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Immigration: Statement of Changes in Rules

My Lords, it is an administrative review carried out by officers who consider the cases. It is not a judicial process, though, as I have made clear to the noble Lord, if there is a disagreement over the effect of the review, there is a possibility of a judicial review. Perhaps that helps the noble Lord. I was asked whether sufficient checks will be in place to ensure that we are making the right decision. The clearer and more specific the requirements, the easier it will be for entry clearance officers and caseworkers to make correct decisions that are unambiguously in accordance with the rules. Overseas, there will be 100 per cent internal review of all refusals prior to their being issued to applicants, and the role of the independent monitor for entry clearance refusals without a right of appeal has been extended to cover all points-based system applications. Our training covers the entire overseas network, which will help to ensure that entry clearance staff understand clearly the changes, how to implement them and manage the quality decisions locally. The noble Baroness, Lady Hanham, made some points about the health service, doctors and the impact of this measure on those wishing to come to work and train in the United Kingdom. In essence, she was asking why we are doing it. It costs roughly £250,000 to train a doctor up to the point at which they reach specialty training. Because they are competing with international medical graduates from outside Europe, many of our UK-trained medical graduates lose out. The taxpayers’ investment in their training can be wasted as a result. The noble Baroness said that we deliberately recruited from abroad in the past, and we could ask how we got to this position. For most of its history the NHS has relied on the contribution of doctors who trained outside Europe. International medical graduates have played a valuable role in providing services across the UK, and we appreciate the important contribution that they have made to our health service. The aim has been for the National Health Service to become much more self-sufficient and less dependent on the migration of health care professionals from outside the EEA. The aim is to have NHS services delivered by trained doctors rather than doctors in training. As I am sure the noble Baroness will recall, back in 1997 when we came into office, we decided to increase substantially UK medical school places, and as a consequence four new medical training schools were established. Medical school places in England increased from just under 3,800 in that year to nearly 6,500 in 2007 to achieve that greater level of self-sufficiency. More UK graduates, coupled with the high number of international medical graduates means that there has been a large number of applicants for speciality training places. We are grateful for the crucial role played by international doctors in the health service for all of its 60-year history, but nothing we are doing prevents them from working as NHS doctors. We are seeking to control access to post-graduate and speciality training posts only. That does not prevent international medical graduates from working as doctors in any other NHS post. The noble Baroness asked whether the provisions preventing work as a doctor in training will be temporary. That is our intention while we seek to create a more permanent solution to the work-flow problems that led us to impose these conditions. I think that I have answered most of the questions, except for the reference sought by the noble Lord, Lord Avebury. I am grateful to noble Lords for their interest and concern on this issue. As I said at the outset, I realise that it has raised concerns. The amendments to the rules that we have laid before the House represent the latest step in the Government’s overhaul of the immigration system—perhaps the most radical overhaul for several decades. The points-based system will enable us to select the migrants that our economy needs, to keep out those whom we do not require and to make more, improved and transparent decisions. While I hear the criticisms of noble Lords, they should appreciate that over time, the points-based system will ensure that there is greater public confidence in how migration is managed. I am sure that it will be widely understood as it is clearly a much more transparent process. Over time, despite some of the difficult adjustments involved, noble Lords will see benefits of these changes in the much greater confidence than there has been in the past in the migration flows into the United Kingdom. We value greatly the work that migrants do in the UK. We know that they make a tremendous contribution to the quality and colour of our life. I hope that the noble Lord will feel able to withdraw his Motion, having heard my explanation and the responses that I have detailed to the House this evening.