[A-List] UK imperialism: development of underdevelopment

["Michael Keaney" <michael.keaney@xxxxxx>]

Scandal of NHS and Third World nurses
By Jeremy Laurance, Health Editor
The Independent, 26 November 2002

Britain is systematically stripping the developing world of its nurses to
shore up the NHS, despite a government ban on recruiting from the Third
World.

In the five years since Nelson Mandela appealed to Britain to stop poaching
nurses from South Africa, the numbers entering the country have risen more
than fivefold - from 393 in 1997-98 to 2,114 in 2001-02.

Two thousand nurses are needed to run a 600-bed hospital in the UK.

Recruitment is also spiralling from other African countries, including
Zimbabwe, Zambia, Kenya, Botswana and Malawi. In total, these five countries
supplied 986 nurses to Britain last year, compared with 91 in 1998-99,
figures from the Nursing and Midwifery Council reveal.

Ministers urged NHS trusts to stop actively recruiting in South Africa in
response to Mr Mandela's appeal but did not formally ban them until 1999.
The ban included Caribbean countries, and recruitment from there has since
declined (although they still supplied 248 nurses in 2001-02).

Last year the Government published a code of practice extending the ban to
all developing countries except where the host government had invited the UK
to recruit. This included countries such as the Philippines, where there is
a known surplus of nurses.

The ban did not extend to commercial recruitment agencies, which critics say
are now doing the NHS's "dirty work". A spokeswoman for the Nursing and
Midwifery Council said yesterday: "Our impression is that most nurses from
Africa are coming through private recruitment agencies despite the
Government's advice not to recruit from there."

The Department of Health said 34 recruitment agencies, listed on its
website, were registered as following its code and operating ethical
recruitment practices, including not recruiting from the developing world. A
spokeswoman said she did not know what proportion of the total number of
agencies this represented.

In a parliamentary written answer to the Liberal Democrat MP Paul Burstow
earlier this month, the department said there were 92 agencies in all -
meaning two out of three had not signed the code of conduct.

Evan Harris, the Liberal Democrat health spokesman, said yesterday: "It's
disgusting and it was predictable that reliance on overseas recruitment
would pull in the precious trained staff from other countries. It is morally
indefensible to allow this to happen without admitting it, quantifying it
and offering some reciprocation. The Government has decided that the
priority is to increase the capacity of the NHS no matter what the cost. And
it is the populations of these poor countries that are suffering."

The Department of Health spokeswoman said NHS trusts were "encouraged" to
use only those agencies that followed the code of practice, but they could
not be ordered to do so because of the Government's policy of devolving
decisions.

She said: "We are committed to the ethical recruitment of staff from abroad.
The NHS does not actively recruit nurses from developing countries or
through recruitment agencies."

Several nurses had arrived through word of mouth or by learning of job
opportunities on the internet. "We can't prevent people coming to this
country and getting a work permit if they want to," she said.

Some countries have a surfeit of nurses. The department currently has
agreements with India, Spain and the Philippines allowing the NHS to
recruit. The Philippines, known to NHS trusts as a "nurse factory", trains
nurses to go abroad so that they can remit their earnings back to their
families at home, boosting the country's economy.

Last year it was Britain's single biggest source of nurses, supplying 7,235,
compared with 52 in 1998-99.

South Africa is the second biggest source of overseas nurses, followed by
Australia and India.

-----

News Analysis: Why foreign nurses hold the nation's health in their hands
Health service trusts are recruiting growing numbers from overseas to ease
staff shortages while home-grown hospital workers emigrate
By Jeremy Laurance, Health Editor
The Independent, 26 November 2002

They are of all colours, all backgrounds and from all points of the globe.
Some come for love, some for money, some for a better life but they are all
here for one purpose - to keep our hospitals, surgeries and care homes
going.

They are the overseas nurses on whom the National Health Service now depends
and, though they might not realise it, they hold the future of the Labour
Government and the Prime Minister in their hands.

Tony Blair has staked his political future on the survival of the NHS. He
has invested huge sums to maintain and improve it, sums so large that they
are close to the limit of what can be spent. His biggest problem in keeping
promises to cut waiting lists, increase the number of patients treated and
improve the quality of care is not, any longer, money. It is people.

The NHS does not have enough pairs of hands to deliver the care that the
nation needs. There are too few home-grown nurses willing to do the job. So
hospitals are turning abroad to find staff.

At the Manchester Royal Infirmary they have recruited more than 250 nurses
from India in the past two years, placing advertisements in local
newspapers, hiring recruitment agencies and holding interviews by video
link. Jinto Joseph, from Bangalore, arrived 18 months ago with 20 of his
compatriots and is now working on an orthopaedic ward in Manchester. "I got
my work permit and my flight was arranged in four weeks. It was very quick.
Everything here is so different," he said.

Those 250 Indian nurses mean the difference between triumph and disaster for
the infirmary. Without them almost 20 wards would have to close, according
to head of nursing, Cheryl Shuttleworth.

"We anticipate there will be 4,000 vacancies for nurses across Greater
Manchester by 2005 unless we do something to boost recruitment. That is a
huge number. Our own trust is growing massively and services are expanding
but the available workforce has shrunk. There is huge competition for
staff."

Indian nurses now account for one in ten of the infirmary's nursing
workforce. The infirmary selected India because, Ms Shuttleworth said, it
had a surplus of nurses. They also had very good training and a good work
ethic. "They are conscientious and caring. Their English is good and we
found them highly skilled. We just want to train them to be a bit more
assertive," she said.

In addition, a dozen other countries supply staff, including the
Philippines, Australia, Spain, Ghana, Germany, Iceland and the Yemen. The
infirmary runs an adaptation course - for which it has won a training
award - to bring its overseas nurses up to the standards expected in
Britain. There has been little racism, few communication difficulties and
only minor problems caused by different cultural expectations. Some of the
Indian nurses have complained that patients do not show them enough respect,
demanding second opinions. But, says Ms Shuttleworth, that is a matter of
adjusting to the lower levels of deference shown to professionals in
Britain. Overall, the international recruitment programme has been a "huge
success", she says.

There is a global shortage of nurses, and a global market that governments,
commercial agencies and enterprising individuals are learning to exploit.
Countries in the developing world are discovering a valuable export in
skilled medical labour. The Philippines is the world's most productive nurse
factory - turning out thousands of young nurses to meet the burgeoning
demand in the developed world.

Filipino nurses send regular sums of money to support their families at
home. So do Filipino technicians and other skilled professionals. By earning
much-needed foreign currency, they have become the engine that keeps the
home country's economy ticking over.

Last year, 7,235 nurses travelled to the UK from the Philippines, bringing
the total to more than 11,000 in three years. In 1998- 99, only 52 Filipino
nurses set foot on these shores.

In total, 15,064 nurses from overseas countries outside the European Union
arrived in Britain last year. It represented a four-fold increase on the
number entering in 1998-99. A further 1,091 nurses from the EU took the
total to 16,000 foreign nurses admitted last year.

They are still a tiny proportion of the 400,000 nurses working in the UK,
but they are essential to keeping the health service functioning. Beverley
Malone, general secretary of the Royal College of Nursing, said: "Overseas
recruitment is not a short-term measure, it is a long-term solution. We must
work with our overseas colleagues and embrace them. There just are not
enough home-grown nurses."

The Government target of an extra 20,000 nurses by 2005, set in the NHS plan
published in July 2000, has already been achieved, more than two years ahead
of schedule, thanks to overseas recruitment. Now ministers have set a new
target, of recruiting an extra 35,000 nurses by 2008.

But the global market is getting tougher as countries vie for position in
the increasingly desperate struggle for extra pairs of skilled hands. Tom
Sandford, London regional director of the RCN said: "Increasingly, people
are fishing in the same pool. The US said it needs to recruit one million
nurses over the next 10 years.

"If you go to a recruitment fair in the Philippines, out of 10 interview
suites, nine will be occupied by Americans and one by the British. The
Americans are offering $5,000 (£3,200) to a nurse who brings a friend to
work in the US plus another $5,000 for the friend. The pool of nurses we
have been totally reliant on is not going to be there in the future."

The global shortage raises an ethical issue. Should we be poaching nurses
from countries that can ill-afford to lose them? The charge is that the NHS
is stripping the developing world of its most vital resource, skilled
medical staff.

The RCN supports overseas recruitment but says it must be done ethically and
that proper support must be given to nurses once they are here.

Three years ago, after an appeal from Nelson Mandela, British ministers
issued a directive banning all NHS trusts from recruiting in the developing
world, except from named countries (including the Philippines) where there
was known to be a surplus.

The abject failure of that directive was revealed this month in figures
published by the Nursing and Midwifery Council showing recruitment doubled
from South Africa last year. We took 2,114 of its nurses, more than three
times as many as in 1998-99 when Mr Mandela made his plea. A further 1,500
came from other African countries, including Zambia, Malawi and Botswana.

The poor have to seek their fortune where they can and few countries are
keen to restrict the free flow of labour. But the loophole in the
Government's ban on NHS trusts was that it did not extend to commercial
recruitment agencies, which are now doing the NHS's dirty work.

Some nurses have alleged exploitation by recruitment agencies, who have
charged fees of more than £2,000 to bring them to Britain.

The Government has set up an international helpline for overseas nurses
where they can report problems or seek assistance to prevent exploitation.

But even as the NHS pulls in nurses from overseas, British-trained staff are
leaving. For every two nurses recruited overseas, a home-grown one moves
abroad. Last year 6,256 British nurses emigrated, the highest number for 10
years. There was a strong recruitment drive from America, which took 1,089,
more than twice as many as the previous year.

One of them is Alison Webster, from Derby, who is on her way to Seattle on
the west coast where she will work as an HIV nurse for twice the salary she
can earn at home.

But it is not just the money, she says. "When I went out to the US the staff
made me feel important and appreciated. When you go to an interview in the
NHS it is about, 'What are you going to bring us'. In Seattle it was more a
case of, 'What can we offer you to come?'."

Nurses who speak English are finding they are at a premium - in demand all
around the world. America, Australia, New Zealand, the Republic of Ireland
and Britain are trying to solve their problems by recruiting from each other
and from the developing world.

Work permits for nurses are being fast-tracked by governments desperate to
solve their staff shortages, and employers are sponsoring applications for
immigration.

British nurses can now pick and choose where they work and more of them are
spotting the advantages of becoming internationally mobile.

Nurses are discovering they have economic power and it is a discovery that
will cause increasing discomfort to the NHS and, ultimately, to Tony Blair.

CYNTHIA ANKRAH-BOI SENIOR STAFF NURSE, 39, FROM ACCRA

Love was what brought Cynthia Ankrah-Boi, 39, to Britain. She met her future
husband - an engineer working in England - while he was on a trip to Ghana.
They were old family friends and when the relationship blossomed, she agreed
to give up her job at Accra's main hospital and move to Manchester.

She arrived three years ago and initially stayed at home to look after their
baby son. Since completing an adaptation course at the infirmary last year
she has been working in the endoscopy unit. She was recently promoted to
senior staff nurse. She said: "In Ghana you struggle every day to get the
equipment and the resources. Here it is up to date and available. I find it
very easy to work here."

Her current salary of £16,000 is incomparable with the £40 a month she
received in Ghana.Though she admits she struggled at first to cope with her
new environment, she now plans to stay.

"Even though I had been trained, the culture was different. I had to get
used to the equipment and the way of communicating. But the staff were
absolutely lovely and I have had no problems from the patients."

JINTO JOSEPH STAFF NURSE, 26, FROM BANGALORE

Jinto Joseph was working in Hosmat orthopaedic hospital 18 months ago when
he saw a newspaper advertisement offering him the chance to work in Britain.
He contacted an agency acting for the Manchester Royal Infirmary in India
and went to Delhi for an interview by video link with his prospective
employers. A few weeks later he was on a flight with 20 others, all bound
for jobs at the infirmary.

"There was some fear among us but as soon as we got here we had really good
support from the international recruitment department at the hospital. There
were no problems except homesickness and after a very few weeks I was
becoming like an Englishman. Most of us are really happy." The group took a
six-month adaptation course, laid on by the infirmary, to ensure their
skills were up to scratch and to help them to adjust to British ways of
doing things.

Mr Joseph, 26, earns £16,000 a year basic plus overtime, some £18,000 a year
in total. Although the pay is better than in India he does not feel rich
because the cost of living is so much higher.

"In India people pay for care and they are more demanding," he says. "Here
the patients are more considerate."

MONA FARRER SENIOR STAFF NURSE, 33, FROM YEMEN

Mona Farrer is ambitious. She arrived here three years ago with a degree in
nursing from Yemen, her home, and a diploma from Kuwait.

In Manchester she is working towards a masters degree and plans to go on to
do a PhD. Eventually she wants to return to Yemen. As a career woman, aged
33 and single, she is a rarity in her home country. "It is not very common
to find someone like me," she admits.

She is an E-grade nurse on an acute medical ward at the Manchester Royal
Infirmary. She earns £17,000. Her previous post, in Kuwait, was as director
of nursing in a maternity unit where her salary was "quite high" although
the cost of living was also high. "Nurses never have good salaries. This is
true all over the world, even though we work hard," she said.

The work in Britain was satisfying but it was a long way from her family,
she said. "I do miss them - although I have lots of wonderful friends."

She does not want to stay single for ever and hopes to have a family. But
for now her career takes precedence. She said: "I do want to do something
for Yemen. We do not have a [regulatory] council for nurses. I would really
like to take that idea back to Yemen."

ROSARIO FERNANDEZ STAFF NURSE, 25, FROM BARCELONA

Spain has a surfeit of nurses. Rosario Fernandez, 25, from Barcelona, wanted
a career that offered a broad range of experience ­ and that was hard to
find at home. "I was a community nurse and I didn't like the conditions of
work in Spain. It is difficult to get a good job. For myself, I found it
more satisfying in Manchester," she said.

Ms Fernandez initially came for 18 months, returned to Spain for six months
and arrived back here for a second time three weeks ago. "I came the first
time for the experience. Then I realised I enjoyed it more so I stayed
longer than I expected," she said.

It was the social life that kept her here, as much as the work. Manchester
is a multicultural community ­ a melting pot of cultures from around the
world.

"England is not only for the English ­ there are people from many countries
here. It is not difficult when you respect each other. It is good fun rather
than a problem. I am quite happy here."

She did not come here for the pay. Nurses are as poorly paid in Britain as
they are the world over, she says. She is a D-grade nurse working on a
surgical ward on a salary of £16,000. Although that is slightly more than
she was getting in Spain, the cost of living here is higher so it works out
about the same.

"I wouldn't come here for the money. I have not met a nurse who is rich," Ms
Fernandez said.