We must end our reliance on foreign health workers

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The Independent Online

Tony Blair will go to the G8 meeting of leading Western nations in Gleneagles in July with an agenda to double aid to Africa. At the same time, Britain and other English-speaking countries are stripping the continent of its most vital resource - skilled doctors and nurses. Without an effective health system, economic progress is impossible. As a strategy, it has a Looking-Glass logic. Morally, it is unacceptable.

Tony Blair will go to the G8 meeting of leading Western nations in Gleneagles in July with an agenda to double aid to Africa. At the same time, Britain and other English-speaking countries are stripping the continent of its most vital resource - skilled doctors and nurses. Without an effective health system, economic progress is impossible. As a strategy, it has a Looking-Glass logic. Morally, it is unacceptable.

The NHS has depended on doctors and nurses from overseas since it was founded. It was always cheaper to import them than to train our own; they were prepared to go where Britons refused - deprived inner cities and tough housing estates - and the expectation was that eventually they would return, leaving more senior posts to home-grown candidates. But demand in recent years has soared, as the NHS has expanded. More than 40 per cent of nurses joining the UK register in 2003-4 were from overseas, including 354 from Ghana. More than one third of doctors in Britain were trained overseas, including 9,152 from sub-Saharan Africa.

The Labour Government belatedly recognised the error of its ways and banned active NHS recruitment from most developing countries in 1999. But poaching by the West is no longer the sole - or even the main - problem. Doctors and nurses cannot be denied their human right to work where they choose. The numbers already in the UK and US are now so large recruitment takes place by word of mouth, codes of conduct or no.

Ghanaian government restrictions have also had limited effect. Awareness that a nursing qualification can be a passport to a better life has led to a fivefold increase in applications for nursing training since 2003. Ghana may wish to act to stem the exodus, but Britain should not refuse them entry. Those who apply for jobs here of their own volition are entitled to be considered along with all other candidates. Nor is Britain the only country raiding the developing world to shore up its health system. The United States, which already has more than half the world's nurses, plans to use its economic might to suck in thousands more.

In the long term, medical migration will only slow if the West becomes self-sufficient in healthcare staff. The British Medical Association, which for decades opposed the expansion of doctor training because of the threat to private practice, has changed its tune under its new chairman, James Johnson, who is campaigning for Britain to become self-sufficient. He is right: the assumption that the developing world will supply our need for health is no longer sustainable.

In the short term, some form of restitution must be made by countries who save on medical training costs by importing foreign labour. Although doctors and nurses working in Britain remit money home to support relatives, that money goes into the domestic economy. It does not support the health service. Funds given under any system of restitution must be ring-fenced for health care. Some Ghanaian officials argue that financial support should be provided to raise the salaries of Ghanaian doctors, but that would be economically and socially destabilising.

There are other means of providing incentives - through professional support, exchange visits and measures that involve Ghana as part of the international medical community. Providing opportunities for Ghanaian staff to gain experience abroad and return would in itself be an incentive to stay. The underlying problem, though, is less Ghana's than Britain's. Unless we can supply, and retain, our own qualified medical staff, we will be dependent on others - often, regrettably, from countries where they are just as essential as they are here.

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