A consultant plastic surgeon who has worked in the NHS for nearly 30 years is torn between her job and quitting to look after her elderly parents abroad due to “harsh” immigration laws.
Dr Maharukh Daruwalla, who specializes in skin cancers and pediatric plastic surgery at East and North Hertfordshire NHS Trust, has already tried to get adult dependent relative (ADR) visas for her parents, who live in Mumbai, but was turned down. She wants to try again with them getting older and having not seen them for three years due to the pandemic, but a crackdown by the Home Office during the past decade has made ADR visas almost impossible to obtain. Many NHS staff have already left as a result.
Dr Daruwalla arrived from Mumbai nearly 30 years ago as a trainee in the NHS. She told i: “When you’re a student you obviously don’t think that far ahead. As time passes by, you and your parents get older and then the worries start. I’m the only child so it’s up to me to look after them. “
Dr Daruwalla’s father, Keki, is 90 and her mother, Ville, is 82. The Covid pandemic has prevented them from seeing each other and Dr Daruwalla is anxious that they should be able to move in with her in Leicester, where she lives with her husband and daughter.
She said: “The ADR visa is supposed to facilitate elderly parents joining their children who are in the UK but the rule change in 2012 has made it almost impossible. The rules are so harsh now. There have been so many cases where elderly parents have had to die in isolation because they are unable to live with their children abroad; and when their children are essential key workers, they are unable to travel to look after them in times of need. This is an issue which just doesn’t affect me – it affects all NHS overseas-born workers.
“The care sector here is accredited, regulated and dependable, but that’s not the case in India, where it’s very risky to hire help for anyone who is elderly and vulnerable.”
Dr Daruwalla’s parents were swindled out of their savings two years ago by a conman who had pretended to be from the hospital her father was in for a knee replacement. She said: “It’s the insecurity of it all that really brought it all to the forefront for me. Gradually, their friends are dying, so there are fewer and fewer people around them they can trust. “
The ADR rule, which states that doctors and others in this country are not allowed to bring their parents from overseas unless they meet certain very strict conditions, has forced NHS staff to quit their jobs and return to their native country to care for elderly relatives who are barred from coming to live with them in the UK. It has disproportionately affected the health service due to the fact about 170,000 NHS England staff are non-British, of which 64,000 are Asian.
The Government stopped publishing figures in 2016 but last year i revealed only 218 ADR visas were granted between 2017 and 2020. No ADR visas were awarded at all by the Home Office in 2017, with only 35 the following year, 113 in 2019 and 70 in 2020. By contrast, 2,325 ADR applications were granted between April 2010 and March 2011, the year before the rules were changed.
Senior NHS staff have called the figures “a slap in the face for hard-working doctors” and continue to call for a review of immigration laws. The British Medical Association (BMA) is also campaigning for a change to ADR rules.
Dr Daruwalla is anxious about the stress of the situation having an impact on her work and feels forced between her patients and leaving at short notice for India if her parents need her.
She said: “That’s not fair to my Trust, or to my patients, who might have made appointments or surgery postponed if colleagues cannot cover for me. The NHS states we as doctors and nurses are expected to treat all patients with the utmost compassion, yet this very compassion is being denied when it comes to our own families. I find that very contradictory. “
Dr Kitty Mohan, international committee chair at the BMA, said: “We are deeply concerned that this rule is having an adverse impact on the lives and mental wellbeing of our members with elderly dependent parents living abroad. It also means they are often forced to take leave, and even make multiple journeys, to look after their parents abroad, at a time when our already understaffed NHS is coping with a record care backlog and needs their dedication and experience.
“There is no evidence that the cost of lifting these restrictions for healthcare workers in the NHS would be a burden to the taxpayer. Perversely, the potential loss to the NHS if these doctors and other healthcare professionals, many of whom the UK has spent money on training, feel they are forced out of the country due to their inability to care for their elderly parents in the UK, would likely to be far greater. “
The government has consistently said those who apply for an ADR visa need to demonstrate they require “long-term personal care which can only be provided by their relative in the UK and without needing to access public funds”. Officials said the NHS could not be given a special status as “relaxing the rules for family members of doctors could undermine this equality principle and discriminate against other professions”.
Dr Daruwalla argued all key workers with elderly parents abroad are negatively impacted by the rules, but a start “needs to be made somewhere”.