How retraining refugees could help tackle NHS staffing crisis

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By Jon Bloomfield

Work placements aim to give medically qualified migrants access to UK jobs alongside English classes

When Horani Othman fled Syria with his Kurdish family in 2012, he arrived in the UK not knowing how he would make ends meet. Sent to live in Birmingham by the Home Office immigration authorities, he and his family were granted indefinite leave to remain last year. Now Othman, 54, is keen to get his career back on track. A pilot project in the Black Country is not only giving him valuable work experience in the UK, it could offer a solution to the growing crisis in NHS staffing levels.

Latest figures show that there are more than 100,000 vacancies for doctors and nurses. Brexit threatens to exacerbate the shortages: 9% of licensed doctors in the UK come from the European Economic Area, while in the West Midlands alone, EU nationals account for 10% of all nursing staff.

In 2017, Lawrence Kelly, widening participation project manager, at Sandwell and West Birmingham Hospitals NHS Trust set up the Use-It programme to help unemployed, medically qualified refugees and migrants in Sandwell and west Birmingham find work in the NHS. The project offers participants free English language classes and work experience in a clinical environment. In little over a year, Lawrence and his team have recruited almost 200 people to the programme. Many of them have been referred by the nearby Brushstrokes community project.

“This far exceeds our initial target of 60 when we set up the programme,” says Kelly. “The feedback from those we are helping has been amazing. People who chose medicine as a career did so because they want to help people. It is frustrating not to be able to practise, due to being displaced from your home country. As they rebuild their lives here, it is good to be able to offer them the tools to improve their English and get back to work.”

Othman, a trained pharmacist, is working at the pharmacy in Sandwell hospital as an assistant for 12 weeks. He works there as an assistant under supervision two days a week and is being shown how the systems work and the hospital’s prescription processes. “I work in the store, assisting with the booking, ordering and checking supplies,” he says. “And on the wards, observing the clinical pharmacist at work reviewing patients’ medication. The practice is different from Syria and I learn more about the patients here.”

The aim of the work placements is to support participants’ registration with their relevant professional medical body. They earn no money during these attachments, but Othman says it’s still worth it. “It’s unpaid but it’s really good as I feel I am back in my field.”

But before Othman can apply to join the General Pharmaceutical Council, he needs to pass the international English language testing system with very high marks. The IELT is a standardised test of English language proficiency for non-native English speakers, covering speaking, reading, writing and listening skills. Othman needs to get high marks in each element to apply to register with the GPC and look for a permanent job. Like many of those on the Use-It programme, he struggles with the written and reading elements of the language course and feels the subject matter isn’t always relevant to his professional needs.

“I understand when the texts are on science and medicine but struggle when it is on subjects like insects, animals and dinosaurs,” he says. When I tried the test later, I struggled with it too. So for now, Horani plans to look for assistant work in a pharmacy or dispensary until he’s ready to sit the IELT.

Even when the participants pass the language test, there are still numerous hurdles to getting a permanent job. Everyone on the programme has their professional qualifications vetted by the National Recognition Improvement Centre. They then often have to complete a practical test for the relevant professional body.

Nikhat Iftikhar, 46, a genito-urinary physcian, specialising in sexual health and HIV, fled Karachi, Pakistan, in 2013, following attacks by Sunni fundamentalists. She has passed the IELT. To meet the requirements of the practical elements of the Professional and Linguistic Assessments Board test set by the General Medical Council, she needs to brush up her medical skills. So as part of the Use-It programme, she has been shadowing sexual health doctors for the past three months. “After five years I’m a little bit rusty,” she says. “I need to be in the work environment again. The placement helps to familiarise me with the system here. And I’ll see the protocols of consulting with patients.” As the next step on her return to work, Use-It is arranging for her to return to GP practice on a two-year foundation training contract with all her further professional studies and registration fees paid. Similar arrangements are in hand for a further two doctors.

Now, senior managers plan to roll out the Use-It scheme beyond Sandwell and West Birmingham to the rest of the Black Country. The Black Country Transformation Partnership’s new £300,000 “health overseas professionals” programme is being introduced this year in Dudley, Wolverhampton and west Birmingham, as well as Sandwell, with the aim of recruiting scores of unemployed medically qualified migrants to the scheme and then into permanent NHS jobs. “Finding skilled clinicians in our communities from around the world and helping them to polish and share their expertise is a programme we are committed to for the long term,” says Toby Lewis, chief executive of Sandwell. “The investment is dwarfed by the return, with talented people joining GP, mental health and hospital services locally.”

For Mariam Darman, a senior obstetrician and gynaecologist from Kabul, getting back to her job is vital to her self-worth. “I saved people’s lives before. I’d like to do it again. I lose my identity without work.”

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