The Intensive Care Society and Paediatric Intensive Care Society’s position on the UK’s future skills-based immigration system white paper


The heart of any critical care or emergency unit, including intensive care units (ICU) and paediatric intensive care (PICU), lies not in its technology but in its people and their skills.  Critically-ill patients need the input of a large array of skilled professions, including not only nurses and doctors, but a wide range of Allied Health Professionals (AHP) such as specialist physiotherapists, dietitians, pharmacists and speech & language therapists, as well as support staff such as porters and domestics. 

In intensive care, staff-to-patient ratios are necessarily high, with up to two dedicated nurses per patient, supported by the wider team. Consequently, a shortage of key professionals can have a huge impact on the safe delivery of care to the most severely ill children and adults. The NHS currently carries a high number of vacancies for specialist staff, with for example 10,000 vacant AHP posts. Under the proposed new immigration system detailed in the White Paper, the numbers cap on Tier 2 visas is lifted. We welcome this, as it currently adds delays and cost to essential NHS recruitment of middle-grade doctors and others.  ​

However, the proposed £30,000 income threshold for all staff is of deep concern, as it does not reflect the true value of the skills held by these individuals to the NHS and many essential members of the diverse and multi-professional critical care team will fall below this salary level, especially at the crucial early and mid-career level which forms the core of specialist recruitment. ​

To put this into perspective, a Band 5 nurse or an AHP such as a physiotherapist, is paid £26,682 with London weighting.  Nursing is currently exempt under a temporary entry in the Migration Advisory Council’s Shortage Occupation List, but this is subject to review. Unlike nurses, Allied Health Professionals relevant to critical care are not currently listed for exemption to this threshold.  From 29 March 2019, many EU staff who are currently not affected, will fall under the requirements listed in the White Paper. ​

In addition to direct impact on recruitment, the imposition of numerical income thresholds sends a damaging message of being unwelcome in the UK and is discouraging to essential skilled staff in these categories, who are widely sought-after and have a wide range of countries to work in. The NHS cannot afford to deter skilled young professionals in key critical care roles.

“Our ability to give life-saving care to the most critically ill adults and children, relies on being able to provide the right staff and skills at the bedside.  ICUs, PICUs and other emergency and critical care areas in the NHS are already under severe staffing pressure, and we strongly advise against persisting with a £30,000 income threshold while we leave the EU and the NHS loses access to EU staff who are currently exempt. We welcome the fact that a consultation is due, and urge a carefully considered, skills-based rather than financial approach” said Ganesh Suntharalingam (President, Intensive Care Society) and Peter-Marc Fortune (President, Paediatric Intensive Care Society).

Next Steps 
We intend to engage with the consultation process following the release of the White Paper. The Intensive Care Society will be holding the first Council meeting on 29 January 2019 where we will liaise with strategic collaborating partners including the Paediatric Intensive Care Society, to review evidence from our members and consider our next steps in response to this White Paper.