It is one month today since RAPAR published its first response to the emergence of COVID19.
It is one month minus one day since its first public statement and press release called upon the State to suspend all detention and deportation activities, including legal processes, and invite all undocumented, displaced and destitute people, i.e. those most acutely vulnerable to COVID-19, to come forward for safe housing, without fear of being snatched or locked up, and so that they may contribute, openly, to making the population as safe as possible. This grounded the Open Letter Petition that anyone can sign here.
RAPAR Patron, Mark George Q.C. says: “The current health crisis has shown us all that when necessary governments take all sorts of action they would not normally consider taking. Now we need the government to take this important action to protect the health and welfare of everyone in our society.”
In the last 24 hours, RAPAR has been:
RAPAR Patron, Canon Professor Nicholas Sagovsky says: 'The Covid-19 crisis has shown us how reliant the NHS and carehomes are on people from many countries who have made Britain their home. Sadly, a growing number have given their lives caring for others. RAPAR is showing us that for many migrants, especially the undocumented, it is impossible to remain safe. This is not acceptable and must be changed.'
Over ten years ago, sitting in the garden of a house inside the Westminster village, a RAPAR member was in discussion with a Lord whose family had been vested with the title in the 1100’s. He observed “The ruling class have perfected the art of doing nothing. They grind you down by doing nothing.”
When people know that what they are doing - or failing to do - is both completely avoidable and deadly, they are committing crimes against humanity.
Today, I'm a part of you dear.
For any Government to call itself Democratic it must be prepared to
Furthermore, however much time is available, fear inhibits learning (see esp. page 16) and so, at this juncture, let’s remember and reflect on Marie Curie’s words:
“Nothing in life is to be feared, it is only to be understood. Now is the time to understand more, so that we may fear less.” Maybe Marie can help us to work out how we can minimise fear and maximise #healthandsafetyforall.
The ‘hostile environment’* was up and running long before ‘COVID19’ developed. And the Institutionalised Racism upon which the Hostile Environment rests was identified half a century ago.
Yesterday, the New York Times carried a quote about this very issue from Professor Aneez Esmail. He is the leader of our campaign for the Registration of Medical Professionals in the UK and you can read Professor Esmail’s comment, following the publication of that NY Times article, here.
Hostility breeds fear: that’s exactly what it is intended to do. How much fear is out there? And how quickly can the people and organisations who reject both institutionalised racism and the hostile environment learn?
People who are Destitute + Documented + in the UK = DDUK = People…
who are denied the right to work legally and who the Government knows are in the UK, somewhere. The Government knows they are in the UK somewhere because they are either:
Are you Destitute and Undocumented in the UK (DUUK)?
People who are Destitute + Undocumented + in UK = DUUK = British People and Anyone Else…
who has no address, which means that the Government does not know exactly where they are right now, there is no lawyer currently on their case, and/or they don't have paper 'proofs' about who they are, like birth certificates or household bills. If they are not British they have also been denied the right to work legally. All of them have fallen through the cracks of either:
“With Covid19 our situation has worsened. Some cases have been suspended altogether, and people cannot meet their lawyers to discuss issues relating to their cases. They are hoping for their cases to be treated and to be given the freedom they deserve but they are not getting this. They live with friends who are sharing their shelter with them or through charitable hosts set up to help destitute people. Essentially, they are living with people who were strangers to them before they became destitute and who have offered them places to stay.
Very few people seeking asylum have phones and the few who do are unable to top up their phones so it is even more difficult for them to connect with their support networks. Some have laptops but cannot gain access to wifi. This has greatly slowed down the support and advocacy activities the people had developed within our communities. It is a trying moment for most of us because we have no way of getting any money to buy top ups or wifi connection. Practically all the organisations that used to support us with bus fees to travel to get their food, or join in on their events, have now been closed down and, in fact, accessing food has become a very big problem.
Many of the charitable organisations that people knew, that used to provide food or help us with food banks weekly, they are closed. Worst of all is the fact that some people are on the verge of being thrown out of their homes and it will be even more difficult for them to survive on the street.”
On Easter Sunday, RAPAR member Mary, Destitute and Undocumented in the UK, DUUK, sent this photo and writing:
“RAPAR gave me good encouragement the other day, by saying to stay strong because the next day one of the lady that I work with she text me to come as she was missing seeing somebody. Then I call her she was crying as she was having some problem and I remember RAPAR said to be strong. So I had to be strong for other people and she was happy when she saw me she gave me food and some money. I keep remembering what you said. We have to be strong for each other. Some days I feel a bit low but I keep remembering what you said to me. Before this, I worked in a shop in xxx. Then I did caring and now I am working in family homes. I wasn't interested in working in people's home but out of it good came. I met good people who understand my situation and are helping me.”
For almost 20 years, since it first began to systematically evict people failed by the migration system into destitution the British State has stoked a fire. But, thankfully, no human being is an island, including the human beings who live in countries that also happen to be islands. A ‘fog of war’*** surrounds us ALL. With each other’s help, can we clear our vision sufficiently to enable ourselves and each other to think out loud, reach rational decisions together and act accordingly?
At this juncture, the only actions that are any use are those based in truthful information: concrete and real, coming from comprehensive, accurate, valid and reliable information sources that are as near to ‘objective’ reality as possible i.e. not intrinsically biased because of the way in which their ‘facts’ have been created.
In the 1990’s, Patricia Hill Collins explained to us : 'For any body of knowledge, new knowledge claims must be consistent with an existing body of knowledge that the group controlling the interpretive context accepts as true.’ She went on to say, ‘The methods used to validate knowledge claims must be acceptable to the group controlling the knowledge validation process.' Her truth invites us to walk in the footsteps of the sociolinquistic theorist Volosinov, who developed a theory of 'language creation from below'. We’ll come back, another day, to retrace those footsteps but, in the meantime, here’s a pdf of his book .
On Easter Sunday, one mainstream press article advised us, statistics wise, about what can we trust and what should we ignore. It began with the assertion that statistics about ‘the number of people who have actually become infected… depend[s] crucially on the testing regime.’
Of course, it’s a massive challenge to decide what to publish on the internet but, if it’s going to be of real use for the overwhelming majority of people, then whatever is published must be precise.
In a Journal of Advanced Nursing website blog about problems with the government lockdown, its first point ‘There might be a real increase in cases but there is a form of categorization occurring in the NHS where deaths with the non-specific symptoms of SARS-CoV-2 (the presumed viral agent)(Covid19 is the disease) are being attributed to SARS-CoV-2 without serological or laboratory (tissue culture) confirmation.’ prompts many questions. As does its third point: The tests for Covid19 are not yet calibrated to different populations like those without symptoms. ‘Died after testing positive for Covid19’ (what we hear daily in the media) is not the same as ‘died due to Covid19’ which is an evidence-based statement of disease causation. This Easter Rising blog began with a Clinical Governance-based reference to how organisations learn. Just in is this early release (due out May 2020) paper from the Centres for Disease Control and Prevention about Emerging Infectious Diseases. Public Health England, the UK Department of Health and the medical Royal Colleges must take the time to respond to all the points being raised through these scientific critiques from JAN and CDC.
And while we’re on the subject of timely responses…
As yet, the Office of the UK Prime Minister has neither acknowledged, nor responded to our Open Letter sent to Downing Street on 27th March and now platformed as a petition for anyone to sign. The Office of the Irish Taoiseach has advised us that he referred our letter to the Minister for Justice and Equality , but that Minister received his own copy of our Open letter at the same time as the Taoiseach and, like Number 10, his Office hasn’t responded, as yet.
It isn’t the first time: See Channel 4 in the spring of 2016 in News from Calais.
While we wait, and rest assured we’re not holding our breath, our Filipino Sisters and Brothers are preparing shrines to honour their dead, and our Congolese Sisters and Brothers who continue to mourn their deaths, are also asserting are lives.
For any Government to call itself Democratic it must be prepared to subject itself to scrutiny, hold itself to account and engage with its population, whether they are ‘Citizens’ or not.
For those of you who’ve arrived here… we hope you enjoy this.
*Moran RA, (2003). Clinical Governance: An International Journal. Volume 8 Number 1 pp. 46-56
**Also see Forthcoming, McMahon G. and Moran R.A. (2020) Young people seeking asylum: voice and activism in a ‘hostile environment’. In Young people’s participation, Revisiting youth and inequalities, editors, Maria Bruselius-Jensen, Ilaria Pitti and Kay Tisda. Bristol, Policy Press
***According to Wikipedia, the first known use of the exact phrase "fog of war" in text only dates to 1896, described as "the state of ignorance in which commanders frequently find themselves as regards the real strength and position, not only of their foes, but also of their friends." “The fog of war” by Col. Lonsdale Hale, Royal Engineers (retired), Aldershot Military Academy, March 24, 1896.
Susan Cueva is from the Kanlungan Filipino Consortium that supports vulnerable Filipino migrant people. She says: “We are aware that there are many undocumented workers in the UK who are in this situation. They have lost their jobs due to the lockdown and are ineligible for government support. They often live in crowded conditions with other undocumented workers and they are too scared to go to a doctor or hospital.”
Today, in partnership with RAPAR, the Consortium has followed up contact with several of the 60 MPs who are reported in both the Edinburgh News
and the Guardian as having written to the Home Secretary. The MP's have requested that foreign nationals working in the NHS be granted indefinite leave to remain. Writing directly to the MP’s and to other political figures who they know, the Kanlungan Filipino Consortium has asked for support in extending this request to all undocumented and destitute people living in the UK and Ireland. They ask the politicians to sign the Open Letter Petition, dating from 27th March, so that “all people, irrespective of status, are extended human rights and offered hope and solidarity during this extraordinary period in the history of humanity.”
And also today, the day after Elvis died, Doctors of the World have been at the forefront of launching an open letter to the Home Secretary and Secretary of State for Health and Social Care calling for the immediate suspension of NHS Charging Regulations.
For more information contact:
Kath Grant, RAPAR Press Officer, 07758386208/ kath.northernstories(at)gmail.com
Dr Rhetta Moran, RAPAR Chair of Trustees, 07776264646/ rhetta.moran(at)rapar.org.uk
Undocumented Workers now looking after British Elders in Care Homes and Irish Carer workers still stuck in Direct Provision Centres
Today, a representative from a Filipino community organisation, which advocates on behalf of frontline nurses and care home workers in the UK, including undocumented workers who lost their jobs in the current crisis and who cannot access any State support, contacted RAPAR. Deaths attributed to the coronavirus have occurred among undocumented workers in the Filipino community.
The representative described how one such worker, Rose, forced to leave her care home job because of Home Office changes to requirements for visas for migrant care worker, is living in a British City with six other undocumented people in cramped accommodation. Rose is surviving from the money she is getting from the children of British elders who are paying her to go into the nursing home where their parents live to look after them.
No one outside of an environment where they can self isolate as needed, stay clean, and maintain social distancing has the power to follow the Public Health directives necessary to limit COVID19 viral transmission to the absolute minimum. Anyone can now sign the Open Letter petition, launched by 37 organisations across Ireland and the UK, with receipt now signed for at Downing Street and the Dublin offices of the Taoiseach, calling upon the UK Prime Minister and the Taoiseach of Ireland to use their vested powers to instruct the British and Irish States to act immediately and in all ways necessary so that ALL undocumented people, destitute people and migrant people in legal process in both the UK and Ireland are granted Status Now: Leave to Remain.
Also today, MASI (Movement of Asylum Seekers in Ireland) told RAPAR “People seeking asylum in Ireland who work as care givers are risking their lives to protect the Irish people and are still having to return to over-populated rooms in Direct Provision Centres. The number of people in the Centres who are presenting with COVID-19 symptoms keeps on growing, yet no one from the Irish Government is disclosing the number of people living in Direct Provision who are testing positive. We call on the Irish Government to house Carer Workers alongside everyone else currently in Direct Provision, in safe places from which they may continue their exceptional work caring for others.”
The Irish and British Governments have the power to enable undocumented people, immediately, to care and protect themselves, their loved ones and their living and working communities. RAPAR asks “When will they stop moving the deckchairs*, use their power and save lives?” (*move (the) deckchairs on the Titanic’: To partake in or undertake some task, activity, or course of action that will ultimately prove trivial or futile in its possible effect or outcome.
Homelessness, HS2 and Here to sign the petition #healthandsafetyforall
See ATD Fourth World's new platform for the Open Letter here.
Meanwhile, the UK Government’s Home Office:
1. …Now has the power to enter your home without a warrant and remove any person living there if they think, with reasonable cause, that they are infected with Covid-19 – see police powers here. We are told by a Police Commissioner that "It's a collective endeavour. This is ultimately about saving lives and not putting a strain on the NHS and our other emergency services." Health Secretary Matt Hancock warns us "we cannot relax our discipline now"….
And yet the Home Office…
2. …Did not intervene when Bailiffs and HS2 security failed to maintain social distancing (see film here) during their attempt – under the cover of darkness on Monday night - to dislodge the young British people trying to stop more trees being cut down. Someone involved in Reclaim the Power one of the signatories to the Open Letter Petition initiated by RAPAR says:
‘This pandemic has shown us that business as usual has to change, but the state is pushing ahead with this expensive destruction of ancient woodlands instead of putting all available resources into healthcare and support for those affected. Tree and land occupations already take a stand for human health; as protecting natural spaces gives us cleaner air, and less extreme weather like floods. Evicting environmental protestors at a time of coronavirus and climate crisis means impacts on human health now and in the near future. To protect all of our health - evictions must stop!'
Just this morning, RAPAR was sent this update where activists claim police are citing "the need for social distancing" to justify blocking news outlets filming the HS2 site.
And, if that wasn't enough...
3.… Homeless people are still on the streets despite government calls to house all during pandemic. Debbie from Youth House, based in Greater Manchester Law Centre, has spoken with RAPAR (See previous work with our UK Citizen Homeless People here) about a collective of three non-commissioned agencies who feed the street homeless on Manchester City Centre’s streets.
Debbie says this week they have been telling her of incidents when Manchester City Council Officers threatened the people trying to feed the street homeless with Public Space Protection Orders (PSPO’s). On Thursday, Manchester City Council confirmed that there are in excess of 100 people still street homeless on the city centre streets. See recent Local TV coverage about our Public Health campaign to minimise viral transmission risk here.
And finally last, but most definitely not least, the Home Office is...
4. … Using UK tax payer’s money to pay the private companies that house refugees.
Correspondence sent on Wednesday from UNHCR to the British Red Cross and shared with RAPAR, sets out UNHCR's awareness of a lack of provision of cleaning products… they say that “many are experiencing anxiety over not being able to disinfect communal and personal, particularly given the difficulties in social distancing in shared accommodations and HMOs” and others “report that they are either unable to afford the level of cleaning products and hand soap needed to regularly disinfect the communal areas and to wash their hands…”. UNHCR also observes that information is not in the public domain about the sub-contracted companies who manage the day to day running of the accommodation for people-seeking asylum. Contractual obligations are outlined here.
A recent individual signatory to the open petition wrote to RAPAR saying “I support this petition...it's the truth". Another new signatory, Baobab Women's Project in Birmingham told us they signed because "Human rights should apply equally to all, and this is especially important in times of crisis. We all should have equal access to resources in order to stay healthy. It is the same blood in our veins, we are human not numbers."
64Open Letter to UK Prime Minister Boris Johnson and Irish Taoiseach Leo Varadkar is calling on both governments to create access to health and safety for all. People can sign the petition, just launched, HERE.
The Open Letter, which has been signed by 64 organisations (as at 17th June 2020) in the UK and Ireland, says it is imperative that everyone’s basic needs are met during the current Covid-19 pandemic and the only way to ensure this happens is by giving Leave to Remain to all refugees and migrants both inside and outside of the asylum and immigration system.
People living in extreme poverty, destitution and without immigration status are unable to socially isolate, many cannot access health care and other support, and they are prevented from helping to make the population as safe as possible during this time of global crisis. Migrant people who are in the legal system cannot keep physically safe on their allowances because those allowances are not enough for them to eat healthily or buy appropriate cleaning materials. Many are living in accommodation where it is impossible for them to socially isolate.
People who are destitute or undocumented fear what will happen to them if they identify themselves. They cannot access healthcare, emergency shelter and food. Or report or seek protection from domestic violence, rape, exploitation and other abuses – the levels of which are already rising.
One of the signatories to the Open Letter, All African Women’s Group, said:
“Many of us are living in dangerous and abusive conditions, either in slum asylum hostels or as unwelcome guests in other people’s homes. We need money of our own and the right to stay. Now is the time for the government to take practical measures to prevent infection. Now is not a time for racism, segregation, enforced destitution or a hostile environment for anyone. We will only survive if everyone has status in the UK and can get food, healthcare and housing.”
Black Women’s Rape Action Project added: “We know that domestic violence has soared but what remains hidden is the violence and exploitation against women seeking asylum, or with no status, who have been left dependant on others for their survival. Women must have the right to stay and an independent income and housing so they can be safe.”
ATD Fourth World UK said: "Now, more than ever, it is imperative to ensure that the most vulnerable of us are protected. Those in immigration limbo are overlooked, unsupported and left to struggle; the COVID 19 pandemic once again shows the fragility of their existence and we call for them to receive the care and attention we all deserve, not just now, but always.
"Although we are glad to see some public policy measures being taken to mitigate the impact of Covid-19 on people in deep poverty, we are reminded that it is only on the ground that it is possible to measure that impact and to understand whether policies are actually reaching their intended beneficiaries. Expertise by experience is essential to getting the response right, as demonstrated by this Open Letter."
Fizza Qureshi, CEO of Migrant Rights’ Network: "At a time of an unprecedented public health crisis, we need this government to react with a humane response so no migrant fears accessing healthcare, or any other service they need. MRN along with others urges the UK government to offer legal status to all undocumented migrants, and those awaiting a decision on their immigration claim, and on public health grounds because everyone deserves safety and protection during these difficult times."
Lucky Khambule, co-ordinator of MASI – Movement of Asylum Seekers in Ireland, says: “Since the start of the Covid19, MASI has always been critical of the way the Department for Justice and Equality responded in assuring the safety of those seeking asylum and living in direct provision. Currently there are over 60 direct provision centres and emergency hotels accommodating, with about 7,500 asylum seekers in the Ireland. For the past 14 months there has been an increase in the number of new applications and this has made the government accommodate people beyond centres’ capacity.
“The life style and living arrangements in direct provision is a recipe for disaster and should there be an outbreak in any of the centres, it would be very difficult for the department to cope. There is no social distancing as advised by the HSE, it is impossible for those living in direct provision as they are forced to share the same space with no privacy as all.
“Even the suggested on site isolation rooms are a joke as they put six to eight beds in one room very close to each other. We have been proactive in letting the Justice Minister and his colleagues know our concerns and made suggestions on what the immediate attention should be. On the 18th March 2020, we wrote to the Minister and amongst other things, we requested that all vulnerable people above 60 years and on long term illnesses be moved immediately from the direct provision set up and housed in a safer environment.”
Dr Rhetta Moran, from RAPAR, added: “Deeds not words save lives and create futures worth living.”
Please contact admin(at)rapar.org.uk for more information.
RE: ACCESS TO HEALTHCARE, HOUSING AND FOOD FOR ALL
cc: UK Home Secretary and UK Health Secretary,
Irish Health Secretary and Irish Minister for Justice and Equality,
All UK MPs,
All Members of the Irish Parliament (the Oireachtas),
All Leaders and CEOs of Local Authorities and Health Services in the UK,
All CEOs of Councils and Health Services in Ireland,
Professor Neil Ferguson, Imperial College, London,
Dr. Tony Holohan, Chief Medical Officer, Ireland
Prof Ruairi Brugha, Professor of Public Health and Epidemiology, Ireland
27th March 2020 (Signatory list updated on 3rd August 2020)
RE: ACCESS TO HEALTHCARE, HOUSING AND FOOD FOR ALL
We call upon the British and Irish States to act immediately so that all undocumented, destitute and migrant people in the legal process in both the UK and Ireland are granted Status Now, as in Leave to Remain. In this way every human, irrespective of their nationality or citizenship can access healthcare, housing, food and the same sources of income from the State as everyone else.
Everyone has the right to be in an environment where they can follow the Public Health directives necessary to limit COVID19 viral transmission to the absolute minimum and to care for themselves, their loved ones and their living and working communities.
It is imperative - being in everyone’s best interests - that the basic needs of all are met.
People living in extreme poverty and/or destitution and/or without immigration status in the UK or Ireland and/or without access to the NHS or the Irish Health System:
Please direct your responses, as a matter of urgency obviously, to admin(at)rapar.org.uk
ORGANISATION SIGNATORIES (as at 3rd August 2020)
All African Women’s Group
ATD Fourth World
BASW Cymru - British Association of Social Workers, Cymru
BFAWU - Bakers’, Food & Allied Workers Union
Birmingham Asylum & Refugee Association
Black Women’s Rape Action Project
Boabab Women's Project
CARAG (Coventry Asylum and Refugee Action Group)
Central England Lipreading Support Trust
Communities For All
Coventry Against Racism
Croydon Refugee & New Communities Forum
Doncaster Conversation Club
DPAC – Disabled People Against Cuts
Eagles Wings (Bury)
EHID - End Heathrow Immigration Detention
EYST Wales – Ethnic Minorities and Youth Support Team, Wales
FAF, GAF, LAFA and Feminist Fightback
Filipino Domestic Workers Association -UK (FDWA-UK)
GDWG - Gatwick Detainees Welfare Group
Highly Skilled Migrants UK
Inini Initiative Ltd
Iran Socialist Alternative (London)
Joint Council for the Welfare of Immigrants
Kanlungan Filipino Consortium,
Labour Campaign for Free Movement
Legal Action for Women
Leicester Quaker Meeting of Sanctuary
Lichfield City of Sanctuary
Lichfield Quaker Meeting
Lichfield Refugee Aid
Manchester City of Sanctuary
MASI – Movement of Asylum Seekers in Ireland
Medical Professionals in the UK Seeking Registration
Middle East Solidarity Magazine
Migrants Rights Network
Migrants Rights Centre Ireland
MOJUK - Miscarriages of Justice UK
MRRC - Manchester Refugee Rights Collective
No-Deportations - Residence Papers for All
No Impunity for the Congolese State - NICS
Payday Men's Network
Positive Action in Housing
Poverty Truth Community
Public Interest Law Centre
QARN - Quaker Asylum and Refugee Network
Race on the Agenda
RADAR - Rochdale Action on Destitution with Asylumseekers and Refugees
RAPAR - Refugee and Asylum seeker Participatory Action Research
Reclaim the Power
South East Asian Centre (London)
Stand Up to Racism
St Nicholas of Tolentino RC Church
The BaRE UK
Transport Salaried Staffs’ Association
Wai Yin Society
Women Against Rape
Women of Colour/Global Women's Strike
You can download a word version of the Open Letter, updated on 3rd August, here
Call for refugee Doctors to be fast-tracked into the NHS- two years after RAPAR launched a similar campaign.
12th April 2020 Update
Our Campaign leader, Professor Esmail was quoted yesterday in the New York Times. Today he tells us:
"The COVID-19 pandemic had laid bare the reliance of the NHS on migrant labour. Nearly 40% of doctors are from BME backgrounds (the majority qualifying abroad). They are currently bearing the brunt of the burden in terms of deaths in the workforce probably because they work in the most deprived and therefore under resourced parts of the NHS. When this emergency is over the sacrifice of these people should be acknowledged and the contribution of all BAME staff to the NHS recognised and rewarded. The NHS represents the best of Britain because it is so international and diverse."
Refugee doctors say:
"LET US WORK TO HELP CORONAVIRUS PATIENTS IN THE UK"
More refugee doctors have come forward to offer their skills to the NHS during the increasingly grim battle with the Coronavirus pandemic.
Two years ago, RAPAR joined refugee doctors to launch a campaign which called for the unrealistically high levels of English language testing to be reviewed and relaxed so that many more highly qualified doctors, nurses and other medical professionals could work in the NHS.
See ITV news item this week which features a Syrian doctor.
The group of medical professionals we have been campaigning with have signed an Open Letter sent by 37 organisations to Prime Minister Boris Johnson and Irish Taoiseach Leo Varadkar. Nearly 1,000 individuals, groups and organisations have signed the petition.
Dr Aneez Esmail, Professor of General Practice at Manchester University Medical School, has backed our campaign from the start. Read his article here in the medical magazine Pulse.
"It is deeply disappointing that just as the NHS faces an acute shortage of medics, hundreds of doctors, including potential GPs, are being excluded from joining the workforce because of an arbitrary change in English language proficiency standards.
At a press conference to raise this issue, I spoke to four doctors in the audience all of whom are legally entitled to live and work in the UK because they are refugees or have been given leave to remain.
They are all highly experienced having worked in Sudan, Iraq and the Congo in very difficult situations. They spoke fluent English – conversing easily with me as they explained their background. Yet none are practising as doctors in the UK because they failed the first hurdle in trying to get registration to work as doctors in the UK.
Current regulations require them to score 7.5 in the International Language Testing System (IELTS). All had previously sat the exam and scored 7, but in 2016 the GMC raised the bar for people wanting to register for the next stage of the registration process – which requires doctors seeking UK registration to sit the Professional and Linguistic Assessments Boards (PLAB) test – to 7.5.
The test does not reflect the skills required for good communication in medicine
It might seem an inconsequential change, but this has barred hundreds of doctors seeking registration in the UK. The IELTS test is graded in bands and skills are assessed in speaking, listening, reading and writing. At Band 7 the person’s standard of English is considered ‘Good’ – meaning they would handle complex language well and understand detailed reasoning. To give an idea of the standard, students from non-English language speaking countries wishing to study in the UK would be required to have an IELTS score between Bands 6 and 7 by most Russell Group universities.
It is essential that everyone seeking to practice medicine in the UK has excellent communication skills – it’s a central skill in medicine and it is right that language skills are assessed and only those shown to speak English at a high standard should be allowed to register and practice medicine.
But the IELTS is designed for academic study and does not properly reflect the skills required for good communication in medicine. It’s partly in recognition of this that the GMC has recently introduced the Occupational Exam Test (OET), which more accurately reflects the level of English needed to practice medicine.
The OET was developed in Australia (where the IELTS requirement is Band 7) and many doctors believe it will be a better assessment of English required to practice medicine here. However, the exam is prohibitively expensive for doctors in this situation, costing three times as much as the IELTS – which many have already paid to sit.
Interestingly, the UK regulatory bodies for pharmacists and dentists set the level of IELTS at 7 and 6.5 respectively.
In the UK, we face a shortage of doctors in a range of specialties including general practice. We have a group of doctors, the majority of them highly experienced, who have ended up in the UK and who are desperate to contribute their skills and expertise.
Setting the standard at an arbitrary level (there is no evidence that having a score of 7.5 as opposed to 7 makes the doctor any safer or better) is not the best way of determining whether someone is able to practice medicine. This approach subordinates people to policy, denying employment to a group of people who almost certainly have the experience and talent to help us deal with an acute shortage of doctors.
We need to support this group of doctors through tests that we have set – most of them legitimate – so that we can use their skills to contribute to the NHS. We could help by offering dedicated training to learn the conversational skills required for medicine in the OET, offering loans so that they can attend the courses to help them do this. We should also avoid setting arbitrary test scores that don’t test the specific requirement for language skills for the practice of medicine.
This is a waste of talent that we need now. Amongst the many hundreds of doctors caught in this state of limbo, there are doubtless a large number of GPs who with the right help and training could help relieve the acute shortage that we are facing, rather than waiting for the promised 5,000 new GPs in five years’ time."
For more information about the campaign see here.
On 26th March 2020, RAPAR blogged:
As tonight’s call went out for the country to Clap For the NHS, health workers and MPs were clamouring for the Government to fast track the registration of refugee doctors in the UK.
Instead of using their skills to care for people who have been hospitalised because of the Covid-19 pandemic, refugee doctors and other health professionals have been forced to work as taxi drivers and in takeaways because the re-accreditation process in the UK is lengthy, expensive and onerous.
Dr Mohammad Haqmal, a refugee from Afghanistan, told The Guardian newspaper that his background in public health and specifically HIV meant he had a lot to offer in the fight against the pandemic. He works in medical research but did not go through the re-accreditation process as a doctor because of the difficulties and expense. He knows many qualified doctors who are driving taxis and working as shopkeepers when they would rather be treating patients.
Under pressure and with an increasing number of health workers falling ill themselves, Health Secretary Matt Hancock has said he will look at the proposal to expedite qualified doctors from overseas into the NHS.
Yet just over two years ago, when NHS cuts continued to threaten the lives of patients and the well-being of health workers, RAPAR worked with a group of medical professionals to launch a campaign calling for the registration process to be less complicated, less onerous and less expensive.
Five hundred medical professionals signed up to the campaign and hundreds more signed a petition. Despite coverage in the medical press and widespread lobbying of MPs, the call was ignored – to the frustration of the refugee doctors themselves and leading NHS medical staff.
Dr Aneez Esmail, Professor of General Practice at the University of Manchester’s Medical School, backed the campaign and said at the time: “When the NHS is really desperate for extra staff, it is strange that there is a failure to recognise the contribution that refugee doctors and other medical professionals from outside the UK can make.”
Dr Hiba Alzamzamy, one of the campaign founders, produced research exposing the unrealistically high level of English testing set by the General Medical Council – one of the barriers to re-accreditation. She said: “We are highly skilled people who want to help patients at a time when the NHS is in crisis.”
It has taken a pandemic for the Government to be forced to listen to that plea.
For more information about the campaign see here.
This article is going out across Europe this afternoon.
Pressure is mounting for meaningful actions by States to ensure that everyone can practice all appropriate public health behaviours that will protect themselves from either acquiring or passing on the COVID-19 virus. RAPAR will be blogging again later today.