ITV published short sharp research findings last week revealing the nature and extent of racism and racist discrimination in the NHS and posing some questions about how that relates to the deaths among front line workers. We asked the Professor of General Practice at the University of Manchester, Professor Aneez Esmail, who is also a hands on GP and who heads up our campaign for the Registration of Medical Professionals in the UK for his immediate reaction to the research findings:
“The findings from the ITN survey concur with my own experience and understanding of why BAME staff in the NHS seem to be differentially impacted by the effects of Covid-19. As a practising GP I have numerous examples of colleagues who have approached me about their concerns regarding the lack of support by management and being forced to work in risky situations.
The NHS is a microcosm of society more generally and research is increasingly showing that BAME people are adversely affected by Covid-19 because they are over-represented in low paying jobs where they have less power and agency to manage their working conditions. Inevitably they are pushed into front lines roles more often than their white colleagues and are therefore more exposed to the risks of contracting the disease. There is no gene for being an ethnic minority and when an enquiry will be finally held I will not be surprised to find that proportionally more BAME died - whether they worked in the NHS or in roles in the social care sector - because of their working conditions and their lack of agency within these organisations."
On the social care side of this same equation, a RAPAR member composed this account about their friend who works in a dementia care home.
Mr B (he does not want to be named even though he is happy to share his experience)
works 12 hour shifts in a private dementia care home and he is feeling exhausted. He is experiencing racism from some of his white colleagues and managers: some of his colleagues are off sick or on leave and there are very few carers left to look after the 100 patients, some of whom are infected with Coronavirus. Some white staff refuse to serve those patients because they are scared they might get the virus and management send him to do the job: he has been with a few of them when they took their last breath. This affected him so much that he started writing about it, and he is thinking of leaving the job after Corona is over. His wife is in high risk groups, only recently recovering from cancer but Mr B's manager won't allow him to reduce his working hours . He said wearing masks for 12 hours makes him sick. He is a healthy man but I can see he is getting unwell mentally. The most shocking thing is, after working for almost 10 years in this job, he receives the minimum wage of £8.50 an hour and has never had a bonus or pay rise.
Obviously workers who are organised in the Trade Union movement have a critical reach out role here. Most recently the General Secretary of TSSA, Manuel Cortes signed our Open Letter in the wake of the death of frontline Transport Worker Belly Mujinga. Manuel explains: "The hallmark of a civilised society is how well it looks after its weak and vulnerable. No one who lives within our shores should be left destitute or without access to comprehensive healthcare. That's why I support this campaign."
And another of our signatories to the Open Letter calling for Status Now, MASI, sent this latest update from the Republic of Ireland:
‘It has been an uphill battle between ourselves as people living in direct provision and the Department of Justice. As of last Wednesday, we saw a sudden rise of people infected with Covid19 to 149. This is attributed to the fact that people cannot observe social distancing due to overcrowded living arrangements: direct provision residents share bedrooms, bathrooms and dining rooms.
We wrote to all leaders of all political parties in Ireland to raise this issue at Government level. It was encouraging then to see time allowed at the Dáil for the Deputies to pose questions directly to both Minister Charlie Flanagan and Minister David Stanton. This has never happened before in the Irish State; that the Parliament would discuss the issues about Direct Provision so passionately and, this time, residents felt well represented.
The following day we heard the two Leaders of the ruling parties admitting that they would like to focus on ending the direct provision system and creating a system whereby people have their own front doors and cook their own meals. The positive thing here is that they are acknowledging that this system is wrong and needs to end. What needs to clear is how it will end, in line with what people seeking asylum want:
1. Amend HAP criteria to include people seeking asylum so that people can move out of Direct Provision and live in the community.
2. Lift restrictions on the right to work for people seeking asylum and allow everyone in Direct Provision, and people seeking asylum not in Direct Provision, to work legally.
3. Extend access to Jobseekers Allowance to people seeking asylum, and extend child benefit to every child in the State, irrespective of immigration status. This is money that is currently paid to the operators of Direct Provision Centres who make millions annually.
4. Grant permission to remain to all non-EU/EEA nationals irrespective of current immigration status: there is no reason to import labour when there are thousands of undocumented people in the country who are very happy to contribute.
And, finally, North of the English border, the Scottish Government is offering an(other) example of how progressive they can be as, today, the make the call that ‘all migrants should be granted Leave to Remain (LTR)’. Yes indeed...
...If anyone can explain to RAPAR why, at their daily briefings, the British Government still do not have a signer who communicates information to deaf people using sign language to interpret, please email admin(at)rapar.org.uk. We are wondering if the reason is the same or perhaps similar to the one that accounts for why our Open Letter calling for Status Now #healthandsafetyforall has yet to be acknowledged, let alone acted upon. You though, can sign it here.
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
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.
English language tests preventing medical professionals from practising in the UK as NHS struggles to survive
Launch of research at 12pm on Wednesday 16th May at Rusholme Health Centre, Walmer Street, Manchester, M14 5NP.
Hundreds of doctors, nurses, pharmacists, dentists and laboratory technicians are being prevented from working in a struggling NHS because of the current English language tests set by the General Medical Council (GMC) and other professional bodies.
A campaign launched through RAPAR - Medical Professionals in the UK Seeking Registration - is growing by the day with over 500 medical professionals already signed up to it. There is also increasing support from the wider general public and a 38 Degrees Petition has been put together.
One of the campaign founders, Dr Hiba Alzamzamy, spoke at a national demonstration in support of the NHS last month. Research about the English language tests put together by her campaign group will be launched at Rusholme Health Centre in Manchester on May 16th - the day before an NHS Skills, Retention and Recruitment conference in the city.
The campaign is backed by Dr Aneez Esmail, Professor of General Practice at the University of Manchester's Medical School, who says:” At a time when the NHS is really desperate for extra staff it is strange that there is a failure to recognise the contribution that refugees and other medical professionals from outside the UK can make.
“”These are highly skilled professionals and we need to help them to start their lives again – this will in turn help the NHS at a time of great need.”
The campaign is calling on the GMC and other bodies to return to more realistic and appropriate English language tests. Doctors who passed the previous language test are currently working successfully in the NHS. But now highly qualified doctors – many of whom have been forced to flee their home countries for humanitarian reasons – are being stopped from using their skills and expertise.
Four years ago, the GMC raised its already high score for doctors in the International English Language Examination Testing System (IELTS) even further and they are now considering whether to raise it yet again.. The exam tests general knowledge of English language and includes topics such as archaeology, jam making and current affairs – much of it irrelevant to the kind of terminology used by medical professionals. In response to concerns, the GMC has now introduced an Occupational English Test (OET) in addition to the IELTS.
There is little information about the new OET which originates from Australia and is almost triple the cost of the IELTS. The new test is still in its early stages in the UK and it is not yet known if it will be fit for purpose. In addition, there is still the problem of the unrealistically high barrier of the IELTS.
Nurses, dentists, pharmacists and other medical professionals are having similar problems with the levels being set by their own professional councils for the English language tests.
Dr Alzamzamy explains: “Most of the professionals in our campaign have studied and gained their qualifications overseas on courses which have been delivered primarily in English. We are highly skilled people who want to help patients at a time when the NHS is in crisis. We acknowledge that communication is an essential element in securing patients' safety but the new test level is not a bar to ensure safety, it is a barrier preventing us from practising our profession.
“The English language test level now set by the GMC is unrealistic and very demoralising. Years of study and sheer hard work are going to waste.”
For more information please contact: Dr Hiba Alzamzamy at medicalprofessionalsuk(a)gmail.com