This week: Neil Anderson, director of Migration Watch
Why he matters: Founded by former ambassador Lord Andrew Green and Professor David Coleman in 2001, Migration Watch has had a profound impact on the debate over immigration in the UK. It describes itself as ‘an independent and non-political think tank’, though many critics believe it is more a right-leaning lobby group.
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Do you think it important that nurses and social care workers should be paid more?
Do you think it right that the UK should train more doctors and nurses?
Do you believe that a wealthy country like Britain should strive to staff its health and social care services with its own residents?
Do you think it morally questionable for health systems in the West to entice clinical staff from their homes in the developing world, where they are often in desperately short supply?
Do you, perhaps, worry that governments and big business sometimes unfairly exploit the free movement of labour to keep wage costs low?
If you do you will find many who would share those sentiments.
One of them would be Neil Anderson. A former teacher, business owner and military man who has been Migration Watch’s executive director for a year.
Mr Anderson is clear how essential staff from overseas are to the NHS at present.
“If we decided tomorrow to get rid of our entire migrant labour workforce the NHS would very quickly collapse”. But, he adds, “the fact is we shouldn’t have reached this situation in the first place.”
Keeping costs down
He continues: “It’s perfectly feasible to source a great deal more medical professionals from the UK population. Our reliance upon foreign doctors is far, far higher than most. In the Netherlands, which is rated in the top five best healthcare systems in the world, they have 2.7 per cent of their doctors from overseas. In UK it’s near 30 per cent.”
[Editor’s note: the UK number apppears to be higher]
Why does he think this “situation” has emerged?
Mr Anderson’s thesis is that the UK’s migration policy is driven by a desire of government and big business to keep costs down by suppressing wages and reducing the need to train the number of clinicians the country needs.
When we can access essentially an infinite supply of labour [from the EU] there’s a sense of complacency. While that source of labour is there, it reduces the need to invest in and train our own medical professionals”
Mr Anderson also suggests politicians of all parties have got their priorities wrong. He fears a “global welfare perspective” holds higher credence with “our political class” than the “interests of the British population. The NHS doesn’t exist to provide jobs for migrant labour. The NHS exists to provide healthcare to the UK resident population”, he declares.
Expanding on the issue of growing our own clinical workforce, Mr Anderson says: “When we can access essentially an infinite supply of labour [from the EU] there’s a sense of complacency. While that source of labour is there, it reduces the need to invest in and train our own medical professionals.”
Mr Anderson warms to his theme. “The government’s migration advisory committee has basically described the government’s attitude to immigration with regards to the health service as its ‘get out of jail free card’. Their failure to train more UK clinicians is inexcusable.”
“We are degrading the opportunities for [British] people who wish to study medicine [or] become nurses.
“The government needs to be providing education to a quality that allows us to produce an appropriate number of candidates to realistically apply to enter medicine. We’ve seen a situation in recent years where you’ve had somewhere around 70 to 85,000 applicants on an annual basis applying [for places in medical school] and only about 7,000 people getting in.
“Obviously not all of them will meet [required] standards, but if it turns out that a large number are not getting places simply because numbers are being restricted because we can source doctors from India for example, then that seems very, very unfair.”
“Historically near 100 per cent of our doctors would have been British nationals or UK residents”
The Migration Watch director also rails against “the huge number of doctors going overseas” after being trained at the expense of the British taxpayer.
Does he think, therefore, that UK trained doctors should be required to work in the NHS longer?
“As an organisation we have never advocated that”, he says, “however, it’s certainly something that should be reviewed”.
“Historically near 100 per cent of our doctors would have been British nationals or UK residents”, he concludes, “the fact that it has changed doesn’t mean it can’t change back.”
Mr Anderson sounds almost like a Corbynista (he isn’t) when he complains “we’re regressing to Victorian times, [when] people [had to fight] for a fair day’s pay for a fair day’s work because of the influx of low paid staff from the EU”.
Litmus test
He declares: “There are four million people in the UK who are either unemployed or underemployed. Now obviously there’s an issue of geography. If they’re in the North West and jobs are available in the South East, then [that’s an] issue. But people would move for work if there were better wages and better conditions.”
He is in no doubt that if the option of cheaper overseas labour was removed the government would be forced to significantly improve the terms and conditions of health and social care staff as stewardship of the NHS is a “litmus test” of any administration.
But where would the – very significant funds – to raise wages (and train more doctors and nurses) come from?
Mr Anderson says that is a question for the Treasury, but states “I’m sure there are huge numbers of areas that we could find reductions in spending in order to fund [these costs].”
We turn from the question of supply to the one of demand.
Mr Anderson is unwavering that the “completely unparalleled” scale of migration in the last two decades has placed a considerable burden on UK public services.
While acknowledging that EU immigrants (particularly those from the Western states) appear to be net contributors to the economy, he claims that this financial lens does not consider the full impact of migrants on British society which “people in their everyday lives see and feel.”
After giving some non-health examples – such as the need to upgrade infrastructure to cope with a growing population or increased pressure on the police – he turns to the NHS.
“In the period 2008 to 2017 there were around six and a half million new migrant GP registrations. Many of those people have subsequently left the UK and [there may be some] double counting. But nonetheless, we are talking about a significant number of people regardless.”
Mr Anderson hails from London’s east end and claims: “If you go to a GP surgery in parts of East London today, it’s much more problematic getting an appointment.”
He is more direct on the need for the NHS to raise its game in recovering costs from those overseas residents not eligible for free healthcare
One way to manage demand on the NHS would be to widen the screening of immigrants for health conditions that would be costly to treat – including, of course, pregnancy.
Again, Mr Anderson is cautious but not afraid to raise the possibility of such a move.
“We have not, at least at this point in time, made any such proposal. That doesn’t mean that we don’t think these are very serious and viable questions to ask, and [that it] is really the responsibility of the government to consider this.”
He is more direct on the need for the NHS to raise its game in recovering costs from those overseas residents not eligible for free healthcare.
Noting that the annual cost of health tourism has been “estimated at between “£200m and £2bn”, he wonders why four in five hospitals have no expectation of recovering the costs and that many have few, if any, managers dedicated to the task.
Lack of will
“The UK is one of the least efficient countries in Europe at recovering healthcare costs. If other countries can do it [better], it begs the basic question, ‘why can’t we?’
Answering his own question, he suggests it is simply a lack of “political will” that the system to recover costs is not “implemented as extensively or as effective as it should be.”
He claims an efficient system would “almost certainly pay for itself” and that if the costs were towards the higher end of estimates, it could make a significant contribution to improving NHS staff and wages.
[Editor’s note: This BBC ‘reality check’ is useful to read in conjunction with Mr Anderson’s comments]
On illegal immigration, the Migration Watch director feels the decision to stop the Home Office getting access to migrants’ healthcare data was “irresponsible”.
According to Mr Anderson, the organisation he represents understands that migration is “part of the natural order of things”. He says Migration Watch’s work is a straight-forward response to the desire of two thirds of the population for immigration to be both more tightly controlled and, as a result “significantly reduced”.
But, HSJ wonders, do he and his colleagues feel their campaigning contributes to the concerns expressed by many migrants – especially since the vote to leave the EU.
“No one who is in this country legally should be made to feel unwelcome or feel unwelcome”, he states, but then adds “I don’t entirely know on what basis people are claiming a sense of feeling unwelcome. I haven’t seen any data to suggest that this is the case. We do know that there were more EU citizens [working in the NHS] than there were two years ago. [Brexit] hasn’t pushed people away. The claim that people are feeling pushed away and [are being] driven out doesn’t really hold with the facts.”
What about the reported increase in racially motivated attacks post the referendum?
Mr Anderson responds that only a “very selective” interpretation of the data would allow anyone to reach that conclusion.
[Editor’s note: This is a useful piece of analysis on this issue]
Next week: Paul Johnson, director of the Institute of Fiscal Studies
Coming up: Medicinal cannabis campaigner and CCG sceptic Sir Mike Penning MP
If there is any political figure you would like me to interview, please email alastair.mclellan@wilmingtonhealthcare.com or if you are reading this on the website leave them in the comments box.
Past bedpans
Brexit expert Professor Anand Menon
Jeremy Heywood - an appreciation
Resolution Foundation director Torsten Bell
Sarah Wollaston: part two - the role of the Commons’ health committee
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