Health secretary Alan Johnson defended his department’s decision to try to restrict the number of medical graduates entering the United Kingdom from outside the European Economic Area (EEA) during his evidence on Monday afternoon to the parliamentary health select committee.
Kevin Barron, chairman of the committee, which is investigating the government’s Modernising Medical Careers (MMC) policy, asked whether the minister felt a moral obligation towards those overseas doctors who had helped to support the NHS for so long.
“No one could suggest in any way that this is failing to meet some moral obligation. This is the right way to go,” Mr Johnson said. “The contribution international medical graduates have made has been enormous.
“You are quite right we would not have been able to run the health service without their contribution. But we have drained the world of medical graduates. I don’t think it was the right policy for other countries.”
Now that there were four new medical schools in England it “simply didn’t make sense,” he said, to continue to accept overseas graduates into specialist training posts.
The department announced on 6 February that, from 28 February, overseas migrants newly applying under the highly skilled migrants programme will not be able to take up a post as a doctor in training. This will affect the 2009 intake but not those already accepted under the programme and who are already working here in training posts.
The department is also consulting on plans to restrict entry to specialist posts from 2009 to people who fall within a strict definition of EEA citizen. It is also awaiting a House of Lords hearing into whether it acted illegally by trying to impose a series of restrictions on overseas graduates.
The committee had earlier heard from Home Office officials that the Department of Health’s move to restrict applicants from overseas was first mooted in 2005, before the first major change to the rules in April 2006.
The restriction imposed on doctors by the highly skilled migrant programme had, said MPs, been criticised by the Foreign Office as an “unwelcome precedent.” Mr Johnson said it was a “government decision.”
He outlined the department’s plans for handling international medical graduates should the House of Lords appeal fail. The preferred option, he said, was to introduce restrictions through employment law, stating that non-EEA graduates would be accepted only for places that could not be filled by EEA graduates.
“If the appeal is not upheld we will look to other options,” he said. “We don’t like using the highly skilled migrant programme. The Home Office were reluctant to take that route.”
One option, he said, was to charge a fee to all doctors who did not work a set number of years in the NHS after training. This would mean that the cost of their training was covered and also that migrant doctors could compete directly for posts.
“The other is to see where we could just introduce legislation from my department—something that would cover this, rather than going through the Home Office.”
Under questioning Mr Johnson rejected suggestions that it might have been better to phase in MMC gradually.
England’s chief medical officer, Liam Donaldson, who also appeared before the committee, said that phasing in MMC could have created problems for doctors applying for posts in different specialties had one specialty switched to the new system while another remained on the old system.
The big risk with the switch was, he said, that there would not be enough training posts to fulfil the demands of the foundation year training programme. But there had been full discussion of that at the NHS management board before implementation, he added.
Mr Johnson also rejected any suggestion that any one individual might be held responsible for what went wrong last year with MMC and the medical training application service (MTAS) (BMJ 2007;335:733-4 doi: 10.1136/bmj.39364.512685.80). “This was a complex issue. I don’t think it could have been laid at the door of one individual.”
Much to the annoyance of committee members Mr Johnson repeatedly refused to be drawn on the department’s initial response to the Tooke inquiry into MMC. The response is due at the end of February, he said.
See Career Focus doi: 10.1136/bmj.39485.377002.DB.
Details of the proposals for managing applications from medical graduates from outside the EEA are available at www.mmc.nhs.uk.