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Under and out: dependant rule drives away doctors

20190746 thedoctor January issue 17

Doctors are being driven out of the UK by a change in visa rules which keeps families apart. Jennifer Trueland speaks to a consultant from a shortage specialty who has recently moved to Australia because of Home Office inflexibility

On the face of it, Nishchint Warikoo is beginning an exciting new chapter of his life. He moved from the UK to Australia on 5 December to take up a post as a consultant child psychiatrist at Sydney Children’s Hospital.

Although the job is going well so far, it wasn’t the positive career move it might look on paper. Rather, he felt driven to it by frustration at the Home Office’s refusal to allow his mother to live with him and his family in the UK.

‘It’s a nice place to work,’ he says of his new post. ‘Work wise, there are nice people and a good group of staff. Pay wise, it’s much better than I was getting in the UK. The weather is great. But it’s not home; not yet.’

Dr Warikoo is one of what is believed to be a growing number of doctors from overseas who chose to make their careers in the UK but have found themselves on the wrong side of immigration policy. Having moved to the UK at a time when there was a reasonable expectation that he would be able to bring his mother to live with him, these best-laid plans were scuppered by a rule change in 2012.

Since then, it has become nigh on impossible for people to bring older dependants to come to live with them, even if – as in the case of the Warikoo family – they undertake to pay for all health and social care needs that might arise.


Settled status

The effect on individuals is immense – but it also means the NHS is losing much-needed medical staff.

‘This is a major issue,’ says Ramesh Mehta (pictured below), president of BAPIO (British Association of Physicians of Indian Origin). ‘We have many doctors – hundreds of them – whose parents have no one to look after them back home. It’s a big issue for these doctors because they’re settled here, working for the NHS, their children are growing up and going to school here, so it’s very difficult for them to leave the country.’

Dr Warikoo, who was born in India, has worked in the NHS for around 15 years, taking UK citizenship in 2014. When he first moved to the UK, his mother Phoola used six-month visitor’s visas to spend half the year with him, his wife, and later, their daughter Soham, who is now 13.

The idea had been to apply for a dependant’s visa to allow her to stay indefinitely when Phoola was 65 but the rules changed when she was six months short of that age.

‘All our plans went out the window,’ he says. ‘It was a major shock. We started taking legal advice, and it has been a very long and stressful process.’

Under the new rules, people must show a much greater level of dependency before they are granted the right to stay. ‘I’d call it almost draconian,’ he says, adding that the process has also been hampered by incompetence. For example, the Home Office denied at one stage that it had his mother’s passport, only later conceding that it had gone missing, then found and sent to the Indian High Commission. They have also not been officially told the outcome of their latest appeal, leaving them in legal limbo.


Further afield

When it seemed as though it was unlikely the application would ever be successful, Dr Warikoo explored moving to Australia, where he was promised immediate permanent residency for himself, his wife and their daughter, and a visa granting his mother the right to stay there. He went ahead and began that post on 5 December, and has gone on ahead, leaving the rest of the family in the UK for now.

In his old job, as well as being a consultant child psychiatrist, he was also associate medical director. Ironically, one of his responsibilities was supporting the trust’s recruitment and retention efforts. ‘I recruited many psychiatrists from abroad, but I couldn’t retain my own post,’ he says, sadly.

Given the UK has a dire shortage of child psychiatrists, you would think that ministers would be bending over backwards to keep the likes of Dr Warikoo working in the NHS.

‘That’s what you’d think, but I tweeted Boris Johnson and the home secretary and neither of them responded,’ he says. ‘My trust wrote to the health secretary. This has not just been my effort – the trust executives, colleagues, most of my patients and their parents have written to their local MPs. One parent got 500 people to sign a letter to the Home Office. I was amazed and really grateful for the support I got.’


Heart-wrenching decisions

Human rights barrister Usha Sood says successful applications to bring adult dependants to the UK have plummeted since the new rules (which she calls arbitrary and discriminatory) were introduced.

She represents around 30 families in similar situations per year, and says while applications can be successful, it requires imaginative use of legal processes, and takes an enormous emotional toll.

‘The clients are extremely, extremely distraught,’ she says. ‘That’s the only phrase that comes to mind. They are distraught at the thought of either abandoning their careers, or having to abandon their parents.

‘They don’t think they should be made to have that choice. They want their parents to be looked after by them in their twilight years – many of them talk of the sacrifice and effort with which their parents have raised them, and have facilitated their careers and their lives.

‘And when it comes to them being able to do their filial duty – and some also believe their religious duty binds them – they are being told “put them in a home” or “get domestic people to help” – to abandon them, basically, then it’s very hard for them.’

She points out that there is no guarantee of quality care for older people in some countries, with residential or domestic services staffed by unqualified people, and not subject to regulation by a Care Quality Commission equivalent.

‘Many [homes] do not have fire certificates or fire drills – would you put your parent in a place where if there was a Grenfell-like situation they wouldn’t survive? You wouldn’t, would you?’ says
Ms Sood.

The strain of having a dependent parent in a different country also potentially has an effect on doctors’ work, she adds. ‘The panic that arises in individuals I’ve been talking to, who have been dragged away from operating theatres, from quite critical events that they are tending to, and having to rush off because they know that their parents need them, but also that their patients need them, is immense.’


Haemorrhaging talent

She warns the UK is losing highly skilled doctors because of this, a short-sighted policy that shows one part of the Government (the Home Office) is acting counter to the needs of another (such as the Department of Health and Social Care). ‘We are potentially sacrificing enormous talent,’ she says.

BMA international committee chair Terry John (pictured below) says. ‘We urge the Government to do everything it can to retain international doctors who play a vital role in helping the NHS meet the country’s health needs, including implementing a more flexible approach to applying the immigration rules.'

Terry John, BMA international committee chair
Taken May 2017

‘We are deeply concerned that doctors settled in the UK, who had trained and worked here and made their lives here, and had contributed so much to the UK, would be forced to relocate their families so they could look after their parents or grandparents. If we lose any more doctors in this way it will be a loss to the UK and its taxpayers, of doctors it desperately needs.’

Dr Mehta says that, unless immigration rules are relaxed, the issue will only become more acute as more doctors become affected; BAPIO is continuing to campaign for it to be effectively addressed.

‘The situation hasn’t really changed – it’s been the same for years and years, but now that these doctors who came to the UK to work in the NHS as young doctors, when their parents were not too old, are getting older themselves, obviously their parents are getting older too. And when there is nobody else in the family to look after them in their country of origin, when things get really bad, I’ve noticed the psychological impact is really bad. These doctors are under pressure, they feel quite depressed and there is a risk that they can’t concentrate on the quality of patient care as well as they want to because of the intense feeling of guilt.’



This situation is leading to some doctors taking what might be seen as drastic steps. He describes the situation of one medical couple in East Anglia, a paediatrician and a public health doctor.

‘Both parents are quite disabled and ill now and are in Mumbai,’ he says. ‘He has to go every six weeks for at least a week to look after them. Yes, they could have some paid people to look after them, but that’s not good enough. Children want to look after their elderly parents, who need their help, and they feel very guilty if they can’t do that. It’s not just an economic drain on the doctors – it has a huge psychological impact on them.’

He utterly refutes any idea that bringing older dependants to the UK would be an economic burden on already stretched health and social care systems.

‘It’s a stupid argument because almost all the doctors who want their parents to come in have said they are prepared to write a bond to say that this will not be a drain on the UK Treasury. But despite this, the Home Office is not willing to be helpful.’

It’s been a difficult time for the Warikoo family on a personal level, not least for Dr Warikoo’s mother, who, he says, feels guilty about being a ‘burden’ on her son’s family, and his daughter, who has faced the prospect of being parted from a much-loved grandmother. And it’s not all roses for Dr Warikoo either, despite the excitement of a new job.

‘It’s feeling a bit lonely here. It’s the first time I’ve been to Australia, so it’s all new. I miss my family, and I miss my home.’

Find out more about the BMA's work on immigration


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