiated junior doctor - the iatroblast, as it were. Even new programmes such as HCP-Med and ScotGEM, while aimed to encourage GP careers, still lead to a general medical qualification, and graduates can enter any field of medicine.

https://www.ed.ac.uk/medicine-vet-medic ... fessionals

https://www.st-andrews.ac.uk/subjects/m ... .en.118111

It is perhaps of significance that both these valuable initiatives have emerged from Scotland.
Interesting, thanks. Obviously more training places need to be funded. Do you think it would help to cut down or have a moratorium on overseas students?
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bolo
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Re: Overseas NHS staff

Post by bolo » Wed Jun 23, 2021 6:34 pm

Herainestold wrote:
Wed Jun 23, 2021 6:25 pm
Do you think it would help to cut down or have a moratorium on overseas students?
Help whom? Certainly not the overseas students, or the countries they come from and may return to.

Allo V Psycho
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Re: Overseas NHS staff

Post by Allo V Psycho » Thu Jun 24, 2021 8:08 am

Herainestold wrote:
Wed Jun 23, 2021 6:25 pm
Allo V Psycho wrote:
Tue Jun 22, 2021 11:33 am
Herainestold wrote:
Mon Jun 21, 2021 9:13 pm
Why not train British BAME and POC people in these medical specialties? That would increase diversity and stop the colonialist raiding of developing countries talent.

Medical students graduating in 2021 (i.e. entered medical school mostly in 2014 and 2015): Asian 29.5% Black British 4.6%
"People from Asian ethnic groups made up the second largest percentage of the population (at 7.5%), followed by Black ethnic groups (at 3.3%), Mixed/Multiple ethnic groups (at 2.2%) and Other ethnic groups (at 1.0%)"
Source: 2011 census (last available) https://www.ethnicity-facts-figures.ser ... les/latest

So what you suggest is already in place, and the Asian community, academically talented and socially ambitious as it is, is already well represented in medical schools. What is needed to increase the number of doctors markedly. The UK averages 2.8 doctors per 1000 people, making it the lowest ranked OECD country (22nd) apart from Poland and Slovenia. Germany has over 5/1000.

Source: https://www.bmj.com/content/357/bmj.j2940 (2017)

It has not been common practice in the UK to train medical students for particular specialties: rather, the task has been to produce the undifferentiated junior doctor - the iatroblast, as it were. Even new programmes such as HCP-Med and ScotGEM, while aimed to encourage GP careers, still lead to a general medical qualification, and graduates can enter any field of medicine.

https://www.ed.ac.uk/medicine-vet-medic ... fessionals

https://www.st-andrews.ac.uk/subjects/m ... .en.118111

It is perhaps of significance that both these valuable initiatives have emerged from Scotland.
Interesting, thanks. Obviously more training places need to be funded. Do you think it would help to cut down or have a moratorium on overseas students?
Short answer: No.

Long answer: Hell no. The UK Govt. sets a strict limit on the number of home students, but then allows a small additional proportion (10% max) of international students. By paying full international student fees, these students subsidise the medical schools and the home students. There are a small (and uncapped) number of international students (Canadians, for instance) who pay about £40,000 per year, and their fees directly subsidise the NHS, to the tune of about £100,000 per student. Moreover, medical students in clinical settings are not supernumerary: they can carry out tasks under supervision, so they contribute to the work force.

The pandemic has shown how valuable this is. Last year, at most medical schools, final year students went into full time NHS work roles several months early, and did as well as junior doctors, and more junior medical students, down to first and second years, helped man testing and vaccination centres. Pandemic preparations for medical students date back to H1N1.

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