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"Foreigner; a person not belonging to a particular place or group; a stranger or outsider"

I try really hard not to be too political or to court controversy, but sometimes sitting on the fence hinders our own commitment to integrity. The press are reporting that Baroness Harding of Winscombe has not only applied to become chief executive of NHS England but, if appointed, is committed to reducing the reliance on 'foreigners'.

The language we use, the recognition and respect we show those we work with has a huge impact on the quality of delivery. There is a great deal of research showing the benefits of diversity in organisations; A 2017 study identified diversity as a key driver of innovation, finding that diverse teams produced 19% more profit. Results showed that organisations which support and welcome diversity amongst their staff groups developed outputs that were more relevant to the people using their services because they were more in tune with the service users' changing needs. Adaptability, flexibility and resilience is a byproduct of varying backgrounds and perspectives generating an array of insights, ideas and solutions. These staff are most definitely not 'outsiders' or 'strangers'. Many will have shared very intimate moments with people from across the country , helping bring new life into the world and supporting people as they finish their life's journey. That is not something that can be entrusted to strangers. These are highly skilled, compassionate and committed professionals, respected peers and sometimes the very people that patients will remember throughout their lives. They make a real difference, day in and day out. They are friends and colleagues, much needed employees, not 'outsiders'.

According to the House of Commons Library, about 170,000 out of 1.3 million NHS staff say their nationality is not British. That is close to 14 per cent of the workforce. many have lived and supported the UK for decades, having qualified here. Aside from the retrogressive step of reducing diversity and losing that enormously beneficial cross-fertilisation that we gain from having staff from across the world, the logistics are going to be an enormous challenge. Many specialties struggle to recruit staff already. There are already ever increasing challenges for trust leaders trying to maintain a safe staffing establishment. We don't want to lose more staff because they no longer feel welcome, surely?

Lets consider the potential impact in, say, ophthalmology which provides 6% of all NHS surgery. The Royal College of Ophthalmologists Workforce Census in 2019 showed that an extra 230 consultant posts are required to meet the rising demand for ophthalmology services over the next two years. Since the number of trainees qualifying in ophthalmology each year is, on average, 74 there are nowhere near enough appropriately trained doctors to fill current and future consultant posts. Add in a predicted 40% increase in demand for eye services over the next 20 years and it becomes easy to see the problem of suggesting we discourage staff from overseas.

That situation of fewer staff will lead to longer waits and in turn to increased levels of avoidable sight loss. Visual impairment robs people of their independence and can compromise their dignity. It also increases the risk of falls with harm , scalds and burns and road traffic accidents. More people will need long term care and that is expensive and impacts further on a care system that is already creaking.

The Royal College of General Practitioners seems somewhat more welcoming than the Baroness and says in their overseas doctors guide, "We are delighted that you are considering coming to the UK to work as a general practitioner. Whether you call yourself a family physician, médecin généraliste, huisarts or médico de cabecera, or indeed any name given to a general practitioner, you are very welcome as a GP in the National Health Service (NHS)." Professor Helen Stokes-Lampard, PhD FRCGP, Chair of RCGP reiterates the sentiments and says, "I very much look forward to welcoming you as a colleague.”

Where would we be without our doctors, nurses, midwives, radiographers, sonographers, porters, housekeeping staff, dentists, finance directors or coffee shop staff who hold a non-UK passport? So much kinder and better for us all to welcome colleagues than to say we don't want to rely on foreigners. The truth is that without them we'd be struggling. Really struggling.

I sincerely hope that Baroness Harding reflects on the use of the words attributed to her and thinks about how that might make the very people we were clapping and cheering last year feel. I'm not sure I would want to work somewhere when I was always going to be considered 'an outsider'. Making valuable staff (and consequently patients) feel they don't belong, rather than celebrating and being comfortable with difference is never a good thing for society. It is something we all probably need to challenge.

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