The Adult Dependent Relative Rule May Result in NHS Doctors Leaving the UK

Danielle Cohen
By Danielle Cohen Immigration Law Solicitor Linkedin
Danielle Cohen has over 20 years of experience as a lawyer and a reputation for offering professional, honest and expert advice.
16 November 2021

Again, we have been asked to assist in an appeal for a Pakistani elderly woman who is alone in Lahore and who relies on her care from her son who is an NHS consultant. 

In addressing cases of adult dependent relatives from Pakistan, we have to concentrate on the social custom of family care in Pakistan and what the consequences are of not following the social custom of the relatives being looked after by their sons.  We need to focus on the availability of non-family elderly care and residential care home facilities. Finally, we need to deal with the issues of live-in carers and the social and cultural attitudes towards lone elderly parents left behind, whilst their relatives live and work in the UK.  Each country and each case needs to have regard to similar issues.

The Home Office when refusing applications for elderly relatives are usually quick to state that the elderly can avail themselves of residential or home care facilities. However, that ignores the fact that in Pakistan, as well as in other countries, infirm or elderly are mostly taken care of in the family context and that family solidarity is very important in the protection of the elderly.  In Pakistani culture there is no concept of leaving one’s own parents with relatives or in old people’s homes.  Caring for one’s parent is a duty on male children and not doing so brings shame and dishonour on the family. In Islamic society, serving one’s parents is a duty second only to prayer and it is considered the parent’s right to expect it.  Given that it is the duty of the daughter in law to take care of her parents in law, even if an applicant has daughters in Pakistan, it will be the duty of the son, who may be resident in the UK, to take care of their parent.  Therefore the pattern of son and daughter in law having the obligation to take care of elderly parents is the common position. 

There are care homes in Pakistan in Lahore, Karachi and Islamabad.  Some are operated by the Government.  However, these care homes do not benefit from legislation to regulate functioning accountability or performance.  Even if these care homes were to be sufficient, it would not solve the social stigma attached to living in an old age home, and it is presumed that parents are being neglected and abandoned by their children if they stay in one of these care homes.  We have obtained expert advice that private care providers for the elderly in Pakistan are also deficient in their training and cannot always deal with special health care issues facing the elderly or those who have physical or psychological difficulties.  Again, there is no legislation in Pakistan to regulate private care and there is always the risk of ill-treatment at the hands of such private care givers 

Since the Home Office introduced these rules, a very small number of parents and grandparents worldwide have had their out of country applications succeed for the first time.  The British Medical Association together with other leading medical bodies have issued a call for the adult dependent relative rule to be amended to allow settled migrant doctors to bring adult relatives such as elderly parents to the UK.  Their joint letter to the Home Secretary asked to exempt doctors from the adult dependent relative rule.  A link to this letter can be found here. 

The Letter to Priti Patel by the BMA 

Since the letter was submitted on 13th January 2021 no further changes to the Rules have taken place.  At Danielle Cohen Solicitors we want to see that the adult dependent relative rule is abolished or amended in a way which will give many doctors working on the front line the reassurance they need to stay working in the NHS whilst fulfilling their personal caring responsibilities for their parents.