EHJ December 2004, pages 365

Nargis Kayani

As part of the Department of Health's quest to meet NHS staff quotas, an international recruitment campaign has resulted in unprecedented numbers of international medical graduates applying to enter the UK. To practice in UK hospitals as doctors, medical graduates of non EU countries and Commonwealth residents with pre-1990 qualifications must pass the General Medical Council's professional linguistic and assessment board examination (Plab test).

To take the test, doctors usually need to come to the UK on a visitor's visa, which requires non EU foreign nationals to get sponsorship by a UK resident, who must satisfy Home Office requirements. This includes providing suitable living accommodation for the applicant, which traditionally EHPs inspect, certifying that the property is not statutorily overcrowded and fit for habitation.

Approximately 8,000 medical graduates enter the UK every year to sit the Plab test attending countless specialist Plab courses in many towns and cities. This has led to an unprecedented demand for affordable accommodation. A recent Newsnight feature highlighted the issue showing medical graduates living in unfit and dangerous conditions.

Having recently been involved in a project to identify and improve some of these properties, it is clear that the scope of the problem has been hugely underestimated. Often students are unaware of legislative controls relating to HMOs or are too frightened to complain, for fear that their landlord will rescind their sponsorship.

Plab courses and HMOs are rife throughout London with accommodation freely advertised in Newham, Redbridge, Camden, Tower Hamlets, Croydon, Barnet and Haringey. The spread of the Plab HMO is not confined to London, with courses held in Glasgow, Cardiff, Manchester, Birmingham, Preston and Bristol. Where there are courses there will also be large numbers of Plab HMOs and there lies the problem for environmental health departments.

Plab HMOs, from the evidence that I have seen, are extremely high risk, lacking fire safety provisions, usually severely overcrowded with five or six occupants per room sharing makeshift beds, with rudimentary and poorly constructed kitchen and bathroom facilities. The properties are often infested with rats, cockroaches and other pests. Unscrupulous landlords/course operators charge between £500-£1,000 (including course fees) for a stay of about 18 days in one of their Plab HMOs. At least one company involved has a property portfolio of over £1m with stories abounding of illegal activities relating to passports and other ambiguous dealings. Certainly, local environmental health departments have not been involved in entry clearance assessments of the properties regarding suitability for occupation.

EHPs encountering these situations feel helpless. The standard of this accommodation breaches moral and legislative codes and requires urgent action, beyond immediate powers available to the profession. The articulate, but vulnerable Plab community deserves a much better welcome. EHPs should ensure that those at risk are adequately protected through a robust multi-disciplinary approach utilising the full enforcement powers of the Department of Trade and Industry, Home Office, Inland Revenue and others.