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Britain accused of ignoring nurse-recruitment ban
World Report
Britain accused of ignoring nurse-recruitment ban Britain has pledged to help developing countries boost their health workforce by banning recruitment of nurses from at least 150 named states. But information gathered by journalists suggests that recruitment agencies in South Africa are bending the rules. Stephen Bevan reports.
www.thelancet.com Vol 366 December 3, 2005
A reporter called the MTA Medical recruitment agency in Johannesburg claiming to be a South African nurse responding to the company’s advertisement in a nursing journal. Headed “Attention all . . . further develop your skills in some of the world’s top hospitals”, the advertisement offered “top UK positions” for nurses with experience in psychology and intensive-care units. The reporter was told there was a “moratorium” on recruiting nurses for NHS jobs, but that the agency did have jobs going in the burns unit at the Queen Victoria NHS Trust in East Grinstead and that “because of the terrible need I think they would probably waive the moratorium”. Yet, according to the NHS employers organisation, there are no exemptions to the ban, even in areas of shortage. When contacted by The Lancet, the Department for Health declined to comment on the claims by Mahlati, but a spokeswoman said: “We have the strictest code of practice of all countries in the developed world and we have
very strict controls in place. We are very aware of the problems developing countries face.” The claims that Britain is breaking its commitment to the developing world come as a new UN report warns that the loss of qualified medical personnel to the wealthier industrialised nations is overwhelming the developing world’s health-care systems. The report, International Migration and the Millennium Development Goals, says that poor countries, many of them with the fewest health-care workers but highest infectious-disease burdens, are “subsidising” the health-care systems of wealthier countries. Africa, for example, suffers one quarter of the world’s disease burden, yet it has only 1·3% of its health-care workers, says the report. The problem is particularly acute in English-speaking countries such as Ghana, which reports a healthcare specialist vacancy rate of 72%, while landlocked Malawi, one of the countries hardest hit by the HIV/AIDS pandemic, has a nursing staff deficit of 52·9%.
Rights were not granted to include this image in electronic media. Please refer to the printed journal
Still Pictures
Britain has been accused of breaking its promise not to poach nurses from developing countries and leaving their hospitals and clinics struggling to cope with staff shortages. 4 years ago, the UK government introduced a recruitment policy for the NHS which banned it from actively recruiting nurses and other health-care professionals in over 150 developing countries. Last December, it announced it was extending the ban to private recruitment agencies working for the NHS and that private hospitals and nursing homes had also pledged to abide by the code. But one of the most senior officials in the South African Department of Health—one of the countries on the banned list—has said that the NHS is continuing to recruit in his country and is circumventing the ban by using private recruitment agencies Percy Mahlati, of the South African Department of Health, says: “They say they don’t [advertise], but the fact of the matter is that they’ve got agencies that work for them . . . It’s no longer the NHS directly recruiting but agencies that are recruiting and doing placements for various NHS Trusts. So, rather than doing it directly, they are doing it indirectly. “John Hutton [UK Minister of Health] was here last year and he was saying ‘no it’s the private sector in the UK that is recruiting here’. But the private sector is very small in the UK. If they recruit people here, within a short period of time they are working as an agency nurse at an NHS Trust.” His claim appeared to be backed up after telephone calls from a reporter revealed that private agencies are still actively recruiting nurses for jobs in the UK—in at least one case for an NHS hospital.
The UK government has promised to stop actively recruiting nurses trained in 150 developing countries
1915
World Report
1916
Rights were not granted to include this image in electronic media. Please refer to the printed journal
Photofusion
Despite these desperate shortages, however, Britain is continuing to hire nurses from these countries. According to the UK’s Nursing and Midwifery Council (NMC), it accepted 272 new nurses and midwives from Ghana onto its register last year, 69 from Swaziland, which is one of the poorest countries in Africa, and has one of the highest HIV-infection rates, and 43 from Lesotho, a similarly impoverished country. According to the latest figures from the NMC, more than 2800 nurses and midwives from countries on the “banned” list registered to practise in the UK in the year to the end of March 2005. While many of these nurses may have been hired initially by private hospitals and nursing homes, most will end up in the public sector—a trend which the respected UK-based charitable foundation, the King’s Fund, recently condemned as a form of “back-door recruitment” by the NHS. It referred to nurses being recruited from developing countries to relatively low-paid jobs in private hospitals and nursing homes but who then move on to better paid jobs in the NHS once they are in the country. One recent advertisement placed in a leading South African nursing journal offered 2-year contracts, free flights, and help with visa and work permits for nurses to work in “private upmarket nursing homes in England, Scotland Wales and Northern Ireland”. The same agency advertised for professional nurses to work in operating theatres and intensive care units for various private hospitals. South African nurses are often attractive to UK employers. Most speak good English and are trained to a similar standard as British nurses. As for the nurses, the primary motive is often money. An experienced theatre nurse in South Africa earns around £7000 a year. In the UK, they could earn up to five times that amount. In the 4 years since the NHS introduced its ban on recruitment 6104
More than 2800 health workers from countries on the “banned” list are registered to practise in the UK
South African nurses have registered to practise with the UK’s Nursing and Midwifery Council while in the first four months of this year, a further 379 asked its South African equivalent to provide proof of their qualifications to the UK—usually the first step towards moving there. Even a new requirement by the NMC that all overseas nurses have to undergo a minimum 20-day training course in the UK before they can be registered has not halted the flow of trained nurses to the UK. Many South African nurses are already registered with the NMC but have remained in South Africa, perhaps until their children are old enough to be left. For others the rewards are so great that they are willing to fork out the cost of going to the UK and doing the course themselves. For South Africa’s health system— which is already struggling with a desperate shortage of qualified health-care workers as low pay, poor working conditions, and stress drive them out of the public sector—the effect is devastating. 5 years ago there were 120 nurses for every 100 000 people. This year there are 109 and the last government estimate was that there are 32 000 vacant nursing posts in public hospitals and clinics across South Africa.
The Chris Hani Baragwanath Hospital in the Soweto township is, with almost 2890 beds, the largest hospital in South Africa and one of the biggest in the world. 2 years ago the hospital couldn’t fill a third of its staff posts and today for every 35 appointments it makes every month, it receives 40 resignations. Latest figures show it has 350 nursing vacancies, which staff admit puts a huge strain on workers who are there. The casualty department sees 11 500 patients a month—including about 40 knife wounds a day—but it is struggling to cope. Ideally, according to Lucy Tshabalala, sister in charge of the casualty and outpatient departments, she should have 80 professional nurses— but there are less than half that number. “It [the shortage of staff] is killing our nurses”, she says. “It kills their love for the job. To deal with a patient properly needs a lot of time. People say the nurses are inhuman because they can’t understand why you are leaving them and going to another one. But that is how we work. We have to see to the critical cases first.” And she said she has no doubt where all the nurses are going. “They’re all moving abroad. They’re all in London”, she says.
Stephen Bevan www.thelancet.com Vol 366 December 3, 2005
Britain accused of ignoring nurse-recruitment ban Britain has pledged to help developing countries boost their health workforce by banning recruitment of nurses from at least 150 named states. But information gathered by journalists suggests that recruitment agencies in South Africa are bending the rules. Stephen Bevan reports.
www.thelancet.com Vol 366 December 3, 2005
A reporter called the MTA Medical recruitment agency in Johannesburg claiming to be a South African nurse responding to the company’s advertisement in a nursing journal. Headed “Attention all . . . further develop your skills in some of the world’s top hospitals”, the advertisement offered “top UK positions” for nurses with experience in psychology and intensive-care units. The reporter was told there was a “moratorium” on recruiting nurses for NHS jobs, but that the agency did have jobs going in the burns unit at the Queen Victoria NHS Trust in East Grinstead and that “because of the terrible need I think they would probably waive the moratorium”. Yet, according to the NHS employers organisation, there are no exemptions to the ban, even in areas of shortage. When contacted by The Lancet, the Department for Health declined to comment on the claims by Mahlati, but a spokeswoman said: “We have the strictest code of practice of all countries in the developed world and we have
very strict controls in place. We are very aware of the problems developing countries face.” The claims that Britain is breaking its commitment to the developing world come as a new UN report warns that the loss of qualified medical personnel to the wealthier industrialised nations is overwhelming the developing world’s health-care systems. The report, International Migration and the Millennium Development Goals, says that poor countries, many of them with the fewest health-care workers but highest infectious-disease burdens, are “subsidising” the health-care systems of wealthier countries. Africa, for example, suffers one quarter of the world’s disease burden, yet it has only 1·3% of its health-care workers, says the report. The problem is particularly acute in English-speaking countries such as Ghana, which reports a healthcare specialist vacancy rate of 72%, while landlocked Malawi, one of the countries hardest hit by the HIV/AIDS pandemic, has a nursing staff deficit of 52·9%.
Rights were not granted to include this image in electronic media. Please refer to the printed journal
Still Pictures
Britain has been accused of breaking its promise not to poach nurses from developing countries and leaving their hospitals and clinics struggling to cope with staff shortages. 4 years ago, the UK government introduced a recruitment policy for the NHS which banned it from actively recruiting nurses and other health-care professionals in over 150 developing countries. Last December, it announced it was extending the ban to private recruitment agencies working for the NHS and that private hospitals and nursing homes had also pledged to abide by the code. But one of the most senior officials in the South African Department of Health—one of the countries on the banned list—has said that the NHS is continuing to recruit in his country and is circumventing the ban by using private recruitment agencies Percy Mahlati, of the South African Department of Health, says: “They say they don’t [advertise], but the fact of the matter is that they’ve got agencies that work for them . . . It’s no longer the NHS directly recruiting but agencies that are recruiting and doing placements for various NHS Trusts. So, rather than doing it directly, they are doing it indirectly. “John Hutton [UK Minister of Health] was here last year and he was saying ‘no it’s the private sector in the UK that is recruiting here’. But the private sector is very small in the UK. If they recruit people here, within a short period of time they are working as an agency nurse at an NHS Trust.” His claim appeared to be backed up after telephone calls from a reporter revealed that private agencies are still actively recruiting nurses for jobs in the UK—in at least one case for an NHS hospital.
The UK government has promised to stop actively recruiting nurses trained in 150 developing countries
1915
World Report
1916
Rights were not granted to include this image in electronic media. Please refer to the printed journal
Photofusion
Despite these desperate shortages, however, Britain is continuing to hire nurses from these countries. According to the UK’s Nursing and Midwifery Council (NMC), it accepted 272 new nurses and midwives from Ghana onto its register last year, 69 from Swaziland, which is one of the poorest countries in Africa, and has one of the highest HIV-infection rates, and 43 from Lesotho, a similarly impoverished country. According to the latest figures from the NMC, more than 2800 nurses and midwives from countries on the “banned” list registered to practise in the UK in the year to the end of March 2005. While many of these nurses may have been hired initially by private hospitals and nursing homes, most will end up in the public sector—a trend which the respected UK-based charitable foundation, the King’s Fund, recently condemned as a form of “back-door recruitment” by the NHS. It referred to nurses being recruited from developing countries to relatively low-paid jobs in private hospitals and nursing homes but who then move on to better paid jobs in the NHS once they are in the country. One recent advertisement placed in a leading South African nursing journal offered 2-year contracts, free flights, and help with visa and work permits for nurses to work in “private upmarket nursing homes in England, Scotland Wales and Northern Ireland”. The same agency advertised for professional nurses to work in operating theatres and intensive care units for various private hospitals. South African nurses are often attractive to UK employers. Most speak good English and are trained to a similar standard as British nurses. As for the nurses, the primary motive is often money. An experienced theatre nurse in South Africa earns around £7000 a year. In the UK, they could earn up to five times that amount. In the 4 years since the NHS introduced its ban on recruitment 6104
More than 2800 health workers from countries on the “banned” list are registered to practise in the UK
South African nurses have registered to practise with the UK’s Nursing and Midwifery Council while in the first four months of this year, a further 379 asked its South African equivalent to provide proof of their qualifications to the UK—usually the first step towards moving there. Even a new requirement by the NMC that all overseas nurses have to undergo a minimum 20-day training course in the UK before they can be registered has not halted the flow of trained nurses to the UK. Many South African nurses are already registered with the NMC but have remained in South Africa, perhaps until their children are old enough to be left. For others the rewards are so great that they are willing to fork out the cost of going to the UK and doing the course themselves. For South Africa’s health system— which is already struggling with a desperate shortage of qualified health-care workers as low pay, poor working conditions, and stress drive them out of the public sector—the effect is devastating. 5 years ago there were 120 nurses for every 100 000 people. This year there are 109 and the last government estimate was that there are 32 000 vacant nursing posts in public hospitals and clinics across South Africa.
The Chris Hani Baragwanath Hospital in the Soweto township is, with almost 2890 beds, the largest hospital in South Africa and one of the biggest in the world. 2 years ago the hospital couldn’t fill a third of its staff posts and today for every 35 appointments it makes every month, it receives 40 resignations. Latest figures show it has 350 nursing vacancies, which staff admit puts a huge strain on workers who are there. The casualty department sees 11 500 patients a month—including about 40 knife wounds a day—but it is struggling to cope. Ideally, according to Lucy Tshabalala, sister in charge of the casualty and outpatient departments, she should have 80 professional nurses— but there are less than half that number. “It [the shortage of staff] is killing our nurses”, she says. “It kills their love for the job. To deal with a patient properly needs a lot of time. People say the nurses are inhuman because they can’t understand why you are leaving them and going to another one. But that is how we work. We have to see to the critical cases first.” And she said she has no doubt where all the nurses are going. “They’re all moving abroad. They’re all in London”, she says.
Stephen Bevan www.thelancet.com Vol 366 December 3, 2005