Nigel Hawkes, Health Editor
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Thousands of doctors trained outside Europe yesterday won a House of Lords ruling that the Government could not block them from applying for training posts in Britain.
By a four to one majority, the law lords ruled that guidance originally issued by Patricia Hewitt when she was Health Secretary, aimed at limiting the employment rights of overseas doctors, was illegal. She had issued instructions saying that doctors from outside Europe should be appointed to training posts only if there were no suitable candidates from Britain or the EU to fill them.
By “dashing the legitimate expectations” of doctors who had been encouraged to come to Britain, the law lords said, Ms Hewitt had acted unfairly.
The ruling ends a long legal battle. Her guidance was challenged by the British Association of Physicians of Indian Origin (Bapio), which lost in the lower court but won on appeal. The department brought a further appeal to the Lords, which it has now lost, bringing final victory to Bapio.
The ruling will mean 4,000 to 5,000 overseas-trained doctors already in Britain are guaranteed equal chances of winning training posts.
A Department of Health spokesper-son said: “We are disappointed that the Lords have ruled that our guidance as it stood was unlawful. However, this is a complex judgment which needs careful consideration.
“We are coming to the end of a consultation on this difficult issue. That consultation is due to end on May 6. We need to study the House of Lords findings carefully, alongside the responses to the consultation, to see what the best course of action will be.”
Although the department lost, the ruling does not mean an ever-open door. The Home Office has changed the rules for immigration to prevent people coming to Britain under the Highly Skilled Migrants Programme (HSMP) from applying for medical training posts.
Bapio’s victory does mean that applications for training posts in the next few years will remain tight, with roughly 700 to 1,000 British-trained doctors likely to be unable to get a training post in 2009, 2010 and beyond.
For this year, the ruling would have had no effect even if the department had won. Competition for training posts in 2008 is likely to be even tougher than in 2007, with about three applicants for every place.
In 2007 more than 1,300 applicants from British medical schools failed to get posts. This year the department estimates that between 1,000 and 1,500 will be disappointed. They will still be able to get jobs in the NHS, but training posts are much more desirable because they lead eventually to qualification for consultant posts.
The issue now is what the department will do to solve the problem. Medical school places have been steadily increasing, leaving the prospect of many expensively trained British graduates being denied the opportunities they hoped for.
One alternative is to increase the number of training places, but that would be pointless if there were not a corresponding increase in consultant jobs. It would be moving the point of unemployment to later in a doctor’s career. Another alternative would be to cut the number of medical school places, reversing the policy of self-suffi-ciency embraced by the Government. But this would take up to ten years, represent a volte-face and would return Britain to its traditional position of dependence on foreign doctors.
In the Lords ruling, Lord Rodger of Earlsferry said that it must have been clear to the Government that, due to a change which it had itself initiated soon after taking office, from about 2005 there would be an increased supply of home-grown medical graduates. To try to put it right, Ms Hewitt “dashed the legitimate expectations which it had fostered and on which the foreign doctors had acted. The advice was accordingly unlawful.
“Obviously, the Government could have achieved its objective if it had amended the immigration rules. For various reasons, it chose not to do so.
“But, if it had chosen to try to amend the rules, it would have been required to pay the political price of subjecting the proposed change, and its highly damaging effects on the international medical graduates with HSMP status in this country, to the scrutiny of Parliament.”
Lord Bingham of Cornhill said that to speak of the guidance being “issued” was to “suggest a degree of official formality which was notably lacking”. It was published on the NHS employers’ website, but no official record had been produced during the legal proceedings. Instead, the Lords had been referred to a Home Office e-mail. “It is for others to judge whether this is a satisfactory way of publishing important governmental decisions with a direct effect on people’s lives,” Lord Bingham said.
Lords Carswell and Mance also dismissed the Government’s appeal.
In a dissenting judgment, Lord Scott of Foscote said that the Health Secretary was entitled to adjust the policy on employment of junior doctors in postgraduate training positions to give priority to British or EU nationals.
Terry John, chairman of the BMA’s International Committee, said: “It’s right that we have a debate about the numbers of doctors coming to the UK in future, but it’s wrong to scapegoat those already here.”
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Arthur - the Law Lords simply judge if what the government has done is lawful according to the laws of the land. The government are free to pass whatever laws they wish, however in their actions they must, like us all, obey the law. The law lords are not the 'real power', they safeguard us.
Neil Anderson, Bridgetown, Barbados
To sell it to public the goverment is putting it as setback for UK trained doctors. What about the thousand of overseas doctors who were recruited legally came to UK with a reasonable expectation and was given a few weeks to pack up , get children out of school sell the house and leave. Thats unfair
Raja, Cardiff, UK
this is a joke. once again the government or the 'higher classes' are proving that british people are 3 rd rate citizens ih their own country. we are constantly being replaced with foregin nationals.
Mark Stuart, wallasey, England
I read with interest your story about doctors. It is worst for barristers! After expensive education and very difficult exams, I cannot get pupillage and I am British. Worst still I will be disqualified and have to resit the Bar exam again if I did not get pupillage within 5 years of graduation.
Les, London, UK
Politicians love to mess about with things. They often break it and then leave the medical profession to pick up the pieces and the blame. What Patricia Hewitt did was wrong.
Dr Timothy Chan, Carmarthen, UK
ABG,
Your information is obviously out-of-date. I am a Brit with a UK degree and an MRCP and yet struggling to get a training job. I have been to interviews where there were several of us Brits and yet the job went to an overseas (i.e. outside Europe) doctor on a work permit.
A.T, London, United Kingdom
We should treat foreigners the same way that they treat us.
MP Allen, Thiruvananthapuram, India
Absolutely bonkers an yother country would just say NO
What a kick in the teeth fo our own junior doctors
John, N Yorks,
Why is everyone ignoring the issue of patients' interests? It should be the NHS' number 1 priority. When hiring, hospitals should do everything they can to employ the most able and competent doctors they can find, wherever they're from. Otherwise they are needlessly endangering patients.
Rowan, Oxford,
What a waste of money, time and effort spent on training our own doctors, for them to be forced to find work abroad. British doctors should come first!
Sara, London, London
Can't the law Lords be had up for Treason?
Bry Barnes, Somerset, Uk
The overturned guidance did not favour UK doctors, it favoured EU doctors. It was certainly no guarantee of British jobs for the British. Rest assured that these highly trained people (trained at another country's expense!) will continue to have plenty of difficulty in competing for any posts.
Bernadette, Oxford, UK
I thought it is the best interest of the patients to have many trainied doctors competeing for consultant posts than junior doctors competing for training posts at the begining of their career. Most of the hospital patient care are done by junior doctors. How can you recruit junior doctors now?
Sam Edirisinghe, Gravesend, Kent
After 5 years in O&G I have been asked to change speciality and start at the begining in order to get a training post. I am not asking the DoH to increase the consultant numbers but to break the current training at ST3 level and create an entry point to those doctors without training posts.
Dona Edirisinghe, Gravesend, Kent
Why should doctors not have to compete with overseas labour, along with the rest of us. All this whingeing about not having a guaranteed job!
Pat, London, UK
Why do people complain about the law lords? They are the ultimate authority in setting out the boundaries of the law as decided by Parliament. If the Government breaks the law it is right that people have access to appropriate recourse to set things right.
Rob, Leeds, UK
The influx of non UK graduates has led to a poorer work ethic and poorer communication with patients. There has been short term attempts to improve things without foresight to look at long term options YET AGAIN. Too many poor doctors are progressing through without penalising poor performance.
Peter Bull, Leeds, UK
I know it is unfair to say that a IMG will get a job ahead of a british doctor.Only who are in the system will understand these issues and for all others it might seem that with this ruling british doctors are at a disadvantage. I can assure they r not and saga will continue unfortunately for IMGs
Krishna, Cardiff,
Michelle go!! There is a much better world out here!
Richard, Plymouth,
Another fine mess Labour have got us into!!! They are so weak on managment imigration and economy.
steve tea, manchester, cheshire
I am fed up with this Government making decisions which end up in court and are subsequently reversed. On this one you wouldn't need to be a lawyer to conclude that the Government was in breach of human rights. This is complete incompetence and two faced to be frank.
mike lincoln, wakefield,
I don't want to have to work abroad but due to this mess it is becoming a very real prospect. How disappointing. I have trained for 8 years and now am not even guaranteed a job.... with all of the corresponding hard work, sacrifices and debt.
Michelle, london,
The law lords have placed the interests of foreign doctors above those of british doctors, and ignored the wishes of the elected government, and people.
Could we not export them (the Law Lords), and instead import foreign judges, possibly French, who have the interests of British citizens at heart
william, deal, kent
So Mr Brown, what happened to British jobs for British people? Yet more tripe from our unelected P.M.
Matt, Blackburn,
Who is in charge - the law lords or government ? I don't remember voting for 4 judges to rule us !!!
Ian Payne, WALSALL,
This will only affect the expats who are residents of UK and are being trained at UK madical schools. I am unaware of an instance where a foreign doctor was selected in an interview also attended by a Brit in the past!
ABG, Chennai, India
Australia will be rubbing its hands in glee - 1000 Doctors
available each year trained at UK tax payers expense! Why spend £250 million when the UK will pay it for them? On the other hand what else should we expect from Patricia Hewitt?
D Stokoe, Liverpool, UK
Arthur,
We don't vote Government in, we vote Parliament in.
The article describes how Lord Rodger of Earlsferry explains that the Government could have put rules before Parliament (Those we voted in) but chose not to do so.
It's good to see that you and the Law Lords seem to agree on this one!
M M , London,
Since when did we vote the Law Lords into power?
Everything the government does (for good or bad), the Law Lords can change. I thought we voted the government in, to do as we wish, not the Law Lords, as they appear to be the real power in this country.
Arthur, Newcastle,
I take it then that the 20 thousand or so IMGs who had to leave the country while this policy was in place during the last 2 years will be compensated. Oh, silly me, of course no such thing will happen & this was the whole point, to implement illegal procedures expecting IMGs to be passive.
S. A, London, United Kingdom