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MPs’ immigration debate has real implications for the NHS

MPs’ immigration debate has real implications for the NHS

Tomorrow (3 November), the House of Commons intends to debate the ‘Adult Dependent Relative (ADR)’ rules. You may not have heard of these immigration rules, but they may have real significance for the NHS.

They affect immigrants in the UK who have elderly parents in their countries of origin.

And unless the rules are immediately revisited, a travesty will continue unabated which is exacerbating the ongoing loss of GPs, hospital doctors and NHS and social care workers.

ADR visa rule changes in 2012 effectively mean that it’s next to impossible to successfully bring your elderly parents to the UK. The number of approvals under these rules have fallen by 93% since, and the Home Office appears to be proud of the ‘economic’ success of the implementation of these inhumane regulations that deprive families of any meaningful bond with their parents and ability to look after them when they deserve care and dignity. Many of us have gone through the harrowing experience of being caught out by these rules.

There are massive concerns around the exodus of the NHS workforce as the pandemic continues to take its toll  – not to mention the serious staff shortages anticipated even before Covid struck. We’ve seen demand soar in primary care and yet nearly 750 GPs had asked to leave the GMC register, amongst nearly 7,000 doctors between 2015 and 2020 – many due to these draconian visa rules.

Instead of stopping this haemorrhage of highly-skilled professionals, the Government has argued that elderly, dependent parents can be an economic burden on the taxpayer. As per the Home Office review, even before the rules changed in 2012, only around 2,325 applications were made a year – 0.0069 % of total immigration to the UK and 0.011% of all non-EU immigration. The numbers involved are minuscule for the damage that this is causing and its disruption to patients, colleagues and the wider NHS.

It takes half a million pounds to train a GP or a consultant. Besides, invaluable years of organisational experience and irreplaceable expertise are simply being lost. These doctors either relocate back to their country of origin, sore and saddened at this unfair treatment, or are gained by comparable nations such as Canada, Australia and even neighbouring Ireland, which have more humane and proportional systems.

Also, the very reason that these professionals want their elderly parents to come to the UK is to look after them – there is no evidence that they rely on residential care settings. The use of care homes is significantly lower in the BAME population, with only 3% of the care home population of BAME origin, while constituting 13% of the total population.

Besides, some safeguards can be considered, such as an annual cap on the numbers, immigration health surcharge or a bond.

The NHS as a whole, and primary care in particular, has always and continues to rely on the migrant workforce, without whom the system will simply be unsustainable. One in five GPs in the country trained outside the UK, benefiting the system in billions of saved training costs for the taxpayer.

There is a dire need for raising awareness of these rigid regulations among our colleagues so that they can appreciate these additional worries that this subset of the workforce has to deal with and can add their support for flexibility in these rules by writing to their MPs.

Overall, I feel that the ADR rules require an urgent review to reflect fairness so that the UK can continue to be considered a credible and fair destination for the brightest and the best. Hopefully, that will be the outcome of the debate tomorrow.

Dr Kamal Sidhu is chair at South Durham Health Community Interest Company, and chair of the BAPIO GP forum. He writes in a personal capacity



Please note, only GPs are permitted to add comments to articles

Mrutyunjaya Kuruvatti 3 November, 2021 1:10 pm

Inhumane. I tried to get one of my cousins over on a short visit for compassionate grounds when my mother was terminally ill a few years ago. Despite guarantees made by my father, myself and my sister (all doctors and economically active), it was declined.

Patrufini Duffy 4 November, 2021 8:42 pm

The NHS is a short-sighted and juggernaut employer. “It” is a somewhat perversely ghost entity to it’s staff, persecutory somewhat. Do not fear, the other countries in the world will soon be asking for all your skills.

Dylan Summers 10 November, 2021 11:06 am


I don’t think this article is about the NHS. It’s about government immigration regulations.