NHS trusts exploit overseas doctors for cheap labour, investigation reveals
Physicians have the opportunity to serve as fellows in English hospitals for two years, aimed at acquiring experience to apply in their respective countries
Pramod Thomas is a senior correspondent with Asian Media Group since 2020, bringing 19 years of journalism experience across business, politics, sports, communities, and international relations. His career spans both traditional and digital media platforms, with eight years specifically focused on digital journalism. This blend of experience positions him well to navigate the evolving media landscape and deliver content across various formats. He has worked with national and international media organisations, giving him a broad perspective on global news trends and reporting standards.
FOREIGN doctors received lower pay and reduced benefits compared to their UK counterparts under a controversial scheme in English hospital trusts, an investigation has revealed.
Doctors from outside the UK arrive at NHS trusts as ‘fellows’ under the Academy of Medical Royal Colleges’ medical training initiative (MTI) scheme, spending two-years in the NHS to acquire experience they can later apply when they return to their home countries.
However, a British Medical Journal (BMJ) investigation said such doctors might receive lower compensation than UK-based doctors hired by trusts. Foreign doctors can also be returned to their home country if they get pregnant, the BMJ found.
At certain NHS trusts, fellows are provided with identical compensation and advantages as doctors who are formally employed.
However, the University Hospitals Birmingham NHS Foundation Trust, Dudley Group NHS Foundation Trust and Walsall Healthcare NHS Trust have an exclusive arrangement with the College of Physicians and Surgeons Pakistan (CPSP).
The BMJ found fellows received lower pay and had reduced benefits than trainees employed by these trusts under this agreement.
Critics, including employment lawyers, doctors, and the fellows themselves, condemned the arrangement as “exploitative”.
Since its commencement in 2009, approximately 7,000 participants from countries such as Pakistan, India, Sri Lanka, Egypt, Nigeria, and Saudi Arabia have engaged in the programme led by the Academy of Medical Royal Colleges (AoMRC).
An internal document obtained by the BMJ revealed that fellows save the trust money, as their remuneration is lower than the standard pay for junior doctors’ posts.
Further investigation highlighted that fellows under the CPSP’s agreement received a stipend ranging from £32,400 to £43,200 a year, while the equivalent pay for ST3 doctors employed by the trust ranged from £51,017 to £55,328 a year, excluding additional or enhanced hours, on-call work or pension deductions.
In 2017 the Birmingham trust terminated the contract of a fellow who became pregnant, the BMJ report said.
She described her ordeal, saying, “I informed my department about my pregnancy at around 20 to 24 weeks. They asked me to tell the international team so that, if there was a maternity package, I could get one. The moment I involved the international team, doctors at the trust who ran the scheme arranged for a meeting. I have tried to forget the way it was all dealt with, but I still get flashes of how rude and inconsiderate they were and the remarks they made.
“The international team told me that they would terminate my fellowship and my contract would end on 30 June. My baby was born on 27 of June, only eight weeks before the end of the fellowship.
“The mental stress had an effect on my physical health. So after my baby was born I just let it go. My husband got a job in the UK and could sponsor us on his visa. The whole thing was a traumatic experience, and it shook my trust on so many levels.”
Hassan Bin Ajmal, a fellow at University Hospitals Birmingham NHS Foundation Trust, said he used two weeks of annual leave when his daughter was born because paid parental leave was not available.
The CPSP promised to review and restructure its guidelines after criticisms emerged regarding the harsh conditions imposed on the fellows.
Asad Rahim, a consultant endocrinologist at Birmingham Heartlands Hospital and regional director of the CPSP’s centre in Birmingham responsible for trainees in the UK, said the scheme had benefits. He was quoted as saying, “Since the scheme, the mortality rates for pregnant women in Pakistan have decreased and there’s been an improvement in medical oncology care and paediatric care, which are demonstrable in the data.”
He added that lack of maternity pay needed to be balanced against the greater good the scheme was having in terms of improving healthcare in Pakistan.
Rahim said fellows receive 25 days of yearly leave and an additional 10 days that can be used for unforeseen situations, such as family emergencies. If they take more time off, it could affect their two-year training term. They are advised to return to their home country, pause their training duration, and resume in the UK when feasible.
Depending on specific circumstances, the CPSP might consent to continue paying the fellows their stipend during leave. For instance, there was an instance where a fellow was given their stipend for four months while caring for their ailing father in Pakistan.
The Ceylon College of Physicians informed BMJ that in the past, some trusts collaborated with Sri Lankan trainees as honorary fellows. These trainees received a £2,000 monthly stipend from the Sri Lankan health ministry.
Unfortunately, due to economic challenges in Sri Lanka, this funding was discontinued for new fellows, although existing trainees in the UK continued to receive their stipends.
In the east of England, Sri Lankan trainees are currently paid by the trust, with additional payments formerly provided by the Sri Lankan government for on-call and weekend work.
Meanwhile, the British Association of Physicians of Indian Origin (BAPIO) established its own training programme due to concerns about the misuse of fellows to cover staff shortages in some NHS trusts. The organisation’s aim was to treat international medical graduates as trainees rather than just additional staff.
“I think what we really wanted to create is a system whereby all these international medical graduates are treated as trainees rather than as pairs of hands,” said Parag Singhal, executive director of BAPIO Training Academy, an organisation in the UK that recruits Indian doctors on behalf of trusts and manages their training.
A representative from the Academy of Medical Royal Colleges expressed concern about the issues highlighted by BMJ. They emphasised the importance of all doctors receiving fair compensation for their work, whether they are part of the MTI scheme or not. However, they noted that this matter pertains to the doctor’s agreement with the NHS trusts that employ them.
University Hospitals Birmingham NHS Foundation Trust told the BMJ: “Undoubtedly the programme benefits the NHS system, but in return it benefits the overseas healthcare structure. Programmes which encourage the upskilling of medical practitioners from countries with less developed healthcare systems have been described by the [World Health Organization] as a ‘brain gain and not a brain drain.’”
A spokesperson for the Academy of Medical Royal Colleges told the report: “The issues The BMJ is raising here are very concerning. All doctors should be paid the correct rate for their work, regardless of whether they are on the MTI scheme or not. But this is a matter between the doctor and the NHS organisation that employs them.”
CEO of the Dudley Group NHS Foundation Trust, Diane Wake, was quoted as saying, “As we do not directly employ staff who are a part of the medical trainee scheme, we are therefore not responsible for their remuneration. Our trust has not received any concerns from our MTI colleagues.”
UK AVIATION engineers are arriving in Thiruvananthapuram to carry out repairs on an F-35B Lightning jet belonging to the Royal Navy, which has remained grounded after an emergency landing 12 days ago.
The jet is part of the HMS Prince of Wales Carrier Strike Group of the UK's Royal Navy. It made the emergency landing at Thiruvananthapuram airport on June 14. The aircraft, valued at over USD 110 million, is among the most advanced fighter jets in the world.
According to a spokesperson for the British High Commission, the aircraft is currently awaiting repairs at the Thiruvananthapuram international airport after it developed an engineering issue.
The UK has agreed to move the aircraft to the Maintenance Repair and Overhaul (MRO) facility at the airport.
"The aircraft will be moved to the hangar once UK engineering teams arrive with specialist equipment, thereby ensuring there is minimal disruption to scheduled maintenance of other aircraft," the spokesperson said.
The F-35B is the only fifth generation fighter jet with short takeoff and vertical landing capabilities, which allows it to operate from smaller decks, austere bases and ships.
The official said the aircraft would return to active service once the repairs and safety checks are completed.
"Ground teams continue to work closely with Indian authorities to ensure safety and security precautions are observed. We thank the Indian authorities and Thiruvananthapuram international airport for their continued support."
The aircraft was unable to return to HMS Prince of Wales due to adverse weather conditions.
Engineers from HMS Prince of Wales had assessed the aircraft after the emergency landing and determined that support from UK-based engineering teams was required.
The Indian Air Force had said a few days after the incident that it was providing all necessary support for the "rectification and subsequent return" of the aircraft.
Earlier this month, the HMS Prince of Wales Carrier Strike Group conducted military exercises with the Indian Navy.
In British service, the F-35B is referred to as the 'Lightning'. It is the short takeoff and vertical landing (STOVL) variant of the fighter jet, designed for use from short-field bases and air-capable ships.
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Relatives carry the coffin of a victim, who was killed in the Air India Flight 171 crash, during a funeral ceremony in Ahmedabad on June 15, 2025. (Photo: Getty Images)
TWO weeks after the crash of Air India flight AI-171 in Ahmedabad, families of victims are grappling with grief and trauma. Psychiatrists are now working closely with many who continue to oscillate between denial and despair.
The crash occurred on June 12, when the London-bound flight hit the BJ Medical College complex shortly after takeoff, killing 241 people on board and 29 on the ground. Only one passenger survived.
The emotional impact of the incident continues to affect survivors and relatives of those who died.
Counselling support on the ground
In the immediate aftermath, the Department of Psychiatry at B J Medical College deployed a team of psychiatrists—five senior residents and five consultants—across locations including Kasauti Bhavan, the postmortem building, and the civil superintendent's office to support families.
"The accident was unimaginable. Even bystanders were disturbed. Then what must be the condition of someone who lost their loved one?" said Dr Minakshi Parikh, Dean and Head of Psychiatry at BJMC.
"If the people who heard the news were so disturbed, then it is not even within our scope to imagine the state of mind of the family members of people who lost their lives," she told PTI.
Processing grief in stages
As visuals of the crash began to circulate, families arrived in large numbers—many still hoping their relatives had survived. The existence of a lone survivor gave rise to hopes that it might be their loved one.
"There was an uncertainty whether one would be able to identify the loved ones they have lost and wait for matching of the DNA samples for three days. In some cases, samples of another relative of the kin had to be taken. The shock would have logically led to acute stress reactions and post-traumatic stress disorder," said Dr Parikh.
Dr Urvika Parekh, assistant professor and a member of the crisis response team, said denial was the immediate response among many families.
Facing denial and despair
"They kept asking for updates, insisting their family member had survived. Breaking the news gently, while having no confirmation ourselves, was incredibly difficult. We had to provide psychological first aid before anything else," she said.
Parekh said the hope placed on the lone survivor became a coping mechanism. "We had to deal with the denial and explain that nobody could have survived the horrific crash (except one who was not their relative)," she added.
Families were initially reluctant to accept counselling. "It was also difficult to accept the truth without seeing the bodies of their loved ones. Counselling aided them at this critical juncture," Parekh said.
She shared the case of a man who remained silent after losing his wife in the crash. "There was immense guilt—survivor guilt (that he is alive and his wife died). We gave him anti-anxiety medication to help ease the immediate stress. Eventually, he began to speak. He talked about their plans, their memories. It was catharsis. We didn't interrupt—we just let him speak and communicated through silence and empathy,” she said.
Parekh said that listening empathetically was a major part of the process. "We were managing their anger, outburst, and their questions like 'why us' (why did it have to happen to us)," she said.
The wait for DNA results was another major source of distress. With confirmation taking up to 72 hours or more, some families insisted they could identify their loved ones without DNA.
"There was one father who kept saying he didn't need DNA tests—he could identify his son by his eyes," said Parekh. "We had to gently discourage that. Seeing their loved ones in such a state could trigger PTSD and depression. We told them: it's better to remember them with a smile than with charred remains.”
Dr Parikh said the five commonly known stages of grief—denial, anger, bargaining, depression, and acceptance—were not experienced in a fixed sequence.
Lingering grief and support
"People cycle through these stages. Someone might accept the loss in the morning and fall back into denial by evening,” said Parekh. "So we mourned with them. That was part of the therapy".
Parekh stays in one of the residential buildings near the crash site. Her building was not damaged.
Some families found the waiting unbearable. One Air India crew member’s family had to wait seven days for DNA confirmation. “The exhaustion, the helplessness—it broke her mentally,” a relative said. “But the counselling helped. Those sessions were our only anchor."
"A calm voice, the right amount of information, and simply being there—these saved a lot of families from spiralling into chaos,” said Dr Parikh.
(With inputs from PTI)
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Prime minister Keir Starmer delivers a speech at The British Chambers of Commerce Global Annual Conference in London on June 26, 2025. (Photo by EDDIE MULHOLLAND/AFP via Getty Images)
PRIME MINISTER Sir Keir Starmer has admitted he was wrong to warn that Britain could become an "island of strangers" due to high immigration, saying he "deeply" regrets the controversial phrase.
Speaking to The Observer, Sir Keir said he would not have used those words if he had known they would be seen as echoing the language of Enoch Powell's notorious 1968 "rivers of blood" speech.
"I wouldn't have used those words if I had known they were, or even would be interpreted as, an echo of Powell. I had no idea – and my speechwriters didn't know either," he explained. "But that particular phrase – no, it wasn't right. I'll give you the honest truth – I deeply regret using it."
Starmer made the remarks last month while announcing new immigration controls. He had said that without proper rules, "we risk becoming an island of strangers, not a nation that walks forward together."
The comments sparked fury from Labour MPs and other critics who accused him of copying the language of Powell, the former Tory minister whose inflammatory speech warned that native Britons had "found themselves made strangers in their own country" because of immigration.
Former Labour shadow chancellor John McDonnell said Sir Keir was "reflecting the language of Enoch Powell," while suspended Labour MP Zarah Sultana branded the speech "sickening."
Diane Abbott, Britain's first black female MP, called the phrase "fundamentally racist."
Sir Keir accepted full responsibility for the mistake, saying he should have "read through the speech properly" and "held it up to the light a bit more." He also acknowledged there were "problems with the language" in a policy document where he claimed recent immigration had caused "incalculable" damage to Britain.
The climbdown marks another reversal for the Labour leader, who has faced criticism for changing course on several policies including winter fuel payments and welfare reforms. Just this week he watered down controversial benefit changes to avoid a rebellion from his own MPs.
Reform UK leader Nigel Farage seized on the apology as proof that Sir Keir "has no beliefs, no principles and just reads from a script."
Shadow justice secretary Robert Jenrick said it showed the prime minister "doesn't believe in borders or the nation state."
Despite the backlash when the speech was first delivered, Downing Street had initially defended the comments.
The prime minister's spokesman said they "completely rejected" comparisons to Powell and confirmed Sir Keir stood by his words.
Home secretary Yvette Cooper had also backed the prime minister, arguing his remarks were "completely different" to Powell's and highlighting how he had praised Britain's diversity "in almost the same breath."
London mayor Sadiq Khan and Welsh First Minister Eluned Morgan had both distanced themselves from the language at the time, with Khan saying they "aren't words that I would use."
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Sir Sajid Javid (Photo by Tom Nicholson-WPA Pool/Getty Images)
A cross-party group has been formed to tackle the deep divisions that sparked last summer's riots across England. The new commission will be led by former Tory minister Sir Sajid Javid and ex-Labour MP Jon Cruddas.
The Independent Commission on Community and Cohesion has backing from both prime minister Sir Keir Starmer and Tory leader Kemi Badenoch. It brings together 19 experts from different political parties and walks of life.
It was set up following the violent unrest that broke out in 27 towns and cities after three young girls were killed in Southport last July. False claims about the attacker's identity spread rapidly on social media, helping to fuel the disorder.
Sir Sajid warned that Britain has become a "tinderbox of division" due to years of neglect. He said governments have only acted when tensions boil over, rather than dealing with the root problems. "We are more disconnected as a country than at any point in our modern history," he told reporters. "There is a pandemic of loneliness that has spread across the country."
According to Javid, who served as communities secretary, home secretary and chancellor in the cabinets of David Cameron, Theresa May and Boris Johnson, social cohesion had been treated as a “second tier” issue by successive governments.
“Communal life in Britain is under threat like never before and intervention is urgently needed," he told the Telegraph. "There have been long-term, chronic issues undermining connections within our communities for several decades now, such as the degradation of local infrastructure from the local pub to churches, the weakening of family units, growing inequality, declining trust in institutions and persistent neglect from policy-makers."
He pointed to several factors making the situation worse, including high levels of immigration that haven't been properly managed, rising cost of living pressures, social media spreading extremist views, declining trust in public institutions, and the breakdown of local community spaces like pubs and churches.
Cruddas, who represented Dagenham for over 20 years, said the commission would listen directly to people across Britain rather than impose solutions from Westminster.
Over the next 12 months, the panel will examine what's driving people apart and develop practical recommendations for government. The group includes former West Midlands mayor Sir Andy Street, ex-Green Party leader Caroline Lucas, and counter-extremism expert Dame Sara Khan.
The commission is being supported by the Together Coalition, which was founded by Brendan Cox after his wife, MP Jo Cox, was murdered by a far-right extremist in 2016.
Sir Sajid remains optimistic about Britain's future, saying the country has "phenomenal attributes" to overcome its challenges. The commission aims to create "a vision for communities that all British citizens can buy into."
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Masum was seen on CCTV trying to steer the pram away and, when she refused to go with him, stabbed her multiple times before walking away and boarding a bus. (Photo: West Yorkshire Police)
A MAN who stabbed his estranged wife to death in Bradford in front of their baby has been convicted of murder.
Habibur Masum, 26, attacked 27-year-old Kulsuma Akter in broad daylight on April 6, 2024, stabbing her more than 25 times while she pushed their seven-month-old son in a pram. The baby was not harmed.
Bradford Crown Court heard that Akter had been living in a refuge since January after Masum threatened her with a knife at their home in Oldham. Masum tracked her using her phone location and confronted her after she left the refuge to meet a friend, believing he was in Spain.
Masum was seen on CCTV trying to steer the pram away and, when she refused to go with him, stabbed her multiple times before walking away and boarding a bus. He was arrested three days later in Aylesbury, Buckinghamshire.
Kulsuma Aktergetty images
Masum, of Leamington Avenue, Burnley, had admitted manslaughter and possession of a knife but denied murder. He was found guilty of murder, stalking, making threats to kill, and assault by beating.
The Crown Prosecution Service said the attack was “planned and premeditated”. West Yorkshire Police described it as a “brutal” daylight attack. Det Ch Insp Stacey Atkinson said Ms Akter “should have been safe”.
The Independent Office for Police Conduct found no breach of standards by officers involved prior to her death. Masum is due to be sentenced on 22 July.