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In May CNM was approached by the Times to respond to an article on the increasing recruitment of nurses from developing countries by the NHS.  This was in light of the recent reporting in some of the British press of the problems with health professionals who spoke poor English and other supposed problems associated with non-UK nationals working in the British health system.  Some of this reporting, especially in the tabloid press was, frankly quite racist and inaccurate.
However, my concern was more on the impact this was having in the developing world.

It is becoming a matter of increasingly high profile concern missionary and overseas development circles that many  developing nations are finding that their health systems, which are already under resourced and ill equipped, now so short of staff that they can barely function. 
  Almost 13,000 overseas nurses were registered in the UK last year. Over 40 per cent were from the Philippines (5,594), which trains extra nurses to work abroad and remit money home, and 14 per cent (1,833) from India. A further 804 came from the European Union.  Over the past five years, Britain has taken 6,739 nurses from South Africa -causing Nelson Mandela to appeal to Britain in 1997 to stop poaching South African doctors and nurses.  As a result, the Department of Health urged NHS trusts to cease actively recruiting in South Africa but did not formally ban the practice until 1999. That ban included the Caribbean, which had lodged similar protests.

In 2001, the Government extended the ban to all developing countries, except for the Philippines and parts of India, which had indicated that they would allow Britain to recruit. It also published a code of practice for private recruitment agencies, which aims "to promote the best possible standards and discourage any inappropriate practices which could harm other country's healthcare systems". Agencies are invited to sign the code of practice and provide two references from NHS trusts confirming that they are observing it. About 50 agencies are listed on the Department of Health's website as having signed, about half the total believed to be operating in the UK.  The remainder, it would seem, do not follow these standards at all.

Figures from the NMC released in May show that 3,472 nurses from countries on this "banned" list were registered in the UK over last year - 900 fewer than the year before, but almost one third more than the 2,638 who were recruited from developing countries in 2001, when the ban came into force.

But even countries not on the “banned” list are feeling the effects of this trend.  A recent BBC report on Newsnight (August 27 2003 - see http://news.bbc.co.uk/2/hi/
programes/newsnight/3184479.stm for a transcript and on-line video clip) highlighted how much nursing staff in the Philippines are, quite literally training to work overseas and never practice in their own country.  As a consequence some Filipino hospitals were functioning with one trained staff nurse for fifty patients.  Furthermore, doctors, dentists, and other health professionals are now re-training as nurses too in order to get work overseas that can pay ten to twenty times as much as salaries in the Philippines.  A similar pattern is replicated in other developing nations.  The media are waking up to this now, and approaching Christian organisations like CNM for our perspectives, and it is a chance for us to speak out on an issue that many Christian organisations have been concerned about for many years.

For instance, the impact of this vast migration of nurses on the work of Christian mission hospitals is particularly devastating.  Offering lower salaries and fewer opportunities for training and career advancement than private and some government hospitals, many mission hospitals cannot recruit staff, or train nurses only to see them leave for the cities or the West within a few years.  Maintaining a viable service and Christian witness becomes extremely hard as a consequence, and the communities that they serve suffer dreadfully.

As I outlined in the very brief letter I was asked to write on the matter for the Times, the reality is that this brain drain is caused by a number of complex factors.  Each year, the NHS loses 9% of its entire workforce, leaving it to find around 100,000 employees annually just to stand still. Chronic recruitment and retention problems are widespread, notably in accident and emergency, intensive treatment and theatre nursing, as well as midwifery.  In addition the Royal College of Nursing reckons there are 73,000 nurses aged between 50 and 55 who are expected to retire over the next five to ten years.  We are not training enough nurses to keep pace with these mounting shortfalls. Furthermore those that qualify often do not stay in practice for more than a few years.  Pay, working conditions and general low morale in the NHS is causing a mass exodus from the profession.

This vacuum creates a strong pull to recruit nurses from other parts of the world.  Couple this with the huge wealth inequalities between the rich and poor nations, creating a huge push to nurses to come and work in the West where they can earn many times more than at home in better conditions and with more chances for further training and professional development, and you can see at once that any attempt to address this situation cannot be dealt with by isolated polices.  For instance, just stopping official recruitment doesn’t plug the gap. 

If people cannot work here, they’ll go to other nations with fewer scruples about where they recruit their staff from, or use British agencies that do not sign up to the DoH guidelines.  Unless we can improve the working conditions and incentives for our own staff, and address the huge inequalities of wealth globally, we will see a continuing, life threatening haemorrhage of nurses and doctors from the poorest nations.

How does this affect us in practice as Christian nurses?  Certainly most of us will have African, Caribbean, Filipino, and Indian colleagues, and we cannot sit in judgement on them for leaving their countries to come here to work - if we were in the same situation most of us would do the same to give our families a chance of a decent quality of life.  Indeed, Asian and Caribbean nurses have been the backbone of the NHS for decades. 

They may well need our support and friendship as they struggle to live and work in an alien culture.  Many will be Christians, and we can help support them in finding and integrating in to a local church.  But we also need to be thinking about how we can lobby our trusts to ensure that the agencies they use are following DoH guidelines on recruiting from developing countries.  We can also think about linking in with groups like the World Development Movement and other organisations campaigning to see structural changes in inequalities between nations. 

Jesus always stood on the side of those pushed to margins - the poor, the forgotten and the unloved.  Scripture rails again and again at the rich who exploit the poor for their own profit.  God cares about these injustices - that women in Malawi die on antenatal wards because of a lack of skilled midwives; that there are not enough nurses to provide adequate care to the critically ill in parts of South Africa.  These are all symptoms of the same problem.  However, one of the wonderful truths of the gospel is that whatever small thing we can do in response to God’s prompting, He can turn to something that will bear greater fruit than we can see.

It is encouraging that CNM is now being approached by the media to speak on these issues, and it gives us a chance to speak a Christian perspective into such situations.  Please pray that such opportunities continue to present themselves and that we are empowered by the Holy Spirit to respond appropriately with a voice that echoes God’s heart.