Richard Smith: An open blog to Prime Minister David Cameron

Richard Smith Dear prime minister,

I heard you give an inspiring speech earlier this week about how Britain was “open for business,” particularly in the life sciences. But when I arrived home I found a desperate email from an Indian friend, a professor of cardiology, describing a most awful plight that the British visa system has inflicted on him. Your words may, I fear, come across as empty and even hypocritical if you cannot improve our visa system, which the London Evening Standard newspaper says is the worst in Europe.You spoke to the Global Health Policy Summit, and colleagues with me from China and South Africa were greatly impressed by the energy and clarity of your presentation. They liked especially how you took questions from anybody in the audience and answered them in detail and with confidence. They couldn’t imagine the leaders of their countries doing so well.

There were five strong reasons why you thought people should invest in life science businesses in Britain. Firstly, Britain has a strong science base and world class universities. (This was all happening in the Guildhall, a giant, mock gothic space filled to the brim with princes, princesses, excellencies, lords, ladies, barons, dames, knights, and a whole lot of people so grand that I thought they were dead. In such circumstances positivity is the order of the day, but I couldn’t help thinking that some unfunded scientists and hard pressed universities might have winced at your claims.)

Secondly, the life science industry is already strong in Britain with large companies like GSK and many smaller companies providing 165 000 jobs. You seem convinced that personalised medicine (now called stratified medicine partly because personalised medicine had been oversold) will become the future, bringing benefits to patients, health systems, and industry.

Your third reason was that the British government is “pro-business,” cutting corporation tax and providing generous tax credits for research and development. You’ve also created a “patent box,” which means that companies will pay only 10% tax on innovations patented in Britain. This has led GSK to invest heavily in Britain.

The NHS, which is providing care to 60m people, was the fourth reason for investing in British life sciences. It provides a great test bed for research, and its purchasing power is unequalled in health. You are planning as well to produce an early access scheme for new drugs for patients who cannot be treated with existing treatments. (After writing this sentence I hear Michael Rawlins, the chair of the National Institute for Health and Clinical Excellence (NICE), describe how many primary care trusts are breaking the law in not making available to patients drugs approved by NICE.)

The final reason was that Britain is leading the world in making data available. Your expectation is that people’s health data will be available in anonymised form unless they opt out.

This was a great sell, and you received long applause. Imagine then my deflation when I arrive home to receive an agonised email from the friend, who is distinguished and influential Indian professor of cardiology who has been a vice chancellor of a university. He trained in Britain 40 years ago and made his contribution to the NHS. An Anglophile, he visits regularly, lectures, meets with research colleagues, and adds to the intellectual creativity in Britain that you want to promote.

His multiple entry visa has expired. As he is currently in the US he has applied for a visa there. He’s had to submit to the British authorities both his Indian passport and his US green card. He was told that his visa would be available in 10 days, and he booked a flight to the UK, allowing some leeway. Three weeks later he has neither his passport, his green card, or his visa. He has tried phoning and emailing the British embassy but can get no response. Housebound for fear of going out without passport or green card (some US states are very unfriendly to the “undocumented”), he has now tried to withdraw his application for a visa. He hopes to return directly to India.

Thinking back on your speech, I note that you didn’t mention the issue often raised by business of the difficulty of bringing brain power to Britain. You know that many businesses these days, especially successful ones, are not British but global. They need to be able to move talented people from one country to another, and if a country makes that difficult they will pass it by. Are you pandering to the xenophobia that is never far away in Britain despite how much we have benefited from immigrants and foreign visitors?

I fear that my talented Anglophile friend abused by the British visa system will not want to return to our country. That will be a loss to Britain, and as story of his abuse spreads among his Indian and other friends all the good you attempted in yesterday’s speech will be undone.

Please, Prime Minister, fix our sclerotic, outdated, shameful, anti-business, abusive visa system.

Yours sincerely

Richard Smith

PS. Since I wrote this blog my friend has received his visa and is still sufficiently fond of Britain that he will return.

Richard Smith was the editor of the BMJ until 2004 and is director of the United Health Group’s chronic disease initiative.