NHS 'too reliant on foreign nurses'

The National Health Service is facing a staffing crisis because of its reliance on foreign nurses at a time when a global shortage of trained health staff is looming, according to research published yesterday.

A report revealed that most of the increase in NHS nurses over the past four years is made up of staff recruited overseas. Health economists warned that the NHS is reaching crisis point because it relies too heavily on foreign nurses to staff hospitals throughout the UK.

And more evidence emerged that developing countries with their own shortages of nurses are still being targeted by British agencies, and their nationals recruited to the NHS, in breach of ethical guidelines.

Launching the report, the Royal College of Nursing (RCN) called on the Government to tighten up the rules on recruitment from developing countries. The study, by James Buchan and Ian Seccombe of Queen Margaret University College, Edinburgh, found that in 1989 there were 635,000 registered nurses. By 2002, that had gone up to 645,000. However, when the tally of internationally recruited nurses was taken away, the number of staff had barely risen.

Last year, 45 per cent of all new entrants to the Nursing and Midwifery Council were from abroad. In the past three years 40,000 foreign health staff have been recruited to the UK, where there are still 25,000 nursing vacancies.

Despite government claims of an increase in nurses, the RCN report showed that the number of students in training was lower than 15 years ago. According to the most recent figures, there were about 18,000 training in 2002, compared with 19,000 in 1990.

The RCN's general secretary, Beverly Malone, said: "Without nurses from overseas, in terms of nursing numbers we would have been running fast just to stand still. We can't guarantee that these nurses will continue to want to come to live and work in the UK, nor should we encourage the targeting of nurses from developing nations. Put simply: is the policy of shoring up the UK's nursing workforce with overseas recruits sustainable?"

In 2001 the Department of Health introduced a code of practice which banned NHS hospitals recruiting from 150 developing nations, including Ghana, South Africa, Jamaica and Malawi. However, the guidelines do not apply to private agencies. There have been concerns that independent agencies are aggressively recruiting in the banned countries with offers of more pay and better conditions. Nurses are employed in private care homes and hospitals in Britain, but frequently leave and find jobs in NHS hospitals, so circumventing the DoH rules.

Thembeka Gwagwa, chief officer for the South African Nurses Association, said: "We have our own shortages of nurses but as a developing country, we cannot compete with the developed countries. The foreign agencies come here and offer three times the salary a nurse can earn in South Africa ... it is leaving our hospitals with huge shortages."

Britain has been the world's biggest recruiter of foreign nurses in recent years, but looming shortages of staff in other Western countries are causing a global battle for health workers from the developing world.

Health economists have predicted that the United States will soon have one million nurse vacancies, and is already luring increasing numbers of British staff as a result.

Barbara Nichols, chief executive of the US Commission on Graduates of Foreign Nursing Schools, said that Britain is also in danger of losing its foreign staff to American hospitals.

"The US recruiters are very aggressive," she said. "The hospitals can pay big wages and Britain is now being seen as a stepping stone to the US for nurses from foreign countries."

MISSION ABROAD

Sandra James, a nurse manager who was sent to the Philippines to recruit 30 nurses, recalled how she compared her mission to a people-smuggling operation.

High vacancy rates and a lack of home-grown nurses in Guernsey, where she worked, had forced managers to look abroad.

"We had more than 60 nurses apply and they were all absolutely desperate to come to Britain," Ms James said. "They were all young women with families who were going to leave their children behind because they were offered more money to work in the UK.

"I found myself asking myself if we were any different in what we were doing as nurses from those who do people-trafficking."

The Philippines has been taken off the list of countries banned from supplying nurses because it now trains more staff than it needs. But students must pay for their training and there are concerns that the policy is supplying Western countries at the expense of the local health system.

Ms James said: "They do not come to Britain as permanent immigrants; they come on short-term contracts. I sometimes wonder if, when they go back home, they are really better off than when they started."

She said some hospitals were still employing nurses from the "banned" list. "Trusts don't recruit directly but if we get approached by individual nurses from those countries, there is nothing to stop them from being recruited," she said.