A patients’ guide to Modernising Medical Careers and MTAS – Part 4

The Wall - from the Pink Floyd stage show (You can find my most recent commentaries on the Junior Doctors’ crisis as it unfolds in 2008 by following this link).

The situation of doctors who trained overseas but who are practising here is even grimmer than the situation facing the home-grown variety. If you are new to this debate, you should know that the British Government has decided that we now have more specialist trainees with ambitions to become consultants than there will be consultancy posts in a decade or so’s time, and that the way to tackle this is to cut the number of specialist doctors right now.

We arrived in this position because the European Working Time Directive outlawed the 100+ hour weeks that junior doctors worked at the time. Suddenly there weren’t enough junior doctors, so med-school numbers were ramped up, and the government invited doctors in from overseas on a Highly Skilled Migrants Programme. Now that we have “too many” doctors the government has just pulled the work-permit rug out from underneath their feet. Now, if the government had been honest and said that this position could be changed without consultation and with virtually no notice, then it wouldn’t be so bad. But they weren’t honest about it, as shown by the recent successful Judicial Review and Injunction achieved by the British Association of Physicians of Indian Origin. It seems that they still are not honest: they are still advertising for overseas doctors, and still offering language tests even though they know that they will not be offering visas.

Apart from the legal dubiousness and the total lack of natural justice in this situation, sending our over-seas trained doctors packing is bad for the NHS.

You see, we don’t just need overseas doctors to make up the numbers, we actually need them to improve and strengthen the quality of care provided by the NHS.

In our larger cities, with substantial immigrant populations, there are medical and ethical problems around interpretation. Now overseas doctors are not the answer to this problem, but they do help ameliorate it. The NHS relies on the following kinds of interpretation:

  • Official Interpreters – these are invaluable, over-worked and frequently unavailable
  • Family members – this is fraught with difficulty, sometimes their grasp of English is poor, sometimes they have their own agenda and don’t translate honestly, sometimes patient confidentiality gets blown out of the water
  • Multi-lingual NHS staff – in an area where there is a community from a particular ethnic or linguistic group, it is quite likely that there will be nursing, secretarial, admin or medical staff from the same group

As I said, overseas trained doctors are not the answer to this problem, and it is racist and foolish to assume that a Tamil speaker can help with a Punjabi patient, but a multi-ethnic medical profession is the only appropriate way to provide a care a multi-ethnic patient community.

Developing-world trained doctors reinforce medical techniques and provide reality checks. The more diagnostic technology you have been trained with, the blunter your diagnostic skills become. I heard a tale from the ward-round of a US-trained physician who wanted to order a CT scan of a rather portly gentleman who had been stabbed with a rather short knife. Simply common-sense and basic anatomy told his UK-trained colleagues that, no, there was no chance a vital organ had been nicked. Ha ha. Cute anti-American story there. But a similar under-development of diagnostic skills has happened in the UK.

We sure as hell need the technology, but doctors who trained in harsher economies, who can use the technology but don’t always need it to do their thinking for them, provide our home-grown techno-medics with good solid reality checks. The people who have the greatest skills with – for example – forceps deliveries are doctors who have worked in developing countries.

As a rule of thumb the skills you need in the UK are the skills that UK-trained doctors are given. However, if I was part way through a dangerous labour I would rather have an obstetrician who could choose sensibly between a foreceps delivery and a ceasar and who could identify foetal distress if I’d removed the electronic equipment in a fit of hormonal and pain-racked stroppiness, in preference to one who couldn’t work out what was happening and who would be unsafe with forceps. (Yes, I’d prefer scented candles and a midwife, but sometimes one doesn’t have that option).

If you come to a country knowing that you will have to leave it in three or five or eight years’ time, you will make different life-decisions than if you come to that country believing you can make your life there.

Recently I met a young Indian couple. She was pregnant and, because of the timing of her baby, she cannot apply for the first year of the training posts. She plans to have her baby, locum for a bit, and if her husband gets a job this time around she will step back into the maelstrom this time next year. She wants to be a GP and if she is given the chance she would be the perfect example of how we can provide good medical care in areas with ethnic-minority communities. Her husband wants to stay in hospital medicine. It’s clear that if he does not get a job offer within the next few weeks that he and his wife will have to up-sticks in the summer with a baby just a few weeks old and go on to Australia or back to India.

Now, if they had been warned that they might face this situation do you honestly think they’d have had a baby? They are doctors. They know how contraception works. They had understandably assumed that their skills – needed in July – would still be needed in August.

There was of course the question of whether it was acceptable to siphon doctors out of the developing world. This is yet another place where the dishonest short-termism of the government bites. If the deal was, “come here as ward-fodder for five or so years – you and your family won’t be able to stay, but you will be able to move on or go home with a first-world training in your speciality and five years’ of first-world savings” then fair enough. Everyone knows where they stand, and it is a Win-Win situation or – if you are feeling cynical – at least everyone understands how they are being exploited and by whom. In fact, that is very nearly an ethically responsible way for the government to behave. No surprise that they haven’t done this then.

Instead, from having a reasonably secure future within the NHS, the overseas doctors have gone more or less overnight to being lined up on the metaphorical dockside waiting for the boat home. The government has taken every chance it could to exclude oversees trained doctors from MMC and the MTAS recruitment rounds. According to the various judicial reviews and injections, it has been failing to follow its own procedures by excluding people with inadequate warning. The legal fight put up by the British Association of Physicians of Indian Origin has managed one step forward followed by half a step back every time. As it stands at the moment, those with visas valid until the 1st of August are being included in the MTAS selection process, which must be a bitter comfort given how flawed that process actually is.

What sticks in my throat, as an outsider to the whole debacle, is that the government is getting away with a divide and conquer approach. Young British medics are understandably fearful for their own jobs, and they are torn between personal anguish as their friends colleagues are stitched up beside them and a more personal and increasingly immediate fear for their own future. Pastor Neimueller, anyone? “They came for the overseas trained doctors, and I did not protest because I did not train overseas…” etc.

Not only is the government treating overseas doctors like inconvenient items past their sell-by date, they are destroying the quantity of medical care available to all of us in this country by vastly reducing its quality, in part by reducing the ethnic and national mix of those providing it.

Update: Dr Crippen has blogged twice on the subject: Looking after Johnny Foreigner and The Royal College of Obstetricians and Gynecologists welcomes Johnny Foreigner. I’ve added emphasis to the email Dr Crippen quotes from the President of the Royal College of Obstetricians and Gynecologists which says: “The completed forms have been particularly difficult to assess and score and seem incapable of allowing the identification of the more able doctors. Also they fail to identify UK graduates, which we all thought was the major purpose of MMC.” Quite.

While I am adding links to this post, read some of the responses to article in BMJ Careers about International Medical Graduates career prospects in the UK. And here is a commentary from the excellent Frontpoint Systems on the subject of institionalised prejudice (homophobia as well as sexism and racism) within the NHS. And another comment from Dr Crippen on how overseas trained doctors do the work of consultants but are sidelined into staff grade posts.


Please – I am very aware that my understanding of the plight of overseas-trained doctors here is lacking and that this has more opinion and less fact than my previous commentaries. If you have anecdotes, comments or stories which you wish to add to this debate, do feel free to use the comments thread here.

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28 responses to “A patients’ guide to Modernising Medical Careers and MTAS – Part 4

  1. Your point that the EWTD (btw, you missed out “Time” in the name above) is the direct cause of the current ‘surplus” of doctors is a VERY important one that I haven’t seen made elsewhere. Because it means that the problem is now a systemic one, not just a one-year-only crisis. The need for doctors has become more pyramid-shaped.

    Other professions (eg accountants) deal with this by exporting qualified juniors into industry before they get to partner-level, which is fine because industry wants them and many of the best would rather be in industry than practice.

    But there isn’t a similar safety-valve for doctors (unless we have a regular pattern of importing overseas juniors for a few years and then re-exporting them plus some UK-trained ones at somewhere rounf registrar level, consistently). The only other solution is to stop “staff-grade” – ie neither a consultant nor still in training – from being a non-status – adopt the teacher model for doctors.

  2. Correction made. Thanks Potentilla.

    The pyramid model is the problem. I’ve already discussed teachers elsewhere. The model with solicitors is a hybrid between the teaching one and the accountancy one in that there is no shame in not progressing, and there are jobs in industry anyway.

    The armed forces handle their pyramid by:

    (a) fully funding training
    (b) issuing short service commissions
    (c) setting the expectations that it is a short-term career
    (d) providing an (admittedly minimal) exit pension

    I also think that there isn’t an agreement on what makes a good doctor. A lot of the MTAS-debate has centred on the fact that research and other qualifications were not taken account of by the application form, but on the other hand there is a separate debate in other parts of the profession about whether a PhD makes you good at cutting and stitching, (for example). Supplementary degrees and research are being used to distinguish between one excellent doctor and another, at Registrar and Consultant level,, without actually contributing to their excellence as doctors.

    Thanks for your comment Potentilla. When it isn’t an emotional subject, it is still an interesting one.

    Aphra.

  3. Just a quick point on research. Many junior dcotors were forced into research as they were told by the colleges and their seniors that they would need to have evidence of research for the old National Training Number recruitment to registrar level.

    The spin off of this was clinically directed research into areas such stem cells, transplantation, cardiology, psychology etc. This has been invaluable in advancing research and directing it towards patient care and medical applications.

    MMC/MTAS now strips doctors of the ability to continue this trend. We will lose not only years of clinical experience but also valuable insight into research and development.

    John Rollo

  4. You are forgetting that there are large number now of British doctors from ethnic minority backgrounds who are bilingual/trilingual and do understand and can cope with the cultural/ethnic/religious differences. Because they were born in Britain, they know better how to communicate between the indiginous and the ethnic populations as they were exposed to both cultures since birth unlike those who come from abroad and need time to adapt and sometimes are not able to do so all because they find the differences too overwheling or does not correspond with their cultural/religious ways.

    Of course overseas doctors should have been told they were coming to Britain on temporary basis from the begining but this situation we are in now was not envisaged until around three years ago. Proof of that are the new medical schools which were opened recentl; Brighton for example, was opened only 3.5 years ago. Now, what do you want to do with all those graduates who are now surplus to requirements?

    As would any politician in the world would do, is say, well, I have to cater for my own first, indeed India would do that too if a choice has to be made and IMO, if that happens it will be for the best or can you imagine the public reaction to seeing overseas doctors in employment while the Brits are on the dole after leaving a creer they worked very hard for? Like overseas doctors, nobody prepared the British medics for the catastrophe that was looming either, no government warning, no indications, no clues, nothing! Hence, those who went to medical school, say, 10/9/8/7 years ago thought they had guaranteed jobs and brilliant stable future in medicine but are now finishing their foundation programme, STs and have not been shortlisted at all. The situation is to say the least, freightening for those doctors and their families. Sad!

    Therefore, the example you gave about the Indian couple with a baby who may need to immigrate to Australia also applies to British doctors because even if all current training posts were offered to British nationals only, there will still be a surplus who will put British doctors in the same boat as their Indian friends. The problem is, will Australia/New Zealand ..etc be able to cope with 8000 British doctors on it’s land this year then a continous stream for the forseeable future? I don’t think so, so, there will be thousands of British doctors who will be forced out of medicine completely not only this year but for at least 5/6 years to come until intake into British medical schools is regualated to suit the need! That will probably mean the closure of brand new and established schools to a huge cost to the British taxpayer! A total waste of resourses, human and otherwise! Those not needed British doctors in the system now and graduating in the next 6 years do not have a back to lean on like their Indian counterparts who can always return to follow their career back home with ease. Of course in this case the politicians would say that Britain will also not be accused of stealing doctors from developing countries.

    This mess is unprecedented and very, very cruel! :- (

  5. John, I hadn’t thought through the implications on research. It really is a short-term, opportunist, bolloxy mess, isn’t it?

    Yaya, thank you for commenting at such length, and you are right I hadn’t taken into account our home-grown doctors from ethnic minorities. Thanks for supplementing this entry in such detail.

    The fundamental problem is, as Potentilla describes it, that the medical professon is now pyramid shaped, and will inevitably involve an annual cull unless MMC can be modified – and modified quickly – to boost the position and numbers of staff-grade doctors and make the giddy heights of consultancy less desirable, even if they are less achievable.

    It is, as you say, unprecedented and very, very cruel.

    Thank you both for commenting. I was nervous about this entry, because I know less about this than other aspects of MMC and MTAS.

    Aphra.

  6. As you know, staff grade is a stagnent position, no qualified training or any aspirations. I doubt there will be a rush for the positions. Those who will accept them will do so because of financial commitments and nothing else. This will result in a very uneasy and demoralising atmosphere in British hospitals as one doctor is put against another, envious of colleagues with the positions they anticipated for themselves, lots of ill feelings are looming! Bad for patients and for doctors. As for the Pyramid shape, the profession is already pyramid shaped and doing very well, however, what the government wasnts is a patient-doctor production-line relastionship putting all control in the hands of the managers and policy makers. That is why qualifications counted for very little in the MTAS form. They want a trainable, controlable majority and they will teach you what they want you to know, forget about your compassion, ethics and the like, no room for those if you are a robot! You will be efficient doing everyday repetitive tasks, efficient only in those tasks they assign to you and nothing else thus Effeciency only is to prevent mistakes (Practice makes perfect) not ability, intellect, compassion and ethics or the honour of the profession. Future “Specialits” will be nothing more than a staff grade but with a fancy name. That is when the later become more attractive and on the same level. Everybody will be the same so forget about aspirations, innovation and the like and join the factory.

    They want to dismantle a world renowned profession and that is what you doctors must prevent at all cost.

  7. Welcome back Yaya.

    I think the shift is from a triangular shaped profession some 5 or 10 years ago to a pyramid shaped one now. The crisis has been created by increase in the number of doctors in response to the European Working Time Directive.

    Dr Crippen argues it pretty well, I think: http://nhsblogdoc.blogspot.com/2007/03/you-get-what-you-pay-for.html tho’ he focusses on the situation with Consutants and GPs.

    “a disproportionate amount of taxpayers’ money is now having to be spent to provide the replacement service.”
    In other words, the government was getting a first-rate out of hours service on the cheap, and is now having to pay the market rate for it. Just as it burnt its financial fingers when it found out the real cost of hospital consultants, so it has burnt its financial fingers when it found out the real cost of an out of hours service in the community.

    I totally agree that the government is – in effect – dismantling the profession. It’s taken them a decade to agree on what to do with the House of Lords. My worry is that it’ll take them a decade to work out what to do about doctors.

    How do other countries manage the Pyriamid? Australia and New Zealand appear to manage it with a shortage of Juniors. But what happens in Europe?

    Aphra.

  8. Well I know that France apparently totally ignores the EWTD, which is ironic.

    But other countries you can set up on your own as a specialist once you have the required number of exams, here you can’t. In other countries if you have underworked specialists the work gets shared around a bit.

  9. I have no idea about Europe Ephra. In a decade, the results of Messing Medical Careers will be for all to see as the new system’s “Specialists” gain their certificates of comptance. That will happen in 5 years time at the most when the first patch imerge and imerge they will as I do not think for a moment that a change of government or party will change the situation. Shame but there will be no U turn on this IMO, the NHS as we knew it is too far gone; messed up big time!

  10. I don’t know if you’ve seen Dr Crippen this morning, but he has a post saying that the part of the point of MMC was to select out the overseas-trained doctors, and that the Royal Colleges were complicit.

  11. Well, the French seem to shrug off most of the EU legislation, Z. So that’s hardly a surprise.

    Yaya, I agree with you, it will in all probability make bugger-all difference. But I remind myself that it was worth marching against the war in Iraq because Tony Blair cannot possibly say “I never knew you felt that strongly” to the million who were there. Likewise, Blair and Hubris and Cameron will not be able to whine “but if only you’d sa-ai-ai-ai-aid” in five or ten years time. I’ll protest, even if it is only to shut off their political escape route half a decade from now.

    Thanks for the tip, Potentilla. I’ve included his links and some of those I found there into the post.

    Thanks all, for reading and commenting.

    AB

  12. Thank you, Aphra Ben for this article. Your article realistically reflects on the issues with overseas doctors.

    However, I don’t agree with some of the comments by Yaya, though Yaya is sympathetic about the mess everyone is in.

    “Of course overseas doctors should have been told they were coming to Britain on temporary basis from the begining but this situation we are in now was not envisaged until around three years ago.”

    I agree that overseas doctors should have been warned and their lives would have been much different now.
    Several hundreds of overseas doctors, have already left Uk in 2005, after arriving in around 2003 – 2004. These doctors arrived in UK from India (as I can quote from the situation of Indian doctors), passed the PLAB exam, struggled to get attachments in Hospitals, later failed to gain a substantive post because of lack of jobs and severe competetion.
    This story is not worth debating at this point of MTAS crisis. But GMC used to conduct PLAB II exams 3 – 4 times a week at several centres in UK and India in 2003 – 2006.
    Why did they conduct so many exams? Why did they encourage thousands of overseas doctors to arrive in UK when they should have known what the requirement was? Overseas doctors spend roughly around 4000 GBP before gaining a substantative post. The doctors left after spending their life time savings or incurring loans back home.
    I think it is a case of mismangement and changing rules to your advantage and not the case of “we really didn’t know this would happen until 3 years ago”.

    I heard that Plab exams are still conducted in India. Ofcourse, not every 3 days now because there are no takers.

    “Those not needed British doctors in the system now and graduating in the next 6 years do not have a back to lean on like their Indian counterparts who can always return to follow their career back home with ease.”

    I feel it is ignorance to say Indian doctors can relocate with ease. Indian doctors moved to UK in the first place because of several reasons (no point in looking at them now!). Logically how would it feel for a british doctor (if he is forced to leave UK after MTAS/MMC debacle) to work in a different country for a few years and then asked to move elsewhere. Could I say in the same tone, that “British counterparts have a back to lean on and can always return to follow their career back home with ease” ?

    My tone is harsh as the sudden prospect of relocating back home has caught me unprepared and as a junior doctor, it is not easy to establish in your home country. I haven’t completed my training to walk back home and fetch myself a job. Where do I start back home?

    I’m afraid I won’t be able to debate on this comment any further in the next few days.

    Aphra Ben, please keep up your excellent analysis of issues on your blog !

  13. I did not say” Indian doctors can relocate with ease.” I said, they will always be valued and find a GOOD job upon returning, for the very reason that India loves British trained doctors. I did not realise that “some” find it intorable to go home!

    I can not see how you justify taking a “British” job and leaving your British colleague and friend without?!! I am sure many British doctors would love to work and train in India, would Inia offer training opportunities to British doctors IF their were more applicants than there is training jobs in India?

    Enough talking about “Ignorance!”

  14. It is the divide and conquor opportunism of the DoH which sickens me. And the wickedness of pulling the rug out from under the overseas doctors who are already here on the one hand and continuing to charge overseas doctors for examinations on the other.

    Thank you both for commenting, Vikas and Yaya. What you have said has added a lot to the original piece and made it much more worth reading.

    Aphra.

  15. Of course it is wrong to give overseas doctors false hopes or charge them for exams that will lead to nothing, I suppose that must have happened due to lack of proper communication between the foreign office and the dept of Health resulting in those exams still in place. That is no loss as they can still use this for other English speaking countries or to be more fluent IMO That said, those who came here benefited well of course, either academically, clinically and financially so, why complain? It is time to return to allow the British doctors the opportunity they benefitted from. They will find work at home for sure and if in the future, the situation in Britain changes, which I hope it will as I do not like the threat of unemployement of British talant, and the country needs their services, then they can be invited back on clearer terms and conditions. But you can’t push a British doctor out and give his place to an IMG, that is not right.

  16. It’s all wrong, really.

    Thanks once again for taking the time to post, Yaya.

    Aphra.

  17. Your posts show a good insight into the current mess. however, may I add that that there are some IMGs who are now having to contemplate not just going back to their home countries but also having to step many years back and humiliatingly, start all over again at much junior levels.Two of my colleagues, from Sri Lanka and Taiwan, both sincere and competent doctors, told me how the systems they had back home would not recognise their foundation and further training, and how they would have to start at FY1 level!If this is not insult to injury, I wonder what is.

  18. Ani, the great thing about blogs is that they comprise the original piece and the comments.

    What a completely horrible thing to happen to the IMGs. Not surprising because governments tend to be shitty like that. Nothing as parochial as a national government, after all.

    I really do feel for your colleagues.

    Thanks for commenting.

    Aphra.

  19. Of course Britons do not have the luxury of getting ANY job at all! Britons be whole selling “The Big Issue” on a British high street near everybody come 1 August!

    I have no idea what “Being British” means anymore!

  20. I don’t think I ever have, Yaya. Or if I have it boils down to the fact that the English at least seem to be really really good at getting fighting drunk. It’s not a skill to be ignored – we built an Empire on the back of it. We inherited it from the Danes, the Norse and the Vikings.

    Aphra.

  21. So therefore you think it is time those from overseas took their revenge?!

    I’ll leave you to it then Ephra but British to me means protecting values and rights … What a shame!

  22. just a comment about the IMGs situation regarding IMGs on HSMP status. the uk govt actively solicited (pun intended) people to come to UK under the HSMP scheme and promote the UK economy and gauranteed equal opportunities under the scheme also it was said in the original HSMP guidance notes that any future changes to immigration rules would not affect people already on the scheme as it is a route to settlement in the UK and subsequent naturalisation as a citizen. people before being accepted on the scheme had to give it in writing that they would make Uk their permanent residence. it was also clearly stated in the rules of HSMP that there would be no retrictions on employment for people on HSMP visas unlike in work permits. all these are still there even in the new HSMP scheme which is still going strong. now suddenly the nhsemployers start saying HSMPs will not be considered equal and thankfully that it is in abeyance pending all the legal cases.

    for a long time various agencies of the uk govt were advertising every weekend simultaeneously in many major newspapers in india about shortage of doctors in 2003-2004!!! the GMC and many royal colleges are complicit in this soliciting (pun intended). please write to royal colle of anaesthetics under freedom of information act and ask for all documentation about any incentives for people wanting to move to uk being advertised on their website. sometime in 2003-2004 there was a document on the rcoa website which documented the incentives available for senior consulatnt level peole wanting to relocate to uk with their families, when i counted all the incentives in total, if someone managed to be eligible to get all the relocation incentives for family ete etc then it almost added up to £30,000, all this excluding the annual salary!!! but dont be under the impression this was for all juniors who came. this was for people wanting to work in shortage areas around london etc and only for people coming across as consultants.

    the gmc was and is still conducting plab exams abroad. earlier this was as frequently as every few days in india and uk. was this opportunistic money grabbing and soliciting when there were clear indications that the job situation was already difficult for the past few years here.

    a few royal colleges conducted various parts of their exams in india and other countries, thousands of people might have already paid the exam fees and passed their exams. many of these college exams insist on uk experience for the final parts of the exam when the colleges very well know this wont be possible for majority of the gullible candidates they have successfully manged to solicit into taking the initial parts of the exams. was this just money grabbing and soliciting and exploiting candidates wanting uk qualifications. why hold exams or parts of exams abroad when one needs uk work experience for completing atleast some parts of the exams. is this not soliciting candidates to come to uk to recover the expenses they undertook taking the initial parts of the exams. even now a few colleges conduct parts of their exams abroad in india when there is no realistic prospect of completing the full process as the candidates wont be able to get uk work experience needed to complete the process.

    is there any value for any guarantee that the uk govt gives in writing? guarantees were given in writing for hsmps when they joined up to the scheme. see home office documents under hsmp scheme (old and new hsmp) and accompanying guidance notes which were given to every applicant under the scheme. tomorrow you buy a house here then suddenly the owner decides he doesnt have a house and says the house he sold is his house again rightfully as the person who bought the house is an immigrant and can go back to where he came from. does this not look silly and unethical and wrong under the law. well then how is this situation different to what is happening to HSMP resident permit holders in UK now looking for jobs or career progression. before people like ‘Yaya’ ask IMGs to go home, they should understand all the details and not jump to conclusions. i guess ‘yaya’ is not a original british name and is of asian origin (making assumptions here and i may be wrong on the origin of the writer but the general principle should hold true even if it does not apply to the writer by name ‘yaya’). if you look back in history. see wikepedia for british empire in case you are interested and see how immigrants from asia came to uk. tomorrow if the job situation gets more difficult will it be right if BNP is in power and asks all people of non EU origin to go back Idi Amin style. No it wouldnt be. so how can ‘yayas’ stand be ok for legal immigrants to go back to make things easier for him or her.

  23. Vinay, I had no idea….

    My first thought on reading your comment was “c**nts”. Then I just felt sick.

    I have never thought the way that IMGs have been treated was acceptable, and have always been aware that your situation had been swept under the carpet in the general MMC / MTAS s**t-storm, but I had no idea just how dispicably you had been treated.

    Thank you so much for posting in such detail. I’d like to take your comment, maybe tidy it up a wee bit, and post it as an entry in its own right, if I may.

    Aphra.

  24. by all means Aphra. nice blogspot BTW

  25. Thank you, and thank you.

    🙂

  26. same arguments hold good for the thousands of students who come to study in UK universities enticed by the soliciting by uk universities especially hard selling the SEGS visa issue every year paying manytimes the fees of uk graduates effectively subsidising the education of uk nationals. see the fee difference of major universities for foreigners and uk citizens. btw you are considered as having to pay higher fees like people coming from abroad even if you have lived a large part of your life in uk and your parents are immigrants who have not yet taken naturalisation as a citizen. there was the new immigration rule which changed workpermit and hsmp candifates entitlement for indefinite leave to remain in uk. it was 4y now it is 5y for indefinite leave to remain. small change some might say but can have disastrous effects on a family affected. if for example. this might affect a few people who have children just about to enter college. they will have to pay many times the fees now instead just cos of the change in rules with retrospective effect. they might have to give up on university education for their children if the family cant afford paying many times the fees paid by uk citizens for all of their children. just find out how many of the thousands of people who are enticed by the uk universities and uk govt to study in uk and enticed by the SEGS visa, how many of them actually get to work in uk in ‘proper’ jobs. just go to any major university and meet foreign students and find out how many actually got ‘proper’ jobs as per their uk qualifications based on SEGS visa. by proper jobs i mean jobs suitable to their level of education after getting uk masters qualification, i dont mean the working in tesco stacking shelves and flipping burgers in ‘mcdonalds’ trying to recover your monetary losses encountered financing your study here in uk chasing that dream sold by universities about SEGS visa and its prospects in UK. it is outright exploitation of the gullible who fall victim to the hard sell by uk universities and uk govt of working in uk under SEGS visa. i am afraid it is just money money money driving policies by many in power in uk and harming people by their thousands because of their shortsighted and money minting policies.

  27. Ah yes, the best system of government money can buy. Forgive my cynicism, but when I was looking at the biographies of the members of the House of Lords, I couldn’t help wondering which ones had paid how much to be there.

    AB

  28. Wow, That was quick! Makes you wonder?! Whose replying to whom! hehehe he! 😉

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