Richard North, 06/04/2015  

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To my piece on the accumulation of "marginal gains" as a means reducing immigration, we need to add a further note, to cover other aspects of immigration control.

A great deal of migration – although no one has put a specific figure on it – arises from the need to fill skilled posts, where there are insufficient local recruits holding the right qualifications, largely because the training provision has been inadequate.

This was an issue to which the Daily Mail drew attention in December last year, where it highlighted the shortage of paramedics and the recruitment of large numbers of trained personnel from Australia.

Now the paper is back on the case with an update to its original story, reporting that "ambulance bosses" are routinely making a 21,500-mile round trip to Australia to hire paramedics on £4,500 "golden hello" payments because it is far cheaper than training them in Britain.

This, though, is an almost exact copy-out from a Guardian story last month, where the headline issue was that managers from the London Ambulance Service, the largest in the NHS, were just about to make 250 job offers to applicants from Sydney and Melbourne.

Adding to this story, the Mail tells us that the inability to meet expected demand for paramedics is not the only issue. There is also the problem that many are quitting the NHS, frustrated at having to spend hours queuing outside A&E units which are too full to accept their patients. There is also, apparently, resentment at being called out to a growing number of non-urgent calls from patients unable to see a GP.

However, it is also the case that career opportunities for paramedics are expanding, as they can now become "advanced practitioners" in A&E units in hospitals and in GP surgeries. They can also get jobs in call centres for the 111 helpline, where the work is less stressful and they can earn more.

The resulting exodus has hit the London Ambulance Service hardest. Currently 340 posts are vacant, a fifth of the total workforce. Last year alone more than 230 paramedics quit. However, Australia has a surplus. Other understaffed ambulance services in the UK are also going abroad, including to Poland.

As well as the 225 paramedics hired from Australia last month, London Ambulance Service hired 175 from New Zealand in September. Managers are considering flying out again later this year and calculate that the first recruitment drive saved the NHS £9 million.

Certainly, the arithmetic seems to make sense. It costs £50,000 to train one paramedic in Britain. Each trip to Australia costs the ambulance service £90,000 in flights and hotel bills, but they return having hired on average 200 paramedics.

Jason Killens, director of operations at London Ambulance Service, said: "It's not our long-term solution but is helping us fill a skills shortage while we train more people to become paramedics in the UK".

Putting a political "spin" on this, one assumes that Ukip – in adopting the Australian "points-based" migrant system – would permit an unlimited number of qualified paramedics to enter Britain, and presumably would also expand the national quota to allow in other migrants where there were skill shortages.

But what we don't see is any attempt at formulating joined-up policy, where demand prediction is improved, and money is allocated to areas where skill shortages are anticipated, to ensure that indigenous workers are able to acquire the right training, and take up jobs where there are vacancies.

Even then, there are further issues which have to be addressed. In Australia, for instance, university fees are considerably lower than they are in the UK, and there are no restrictions on popular courses, such as the Bachelor of Paramedic Science, leading to a surplus of qualified graduates.

In the UK, they are offered a starting salary of between £21,478 to £27,901 – which can increase to £30,200 per annum, with London weighting,. For team leaders or paramedics who have undertaken extended skills training in critical care or trauma, salaries fall between £25,783 and £34,530.

This is higher than the equivalent in Australia – where paramedics are considered to be underpaid. For Antipodeans, there is the added bonus of being able to explore England and the rest of Europe, while living in cheap rented accommodation, before returning home.

For UK graduates looking to set up home and start a family, and having to repay student loans, the pay for London employment is not particularly attractive. And it is here that the lack of subsidised accommodation – which used to be a feature of NHS service – which also takes its toll.

In the 1980s and the early '90s, under a programme initiated by Margaret Thatcher, Hospital Trusts were allowed to sell off staff accommodation in high value areas, using the cash to fund expansion without having to go cap-in-hand to the Treasury. But now the great sell-off reflects in the difficulty in attracting local staff.

And all of this illustrates the complexity of dealing with immigration. To recap, in order to minimise the inflow, we need better job market intelligence, more responsive training to ensure that demand for skilled workers can be met locally, a more flexible higher education finance system, to attract students to the right courses, and perhaps a return to tied accommodation, so that key workers can be offered housing as an inducement to work in high-expense areas.

Then, on top of all that, there is a need to sort out the GP service. Despite over-generous salaries and improvements in working conditions, it gets harder and harder for people to get appointments with their GPs. If the pressure on A&E departments is to be reduced (and with it the pressure for more paramedics), accessibility to GP surgeries must be improved.

On the other hand, there is an argument for using immigrants to top up the labour market, when there are specific skills shortages. And if recruits are not allowed to bring families and dependents, and are offered short-term contracts without any provision for citizenship (as with posted workers), then we get the best all worlds.

The trouble is that, in order to make that happen, we need joined-up policy. And that is something which seems beyond the ability of existing political parties to deliver. As for Ukip, policy-wise, they're not even in the same room.

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