By Dr Indranil Chakravorty MBE
The world is a very different place since our last newsletter. We have now completed 100 days of the new ‘T’ administration across the pond, and what impact the ‘T-economics’ is having around the world. From teetering markets, swinging fortunes of economies and multiple war fronts, to the destabilisation of the diversified social fabric of many nations. The UK is one of the most diversified populations due to the legacy of its colonial past and the influence of the Commonwealth. Unfortunately, the rhetoric from UK politicians is also mimicking the same anti-immigration sentiment, while recognising that a significant contribution to health and social care is provided by colleagues from abroad. All these actions lead to seismic change in the political landscape, how people interact, and give rise to uncertainty for the people who choose to give their expertise and labour to the UK and similar countries. We, as healthcare professionals and members of an organisation which stands for justice, equality and inclusion, are bound to be affected at a personal, institutional and societal level.
Starting from across the pond, the destabilization began with the United States of America under the current administration, withdrawing from the World Health Organisation, changing the funding structure of the Centre for Disease Control, the National Institutes of Health and the attempt to influence how higher educational institutions are governed, recruited to and manage their curriculum. The populist undercurrent of anti-immigration rhetoric and protectionism under the banner of #MAGA is leading to a very uncertain and unnerving future. The impact is likely to be felt by those on the fringes of society and counted as ‘minorities’ within any state. There is also a further danger when normal constitutional checks and balances (i.e. the judiciary) are put in abeyance or ignored by populist administrations and their supporters. However, there is some hope in this toxic milieu with the green shoots appearing in movements such as the ‘anti-oligarchy rallies’ occurring in some parts of the USA. We can only wait and watch as this political circus unfurls.
Closer to home, the momentous decision to dissolve the NHS England by the current Secretary of State began with the change of guard at the top. Just prior to this action, the apex Health Education England had been merged within NHS England as the NHS Workforce Training and Education department, and the inevitable loss of legacy and expertise, along with the exodus of staff. This decision was based on the declared premise of reducing redundancies and bringing decision-making closer to the political masters in the Department of Health and Social Care. Along with the responsibility for decisions that affect the department with the largest single budget in the UK government, and often a big influence on political futures, there is also the promise of direct accountability. This change comes at a time when the NHS’s performance and morale are lower than when the pandemic ravaged health systems around the world. Against this backdrop, the COVID inquiry continues to delve into the money, politics and impact of decisions taken during the pandemic years. It will be prudent to remind ourselves that the UK fared worse than many nations with developed economies and advanced healthcare systems, in terms of mortality and morbidity. We live in hope that there will be transparency and lessons will be learnt.
The anti-immigrant rhetoric continues in the UK and is reflected in recent discussions on social media about the rise in numbers of international medical graduates who, after passing the necessary exams (PLAB), are being registered by the General Medical Council and are released into the UK healthcare market. This is occurring on a background of record levels of vacancies in the NHS and rising mistrust of alternative workforce experiments such as Medical Associate Practitioners. While the institutional leadership remains silent, there are vocal proponents who are moving the publicly demonstrated argument towards protection for ‘locally trained graduates’ to access official training placements. The argument that ‘every state should protect its own’ is playing out, and in recent weeks, there has been a formal resolution adopted by the British Medical Association Resident Doctors Committee to give priority to local graduates for training posts.
There is also a minority voice publicly, but incorrectly, claiming organisations such as BAPIO and its training arm (BTA) are aiding and abetting this unfair situation for local graduates by being in cahoots with the NHS Leadership. There is also mention of ‘false promises’ of training for IMGs. While one is never in favour of having public discourse on social media of important and sensitive topics, by responding to 144-character allegations (such as on X) from people hiding behind anonymised accounts, there is an argument for organisations to protect their reputation by being and open and transparent not only to its membership, but also to the public.
BAPIO continues to stand up for their rights and uphold the principles of equality, justice and inclusion. Perhaps, it is time to remind us of the dedication, service, and economics of inducting fully trained professionals from overseas to the UK health service. Each trained doctor saves the UK taxpayer circa 250,000 GBP in training costs, while providing critical service to the nation. The majority of these are in locally funded, non-training posts with little or no prospect of career progression. Well, that is differential attainment and another whole story. BAPIO provides for induction, access to top-up training, opportunities for research, leadership, and medical defence support through its many functions, forums and arm’s-length bodies.
Finally, this month we had the BAPIO women’s conference in Leicester and the Young Doctors Forum MERIT conference in Bristol. The women’s conference focused on the state of women’s health, challenges, careers and support. This comes at a time when the UK Supreme Court has ruled that gender affirmative action must be determined only by biological sex or gender assigned at birth. This brings a new challenge for transgender individuals (estimated to be 0.5% of the UK population), a setback for the gender identity argument and for institutions, including the health sector, in deciding its implementation. There is a wealth of evidence that transgender individuals have poorer physical or mental health outcomes, suffer discrimination, violence and social deprivation. These outcomes are further complicated in transgender individuals from minority groups. The Equality Act of 2010 should offer protection from discrimination for transgender individuals based on their minority status.
It is exciting that the BAPIO YDF forged ahead with its MERIT conference, and the BAPIO Institute for Health Research (BIHR) is proud to support the over 60 scientific abstracts which were presented at the conference and published in The Physician. The conference focused on careers, research, professionalism, anti-racism and leadership among other topics.
BIHR is inviting members with research interests to join its committee, panel of experts and contribute to developing the next 5-year strategy. So please let us know. We are also keen to hear of your achievements, events, success stories, as well as challenges. So please write to us.