Doctors and Nurses (Developing Countries) Bill

17th November 2020

Andrew Mitchell presents his Private Member’s Bill to Parliament.

I beg to move,

That leave be given to bring in a Bill to require the Secretary of State to report on the merits of a scheme for the United Kingdom to pay to train two doctors or nurses in developing countries for each doctor or nurse recruited to the National Health Service from those countries.

I am extremely grateful to you, Mr Deputy Speaker, for granting me this opportunity to make the case today for my Bill—my first ten-minute rule Bill since I was elected to the House 33 years ago. I am supported by a distinguished cross-section of Members from both sides of the House. I believe this Bill to be uncontroversial, but a genuine boost for the reputation of global Britain and the international values that this House supports, particularly ahead of the integrated review. It builds on the past reputation of our country as an international development superpower. We were the first of the major developed countries to honour our promise to the world’s poorest people to spend 0.7% of our gross national income as part of our mission to elevate the lives and social conditions of some of the most desperate people on the planet—people deprived not for any reason of their own, but because of where they were born.

One of the proudest moments of my political life was when the coalition Government, in spite of the austerity that our country faced back in 2010, declined to balance the books on the backs of the world’s poor and agreed to honour the 0.7% promise. I am still certain that that chimes with the values and instincts of the vast majority of our fellow citizens, even at such a dreadful time as this for so many.

Secondly, I want to emphasise how much we rely on those doctors and nurses and other healthcare workers who bring their talents and skills to this country to support our NHS from overseas. We respect them and we are hugely grateful to them. Indeed, if I may use a second world war analogy, much beloved by some of my hon. Friends, the heroes of this war against covid are not, as in the battle of Britain, the men and women of the Royal Air Force but, all too often, workers from overseas working in our hospitals, giving their all in our care homes, putting themselves in harm’s way, and often living on the minimum wage.

When we persuade a doctor from the developing world to come here, we do so in the knowledge that our gain will inevitably be their country’s loss. In this country, we have 215 doctors, nurses, health workers and midwives from Sierra Leone; from Nigeria, 4,099; from Pakistan, 3,394; from Ghana, 1,118; and from India, just short of 20,000. All these countries are developing nations with whom we have, or have had, a significant development partnership. What I am describing—the export to us of their doctors and clinicians—is reverse aid: not from Britain to help developing countries, but from those developing countries to help Britain; and it is clearly wrong. In Britain, we have one doctor for every 357 people—effectively, three doctors per 1,000 people—with some 15% of our nurses coming from overseas and about a quarter of our doctors.

What should we do about this dependence on doctors from overseas, and especially from the developing world, where we are effectively poaching their key public assets? First, we should grow more doctors and nurses here in the UK. The Government have recognised this and increased the number of doctors trained here from 6,000 a year to 7,100 from 2018. It was particularly good to see that universities like Aston in Birmingham now run a foundation course bringing more students from disadvantaged backgrounds into medicine.

We recognise also that it would be wrong for us to end the opportunity for those doctors in the developing world who wish to exercise freedom of movement. The House will be as shocked as I was to hear that not long ago there were more doctors trained in Sierra Leone practising medicine in Manchester than were practising medicine back in Sierra Leone—the country that had trained them. We should not restrain their career opportunities by cutting off their ability to come here if they wish and if we want them to do so.

So let us work with the grain of human nature, do the right thing, accept our moral obligation to people much less fortunate than ourselves, but also meet the needs of our citizens and ensure that they have the best possible healthcare. Therefore why not do the following? For every doctor or nurse we poach from a developing nation, we should ensure that that developing country—on losing their trained professional to our advantage—receives from the existing British development budget sufficient resources to train up and replace them, two for one? When we are lucky enough to secure such professionals from the developing world, we should replace them twice over, and expand their public health services accordingly.

Remember these figures: in Britain, one doctor for 357 people; in Nigeria, one doctor for 2,753 people; and in Sierra Leone, 1.4 doctors and nurses for every 10,000 people. Ghana—a country with which Britain has a close historic relationship—has in the upper east region, one of its poorest, one doctor for every 26,000 people. All the time, these countries, too, are fighting covid. Nigeria has 64,000 cases, Ghana has 49,000 cases, and Sierra Leone has 2,385 cases. India has an estimated shortage of no fewer than 600,000 doctors and 2 million nurses. India, where Britain actively recruits doctors, has one doctor per 10,189 citizens and has 30% of all the world’s acute child malnutrition.

The case we make to Parliament and the Government today is as follows: it is immoral and selfish for Britain, with its wealth and infrastructure, to poach doctors from the developing world. However, by taking the action I have suggested, we can turn that into a win-win for us and for developing countries. It would not be right to fetter freedom of movement for those medical and health personnel who wish to come here and who we as a country wish to admit—and to whom we are truly grateful for bringing their skills to these shores. By replacing twice over the health service professionals who come here from developing countries with which Britain has a close development partnership, Britain can help to meet its own healthcare needs while providing additional healthcare capacity within those countries.

On 1 January, the UK takes over the chair of the G7 group of nations. At a time when the new US President-elect is determined to reinvigorate the international rules-based system, when this major pandemic has destroyed lives and livelihoods around the world, and when we know that covid will not be beaten here until it is beaten everywhere, especially in countries with weak public health infrastructure, Britain’s international development leadership and commitment to the 0.7% promise to the poor—Britain’s example—have never been more needed. My Bill will contribute to that leadership and to the international progress we so badly need.

Hansard