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The Department of Health has revised its guidelines for recruiting overseas professionals – including nurses. But although they are essential to running many parts of our NHS, many developing countries are losing out to this 'brain drain'
Overseas nurses: the ethical dilemma
With nursing shortages in the NHS rarely far from the headlines,
it's time for some new thinking to prevent a widening of the staffing
crisis.
One of the solutions has been to fill places in the UK with qualified
nurses from abroad. This has had a positive effect on diversity within
the NHS and has proved to be essential to running an effective health
service, with internationally recruited nurses accounting for 40% in some
hospitals.
However, this process throws up particular questions, not least whether
it is ethical to undertake blanket recruitment of nurses from developing
countries when their own health services are desperately in need of staff.
UNISON has welcomed the recent revision by the Department of Health of
the code of practice for the international recruitment of healthcare professionals.
The code ensures developing countries will not be targeted unless there
is an explicit government-to-government agreement with the UK to support
such a move and that internationally recruited healthcare professionals
are protected by UK employment law.
Developing countries will have spent precious resources training their
clinical staff. If large numbers leave to find better paid jobs in other
countries this will have a hugely damaging effect on their countries'
health provision and economy.
The new code, however, only covers the NHS and the parts of the independent
sector that provide services or staff to the NHS. It does not cover recruitment
agencies or the vast majority of the independent sector, which leaves
them free to recruit as many nurses as they need from abroad.
Nurses recruited in this unethical way are then free to move across to
the NHS. The only way to prevent this is for the DTI to intervene to prevent
unscrupulous employers from viewing international recruitment as a means
of finding cheap labour. The intervention would also prevent further damage
to the other countries' economies.
Even with the implementation of ethical recruitment, more needs to be
done to ensure that nursing staff who choose to come to work in the UK
are not used merely as a buffer to existing staff. They must be viewed
as a valuable part of the healthcare team and given the opportunity to
develop their careers.
In the '60s and '70s, the UK had a huge recruitment drive in Commonwealth
countries, particularly the Caribbean, South Africa, Hong Kong, Malaysia
and Mauritius, encouraging people to come to train as nurses. But when
they arrived their experiences were often marred by racial discrimination.
They had little or no career structure, faced bad treatment and were prevented
from advancing themselves. Retaining these staff became increasingly difficult
and a knock-on effect was that many discouraged their friends or children
from joining the profession. This is demonstrated by a lack of second-
and third-generation black and ethnic minorities choosing nursing as a
career.
UNISON has been at the forefront of campaigns to ensure that all nurses
should receive fair and equal treatment, regardless of where they were
recruited.
So how can we prevent damage to other countries' economies, even with
the DoH's code of practice in place?
If the UK were to start recruiting young people from developing countries
to come to train as nurses, rather than employing fully qualified nurses,
it would mean that we would be investing our own resources in our health
service, rather than siphoning off another country's.
In this way, the student nurses would contribute to clinical care through
practice placements during their studies. After qualification they would
be free to stay on to work in the NHS or return home. From past experience,
we have seen that the majority is keen to stay on.
However, this does not remedy the high drop-out rate among student nurses.
The introduction of a wage for student nurses and midwives would help
to alleviate the pressure they face.
To qualify as a registered nurse, students are required to fit 4,600 hours
of learning into a three-year period with over half of them on practice
placements and are often required to study through the long university
holidays. This is why their training sets them apart from other students.
For internationally recruited student nurses, that wage would mean that
they could afford to live here and also send some money to their families
- their main reason for travelling so far from home.
The government of the Philippines has signed an agreement with the UK
encouraging nurses to come to work in the UK; the remittance revenue generated
by the emigration is hugely beneficial to the country, while the nurses
are able to send money home.
It's time we stopped looking at quick fixes. By 2010, 100,000 nurses are
due for retirement in the UK. Though the ethical international recruitment
of nurses is beneficial to all countries through the skills transferred,
the international pool of nurses is decreasing and we cannot hope to fill
all these vacancies.
We must address why it is so difficult to recruit and retain nurses within
the UK. An important first step would be to give student nurses a decent
living wage so that more of them can afford to train to make nursing their
chosen career.
Report by Celestine Laporte, assistant national officer, Health, for UNISON.
First published in The Independent newspaper.
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