Forced apart

by Tim Tonkin

Doctors needing to care for relatives living overseas have been left with an agonising dilemma because of highly restrictive visa rules. Many are being forced to cut their NHS hours – costing them, and the health service, dearly

Location: International
Published: Wednesday 24 April 2024

Consultant Aniya Kumar’s* life used to be a happy and straightforward one. 

Having trained in the UK and worked in the NHS almost continuously since 2002, Dr Kumar lives in north London roughly a mile from the hospital that, until three years ago, she worked at full-time.

In the summer of 2021, however, Dr Kumar’s life was turned upside down when six members of her extended family in India lost their lives to the COVID-19 delta variant which was then sweeping the country. 

Aside from the tragedy of losing so many relatives, the deaths meant Dr Kumar’s older widowed mother, who herself has been left physically debilitated as a result of COVID infection, was now alone and without support.

As the eldest child in her family, Dr Kumar’s first instinct was to try to bring her mum to the UK to live with her so she could be financially supported and cared for. 

I can’t leave my mum by herself, because if something happens there is no support
Dr Kumar

Unfortunately, this wish has so far proved impossible owing to rules imposed by the Home Office on those applying for visas for ADRs (adult dependent relatives).

Immigration rules were greatly tightened in 2012, and those wishing to bring adult family members to the UK must be able to demonstrate their relatives’ health is sufficiently poor that they require long-term care, and that the requisite level of care cannot be obtained in their home country. In practice it has meant very few have gained permanent entry.

As a result, Dr Kumar was forced to take the difficult decision to leave her job and work instead as a locum, a decision which has reduced her hours in the NHS and affected her finances and career, so that she is able to spend up to half of each year in India looking after her mum.

‘I think this is the height of discrimination, that’s how I feel,’ says Dr Kumar.

‘Just because I was not born here and my family is not from here, I can’t care for my mother. At the same time, the NHS and the Department of Health and Home Office want me to care for other people of her age by working in the health service.’ 


Many affected

As extreme as Dr Kumar’s situation is, her experience is sadly far from unique for many doctors with dependent relatives overseas working in the NHS.

A recent BMA survey into the effect of UK immigration rules around visas for ADRs, exposed just how significant a personal and professional effect restrictions on bringing family members to be cared for in the UK is having on many doctors. 

Garnering more than 3,300 responses and with 90 per cent of those participating stating they had dependent adult relatives overseas, 76 per cent of doctors told the BMA they had been forced to take time off work in the past five years to travel abroad to provide care to relatives. 

Eighty-four per cent told the survey they knew of at least one colleague who had quit the NHS owing to carer responsibilities, with 94 per cent warning immigration rules made it less likely they would remain in the UK in the long term. 

I think this is the height of discrimination
Dr Kumar

Occupational health physician Shailesh Katyal is facing a similar dilemma with regards to continuing his career in the UK owing to the obligations he feels towards his parents in India.

Dr Katyal says he has so far not sought to engage with the process for applying for ADR visas, owing to the sheer hopelessness he feels he and others are faced with when attempting to meet the almost impossible set of criteria the Home Office sets out.

‘When I first came to this country [in 2003], doctors were allowed to bring their parents to come and live with us without any of these criteria recently set out by the Home Office,’ he says.

‘Learning that this was no longer the case came as a shock to me as I had no idea it had been changed. There was no consultation with the BMA in this regard as far as I am aware. Both my parents are old and infirm and not in good health any more, and to be able to bring them here, to look after them and just be with them for whatever time they have left, would mean so much.’

Dr Katyal says he understands how many doctors in his position might consider leaving the UK altogether if forced to choose between their career and looking after their parents.

‘Having been a part of this country, having lived here and served in the country for several years, one feels let down by the UK. If it was conducive, I would have brought my parents here as soon as possible. Events like the pandemic really bring things to the fore: one is always thinking, are you even going to be seeing your parents again. Living here under the circumstances is a continuous dilemma.’

home office The Home Office

Dr Kumar says that, while her former clinical director had been understanding and tried to accommodate her needs, it simply hadn’t been feasible to continue to balance work, international travel and looking after her mum.

She says that, while her mother had been granted a visitor visa to the UK, this did not allow her to remain for the extended periods needed. 

She adds that, were her mother to relocate to the UK, she was fully able and prepared to support her financially and pay for private medical care, so there was zero burden on the NHS.

‘I can’t leave my mum by herself, because if something happens to her in India there is just no support available there for her,’ she says.

‘I go to India for three to four months of the year and then I come back to the UK and locum for three months and then go back again to India.’

She says that if the Home Office was reluctant to grant dependant visas for people such as her mum, the introduction of a long-term visitor visa could be an acceptable compromise.

The BMA has official policy calling for the Government to relax the requirements for ADR visas and following its latest survey, association council chair Philip Banfield wrote to home secretary James Cleverly imploring him to take action.

The letter said: ‘Our survey shows that if unaddressed, [this] issue risks doctors leaving the UK, further exacerbating the existing workforce crisis in the NHS. [It] also demonstrates how the rules are already disrupting patient care with doctors being forced to take leave to provide care for their relatives overseas.’

Home Office minister Tom Pursglove wrote in response to Dr Banfield’s letter that the ADR rules were fair and that there was no evidence they were deterring overseas doctors from coming to the UK – despite the evidence to the contrary in the BMA’s survey.

* Dr Kumar’s name has been changed