South Asian History Month: Dr Raghunandan Gaind
30 July, 2020
Dr Raghunandan Gaind, Past-President and current Vice-President of the Indian Medical Association GB, and Patron of the Amritsar Doctors and Dentists Association, writes for South Asian History Month.
In February 2016, there were 273,853 doctors registered with the General Medical Council (GMC), of which 25,038 are of Indian origin, with 5,622 working in psychiatry. This is a remarkable figure given that ethnic minorities constitute only 8% of the population of the UK.
The NHS has seen substantial expansion since its inception in 1947. During the 1950s and 60s, it recruited large numbers of doctors from India with a further influx following the publication of the NHS plan1 by the Department of Health in 2000. The inclusion of Indian doctors in such large numbers is understandable given the historical relationship between the UK and India. The development of modern medicine in India owes much to British rule and the Indian Medical Service (IMS). The racism and challenges Indian doctors have endured here, despite being so crucial to the system, is in itself a poignant story.
A momentous decision
Lord Macaulay’s2 momentous decision to introduce English into the Indian school system was followed with a vigour never seen before or since for any language. He was a leading Parliamentarian and one of the commissioners of the Board of Control representing the Crown in its relations with the East India Company. Having accepted Membership of the Supreme Council of India, he arrived in Madras, in 1834 returning in 1838. A studious and learned man, his days at the Board of Control helped him to learn much about India – its religions, caste system, missionary work in the country and much more.
By the start of the First World War, a few score Indian doctors were working in the UK, mostly in industrial towns and poor neighbourhoods of London. Their number increased to 3,000 by the end of the Second World War. The period after 1947 saw a great influx. Many came to the UK to undergo training in varied specialities under Commonwealth and other scholarships and often were self-financing.
By the 1960s the number had increased to 15,000. They contributed to the backbone of the NHS. They had arrived full of hope and ambition to work in Medicine and Surgery in teaching hospitals and other Centres of Excellence. Soon they found the employment available to them was in “Cinderella” specialities. In certain areas up to three quarters of GPs and Junior Doctors came from India.
Professor Aneez Esmail3 wrote a seminal article on Asian doctors in the NHS. He observed that the pattern of medical education and training in India was geared towards “meeting the needs of the GMC and IMS”. He wrote, “The failure to produce a coherent medical policy and the absence of public health medicine and health facilities in rural areas meant that Indian doctors were quite suitable for working in England but probably totally irrelevant for working to the benefit of the vast majority of the Indian population... it was the South Asian doctors who have provided a service to these communities. I believe that without them the NHS would have collapsed”.
In 1961, Lord Taylor of Harlow stated in Parliament4 “the Health Service would have collapsed if it had not been for the enormous influx of Junior Doctors from such countries as India and Pakistan … they are here to provide pairs of hands in the rottenest, worst hospitals in the country because there is nobody else to do it”.
Racism and prejudice
An upsurge of racism surfaced within the profession. Enoch Powell5 as Health Minister had encouraged the recruitment of Indian doctors. However, in his speech “Rivers of Blood” he reflected the general prejudice that prevailed at the time about immigrants. Interestingly, when he appealed for help to staff his massively expanded health service nearly 50 years ago, about 18,000 Indian doctors answered his call.
In 1978, Prime Minister Margaret Thatcher expressed similar sentiments “this country is being swamped by people of different cultures.” Comments were published that the standard of overseas qualified doctors was poor. A survey carried out at the time indicated that 17% of overseas qualified doctors had problems communicating with their patients and professional colleagues. In the 1970s, advertisements would be published stating “Only British Graduates need apply for the vacant post”. Following the Race Relations Act., 1976 such overt racism ceased.
In 1927, four Indian doctors established the Indian Medical Practitioners Association later renamed Indian Medical Association (Great Britain).
Historically, Indian medicine owes much to the British Raj, but equally Britain’s National Health Service is today beholden to the Indian physicians who represent such a significant proportion of its staff. Mutual esteem has been established.
With the introduction of TRAB, PLAB and what followed, an era has ended. Immigrant doctors are now obliged to submit themselves to a test of clinical knowledge as well as fluency in English. Following two centuries of close co-operation between medical men and women in the two countries, Britain’s GMC has withdrawn its recognition of Indian Medical Qualifications and the Indian Government has reciprocated. It is possible that fewer Indian doctors may now come to this country and the history of mutually profitable working relationships may decline. It would be sad indeed if this were so.
The majority of Indian doctors came to acquire skills and return. However, from the outset it was obvious that the experience and training available to them would be very restricted. They remained at junior level and very few of them went on to become Consultants.
‘Racism in Medicine’ a report by Kings Fund, edited by Naaz Coker6, Race & Diversity Director, observed that “no aspect of a doctors working life is untouched by racism… discrimination begins in medical school and affects the whole career…” The Ethnic minority doctors are similarly discriminated in the allocation of Distinction Awards / Clinical Excellence Awards A Report by David Smith published in 1987 found that one third of the doctors arriving in the UK during the 1970s achieved their goal and returned home, but the majority did not. Some had married local women settling here but most became indentured workers of the NHS
The saviour of the pariah
The so-called problems of communication with overseas qualified doctors was a red herring. Once the immigrant doctor had worked in the UK for more than three years, the problem disappeared. The racism experienced by Indian doctors was at variance with the needs of the Health Service, which remained dependent on them. Were they, as Professor Esmail commented “the saviour or the pariah“
The work of the Professional Conduct Committee (PCC), shows that ethnic minority doctors are six times more likely to be investigated, twelve times more likely to be charged with sexual misdemeanour and thirty times more likely to be charged with improper demand for fees. Dame Janet Smith7 observed in her Report “thus in the three studies conducted over a period of nine years, the PSI (Policy Studies Institute) found unexplained differences in the treatment … of overseas qualifiers dealing with them more severely. This may, or may not, prove that there is a racial bias ...”
The NHS is described by most in this country as a unique British institution providing a meaningful and effective service to all citizens. The contribution of overseas qualified doctors is significant and sadly overlooked. Feeling treated as pariahs they were dissatisfied, stigmatised and demoralised.
Meanwhile in the context of the continued dependence of the NHS on the injection of carers from India, progress has been made. As talk continues of a further influx to meet the current unmet needs of the NHS, this new intake will hopefully not experience the same trials and tribulations of their predecessors.
Dr Raghunandan Gaind MB FRCP FRCPsych. DPM Lon
Vice-President Indian Medical Association GB
Patron Amritsar Doctors and Dentists Association
Past President Indian Medical Association GB 1972-79
- Department of Health: The NHS Plan: a plan for investment, a plan for reform, London: The Stationery Office; 2000
- Language in India: Volume 3: 4 April 2003: Lord Macaulay The Man Who Started It All, And His Minute. Editor M.S. Thirumalai Ph.D.
- Aneez Esmail PhD MRCGP MFPHM, Professor of General Practice
- Br J Gen Pract 2007 October 1,57(543) 827-834
- Taylor DJ, Esmail A, Retrospective analysis of census data on general practitioners who qualified in South Asia; who will replace them as they retire? BMJ. 1999-318(7179) 306-310
- Powell E “Like the Romans, I see the River Tiber foaming with much blood” 1968: Apr 20 The Telegraph
- Racism in Medicine An agenda for Change. Edited by Naaz Coker. King’s Fund Publishing. 2001
- Smith J Fifth Report. Safeguarding patients’ lessons from the past – proposals for the future, London. The Stationery Office 2004 cm6394