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Last Updated: Wednesday, 8 September, 2004, 11:48 GMT 12:48 UK
Foreign doctors

The National Health Service, once boasted of as the envy of the world, increasingly only functions because so much of the rest of the world keeps it afloat.

Around a third of junior doctors working in our hospitals are believed to have come from overseas. The word is out that British government Ministers believe that, in the short term, NHS shortages can only be met by importing expertise.

Yet, remarkably, many of the foreign doctors who think they're answering the call end up unemployed and living in slums here. Jackie Long reported.

Thousands of miles from home and a world away from their dreams.

I've not been able to get one single job. You feel so low about yourself. You feel what on earth am I good for.

The young Indian doctors come in their thousands every year.


Problem is getting out of hand. We have opened the flood gate.

Now many are finding themselves out of work and living in slums.

Lots of rats, lots of cockroaches, lots of filth. It was quite shocking.

Filling time, unemployed orthopaedic doctor, Satish Bhat spends most of his days filling in forms. 250 job applications in the past six months. He's left his wife and child in Kerala south India, in search of jobs and training with the NHS.

The perception in India is that there is a dire shortage of doctors in the UK. I was expecting to get a job at least a few months so far, there's no sign. I keep meeting so many people day in and day out who are in the same boat as I am. They are also here for months on end without any jobs. Without any hopes of a job. Moving from place to place, and totally devastated, totally disillusioned.

The NHS couldn't survive without overseas doctors. A third of all hospital doctors are from abroad. For the past three years, the NHS has been actively recruiting from countries like India. The doctors come by the thousands, yet shortages in the NHS are getting worse. What's gone wrong? We began our journey where the doctors begin theirs. This is East Ham, if you're an overseas doctor who wants to work for the world famous NHS, then this unlikely spot is where it all begins. Thousands of doctors, mainly from India, come here every year. It's home to a thriving cottage industry of crammer centres for doctors desperate to pass the exam which qualifies them to work for the NHS. Finding a job in the NHS is a different matter. It may not look like the cutting edge of medical training but this course is packed, seven days a week, every day of the year. This year alone 3,000 overseas doctors will take this course. And rival courses, are springing up all over East Ham. For around 300 for ten days, these doctors will be taught how to take the PLAB exam - the Professional Linguistic Assessment Board. The exam run by the General Medical Council tests whether overseas doctors can transfer their skills to the UK.

Brilliant, lovely, marvellous. You need to remove around, relax, settle a little, then I'll come and watch you make mistakes.

Dr Mahadeo Bhide started running this course in 1986. Now he is a doctor in the PLAB course in East Ham. Everybody seems to know Dr Bhide. The numbers doing PLAB have exploded. Part one of the exam is taken in the home country. In 1999 over 3,500 doctors took it. Last year, that figure rose to over 12,500. Part two has to be sat here in the UK. In 1999, just over 1,000 took it. By last year, more than 6,500 overseas doctors took PLAB 2. Amit Singh took and passed the PLAB test last year but he's also still looking for work. No-one knows exactly how many unemployed international doctors there are. Estimates vary between 3,000 and 8,000. But what is becoming clear is that the more doctors take the PLAB exam, the more doctors are out of work.

Moving to any country, moving to a new place is always traumatic. It's never easy. So I was prepared for a bit of hardship. But, everything's fine if there is light at the end of the tunnel. One has to see that light. I have been here for a year. I don't see that light.

Like many others, Amit said he was drawn to England by the reports of the doctor shortage. After four new PLAB exam centres were set up in India he was convinced the NHS wanted and needed people like him. If they didn't why allow them to take an exam so inextricably linked to working in the UK?

How can the country absorb this many doctors? Is it possible? I do feel confused. How could I have been so wrong? I spent over two, or three years planning for this, planning to come to the UK. I have been so wrong. So if I have been so wrong, after so much preparation, then there's something wrong with me perhaps!

Earlier that day, Amit was told the latest of the 450 job applications he's made were unsuccessful. Paediatricians Amish and Poorva Deshpande are just getting used to the world of work in the UK. A young, married couple they're lucky to have got jobs together. They have been out of work for six months.

There were a lot of reports in the newspapers, they were not advertising as such, just reports, saying that the NHS needs doctors.

At the same time we took a number of exams, PLAB exams by the GMC. We were given the dates and centres, they were also giving us a hint that they wanted us to come here.

The plight of overseas doctors is now being looked at by the GMC. It said the system is broadly successful. Most doctors do get work within a year. However it acknowledges that the true picture is far from clear. There are questions about what sort of work they get and for how long. The GMC admits the anecdotal evidence is growing. Amish and Poorva have seen it for themselves.

The most horrible thing in this town was the number of doctors. You have to employ, in every corridor, everywhere you have people doing the PLAB exam.

Alongside the PLAB courses, there is a grimmer side to the whole East Ham experience. While the doctors study, they have to live somewhere. A burgeoning market has grown up, the stories are depressingly familiar.

I was waiting in East Ham, when they were all eaten by bugs, bedbugs. It was teeming with bugs.

The house was infested with cockroaches.

At one point there were 22 people in the house.

We want to look at doctors' quarters, East Ham style. The council is investigating over 50 properties being rented out solely to PLAB doctors. These houses were all part of a successful council prosecution. The landlords warn they could face jail if they're not improved. Inspectors found the cockroach infested houses crammed with doctors. The kitchen and toilet facilities were inadequate with dangerously few fire escapes. The next house we visited had doctors living in it. They were too nervous to go on film. They said although there were four of them there at the minute, more were expected to arrive. There were beds for at least ten.


It's unfit for human habitation. And unfit for the number of people occupying it. So the council have severe concerns. We need to address those issues, with, if necessary, formal action.

The property's one of several being investigated by the council. All owned we discovered by a man well-known to the doctors of East Ham, the founder of PLAB master, Dr Mahadeo Bhide. Do you feel cramming these people into these houses, at 40 a week, do you feel you've exploited these people?

It's not a question of 40 a week and eight people in the centre. We can't see that without the context of the other inclusions which say you don't pass you don't pay.

It doesn't matter when they pay. It matters what they're paying for. "Payable when able" - your catch phrase, that's irrelevant. They will pay at some stage most of them. What they're paying for is what you're providing for them?

It's always desirable and it's not just in the interest of my business, but the whole sector that things get better.

Do you feel good about what you're doing on the accommodation front?

No, I don't feel good about anything but that is my nature. I haven't felt good about myself. I felt good about the service I've done. I've felt good about the training I've done. I've felt good about the support that we've given. And I feel good that we're learning lessons and putting things right in terms of the accommodation. But, the satisfaction, that's... That's something that I hope will make me a better person.

And ashamed?

Ashamed of the accommodation - yes, sometimes yes.

Umesh Prabhu came to work from India in a much-less troubled era. He said with many overseas doctors struggling to find unpaid clinical attachments, let alone full-time work it's time for action.

If the plan continues I think within the next five years there will be thousands of unemployed doctors in this country. The GMC should restrict the numbers of doctors being allowed to take the PLAB exam. That should go on the need of the number of doctors that this country needs.

But the GMC said it's only responding to the demand for PLAB exams from the overseas doctors. That demand's rising all the time. The Council runs PLAB exams three times a day, four days a week. From October, it'll hold exams every weekday. The GMC insists passing the PLAB has never been a guarantee of a job. And restricting it is NOT the answer.


I think that it's incumbent upon us to ensure that the doctors understand the nature of the commitment. But it is not our role, Parliament has not given us the role, I believe it would be illegal if we attempted it. It's not our role to ration access to the PLAB test in order to deal with an imbalance in the employment market. The proper response to that is through better information.

For the doctors stuck out of work and in a foreign country there's real bitterness. The GMC said it's only responsible for administering the exam. The Government said it always made clear the type of doctors it wanted to recruit, consultants and specialists, not the thousands of juniors looking for training posts. Doctors who thought they were being invited to work in Britain have found themselves not welcome.

It has been an ordeal here. I'm sure there are several doctors out there who are going through the same nightmare. Who came here with high hopes, and who have ended up being emotional wrecks, who've become so frustrated and disillusioned with the system. I'm sure there are so many of them there.

For many doctors, going back home is not an option. They've invested all they had to come here. So they stay, and hope. And those who do return home, know there are more waiting to take place, still taken in by the dream of a job in the NHS.

This transcript was produced from the teletext subtitles that are generated live for Newsnight. It has been checked against the programme as broadcast, however Newsnight can accept no responsibility for any factual inaccuracies. We will be happy to correct serious errors.

Newsnight's Jackie Long
investigated the situation of highly qualified doctors who come looking for work in the NHS and end up unemployed.


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