Esther Simpson, pioneer and inspiration for Making it to the Registers

By Marie-Andrée Jacob

In this first blog entry I introduce our 2023-2025 AHRC project Making it to the Registers via a foray into the personal archives of tireless activist Esther Simpson.

4 August 2023

To many residents of Leeds and staff and students at the University of Leeds, Esther Simpson will be known as being a new university teaching building opened in 2022. Cambridge barrister and law reader John Eidinow has recently published her biography: Esther Simpson: The True Story of Her Mission to Save Scholars from Hitler’s Persecution (Robinson publisher, 2023)

Esther Simpson is intimately connected to our AHRC research project Making it to the Registers: Documenting Migrant Carers’ experiences of registration and fitness to practise, which we launched at the Leeds Playhouse on 31 March 2023.

She worked, between 1933 and 1978, as Secretary of the organisation Academic Assistance Council (which then became the Society for the protection of science and learning).  In fact, she was much more than the organisation’s secretary: Esther Simpson was a lobbyist, an administrator, negotiator, translator, and interpreter. She worked tirelessly to arrange for grants and opportunities to help find work and relocation plans in Britain and across the Commonwealth for refugee academics who were fleeing Nazi Germany and other persecuting regimes. Over the years she has used her extensive networks to help hundreds of academics. In the words of a journalist interviewing Simpson in 1992, to the Society for the Protection of Science and Learning, ‘the idea was to salvage people and not to let remarkable talents, experience and expertise go to waste.’

In 2023, there is not a week that goes without the media lamenting on the shortage of qualified staff to sustain the NHS. And yet internationally trained healthcare staff, doctors, nurses, and pharmacists arrive here with skills and expertise but find extremely hard to access jobs they are trained to do. Talented, educated people being disabled, and hobbled by various regulatory hurdles. This disconcerting puzzle is at the centre of our project.

The background: who is relied upon in times of emergency?

Our inquiry into the regulatory hurdles faced by internationally trained healthcare workers started in during the 2020 global pandemic. Whilst looking for information about the UK General Medical Council’s response to the pandemic, we came across archivist Courtney Brucato’s blog on the history of the GMC’s responses to doctor shortage in times of crisis.  We found out that during World War II, facing an intensified demand for doctors, the General Medical Council (GMC) extended emergency registration to Jewish refugee doctors and overseas- qualified doctors primarily from British colonies.

In 2020, the GMC was facing a similar challenge. Article 2 of the 2020 Coronavirus Act, stipulated for the emergency registration of health care professionals.  The GMC and other statutory regulators opened their registers to get more staff to help out. On that occasion, the regulators focused mainly on bringing back retired doctors on to the Medical Register.

Given the history of the GMC policies, we can ask how else could the Register have been opened during the pandemic?  In times of need, who is envisaged and trusted to answer the call of duty?

When researching the history of UK medical registration from its inception in 1858, we saw that the definition of who can become and remain and health care professionals is flexible, and that the register can open and tighten depending on circumstances.  For example, our research has discovered that the 1960s a perceived ‘oversupply’ of foreign medical graduates led to the termination of reciprocal registration arrangements with Commonwealth countries. The register, as well as the fitness to practice procedures (that relate to the skills, knowledge, health, and character that professionals must satisfy to remain on the register), are highly adaptable to changes of circumstances.  This taught us that the medical register is not devoid of political consideration, and is far more complex and richer than being just a bureaucratic tool compiling names of qualified practitioners.

What we are dealing with is a regulatory instrument that is intimately connected to colonial legacies, and responsive to political, public health and economic pressures, including interactions with professional associations, lobby organisations, and trade unions.

We also know that despite the well-researched fear of migrants embedded in the creation and maintenance and delivery of health services, the NHS has been since its inception, and still is, reliant on immigrant labour.

Hence the question: what does it takes to become, and to remain a healthcare professional today?

This is the background question at the heart of Making it to the Registers. Some sub-questions we aim to explore include: How have regulators, historically and in the present day, adapted registration requirements and FtP procedures for emergency conditions? What are the past and present experiences of registration for migrant health workers of these requirements and procedures?  What other mechanisms regulate the conduct of future and present professionals broadly speaking, and what sort of exemplars might they offer for the Fitness to Practise model. What is the role of modern registration in maintaining Fitness to Practise, ensuring patient safety and supporting regulatory objectives such as widening participation?

To answer these questions, we need to better understand the impact of registration and Fitness to Practise on broader social, legal, culturally competent ways to acknowledging the contribution of internationally trained carers in the UK. To answer these questions, we will be looking at the history using various archives, including those of the General Medical Council, Nursing and Midwifery Council, British Medical Association, Royal College of Physicians, Royal Society of Medicine, Home Office, Foreign and Commonwealth Office, as well as the archives of our partner organisation British Association of Physicians of Indian Origins, as well less institutional archive collections. To capture contemporary experiences we will  interview health care workers, organisations who represent and lobby for them, as well as regulators.

Esther Simpson’s lifelong goal was not to let talent, expertise, and knowledge that we need go to waste. Our initial findings show that people with the expertise that is so sorely needed need to go through such hurdles to make it to the registers and to be recognised as available to contribute to collective efforts, including in times of crisis.

 

The Making it to the Registers team includes Priyasha Saksena, Nasreen Ali, Amrita Limbu and Marie-Andrée Jacob.