This is going to Hurt, but the way international healthcare workers in the NHS are treated will leave you heartbroken, says DAUK’s Dr Pushpo Babul Hossain

he BBC’s adaptation of Adam Kay’s best-selling book This is Going to Hurt, which shows the stark reality of how it feels to work in the NHS, aired last week.

The seven-parter is loosely based on Kay’s time working as a junior doctor – health workers across the UK have praised the show, saying it shows the racism, trauma and burn-out doctors and nurses experience while working in the health service.

The first episode played out a horrific racist moment in which a patient screamed ‘Get that P*** off my baby’. As an international graduate, it sadly reflects my experiences of racism within the NHS where comments such as ‘Why don’t you go back to where you came from?!’ or ‘I want to be seen by a white doctor!’, are all too common.

I joined as a doctor from my home country of Bangladesh in January 2020 – just before the pandemic hit the UK. I’d always wanted to become a part of the legacy of the NHS, to contribute to an institution that provides almost all services to patients for free.

Nothing is more rewarding than knowing you can provide your people with the best healthcare without handing them a bill at the end. This is what attracts so many international staff to the NHS every year. But little did I know that following my dream to treat patients for free had a huge price tag – just because I’m not British.

Almost 200 different nationalities are represented within the NHS. And the majority of these are at the mercy of yearly hospital contracts to get their visa renewed.

To legally reside and work in the NHS, visas typically must be renewed on an annual basis, which can cost up to £500 per applicant, per year. Their fate is almost always tied to obtaining a card called the Biometric Residence Permit. To put this into context, without this permit staff are unable to work, open a bank account, apply for a license to drive or even rent an apartment. Travel outside the UK for incidents such as a family emergency is avoided – as without the BRP one cannot re-enter the UK.

After five years in the UK, we then become eligible to apply for an Indefinite Leave to Remain, which means we are then a permanent resident. Despite working on the frontlines of the pandemic, there is no guarantee of getting this application accepted, and the rejection rates are alarming even after submitting a perfect application. Each application comes with a huge price tag of around £2400 per applicant.

What’s more, the state of the NHS depicted in This is Going to Hurt has only got worse. Since Kay wrote the bestseller, we’ve seen ten years of austerity, severe staff shortages and the pandemic – yet as an international medical graduate, I’ve had to run an extra mile to prove that I’m worthy to live in the UK.

On top of this, in order to avail NHS services myself, I had to pay an international health surcharge of around £400 before being granted a visa to work in the UK. This charge was scrapped thanks to campaigning by Doctors’ Association UK. Since I joined the NHS, I have paid my taxes religiously but I don’t have any recourse to public funds should I become sick or unable to work.

Sometimes I wonder if it is worth it at all, to stay away from my home and the life I knew so well to come and live in the UK where immigration rules seem so hostile.

I’ve worked side by side with my British colleagues and cared for all the patients’ as if they were my own family – but when the storm of the pandemic calmed down – I was made to feel disposable. I watched as other countries recognised the contributions of their international workers and, at times, I feel I’ve chosen badly. It’s a likely prospect that I’ll make the difficult choice to leave my NHS dreams behind for a better opportunity somewhere else.

Until the authorities acknowledge the contributions of international healthcare workers in the NHS and establish measures to retain staff, the quality of care and patient safety will suffer – and that is going to hurt.

Dr Pushpo Babul Hossain, International Medical Graduate Lead with the Doctors’ Association UK

On Friday March 4, the  DAUK celebrate Overseas NHS Workers Day  with a showing of the Hostile documentary, to raise awareness of the extra pressures faced by international staff, and support Indefinite Leave to Remain for Overseas NHS Staff