No exit: misleading recruitment of nurses could mean hardship for those from lower income countries
Edmund Stubbs, 31 July 2015
Recruitment bodies, working in Europe and supplying the NHS, have apparently been making enticing promises that cannot be kept for example, the offer of unrealistic wages, free or discounted accommodation and language training.
These bodies often have the audacity to target medical training institutions in European countries which themselves experience shortages of nursing staff. It is true that the NHS needs more nurses but, due to underinvestment in nursing training in the UK, our nation is actively depleting the supply of nurses elsewhere by its recruiting strategy. It is obvious that recruiters will present a rose tinted view of what working for the NHS will be like compared with the daily reality but, as a result, and after considerable expenditure (some in-house NHS recruitment teams have been criticised for staying in five star hotels while hardly recruiting anyone) many overseas-recruited staff only stay and work for a matter of months.
A proportion of the European staff recruited who become disillusioned with the NHS end up working for agencies, often then employed by the NHS at high cost. The president of the Spanish Council of Nursing, Dr Maximo Jurado, cites the example of nurses who establish themselves in England thinking that they are to work at a specific hospital but who find themselves working in multiple hospitals and treatment facilities around their wider area.
A major concern is that if such misleading and ultimately harmful recruitment practices are prevalent in Europe, where institutions enable relatively comprehensive monitoring of recruitment methods, how might they be equally or more harmfully used in lower income and transitional economies? If misleading recruitment procedures are occurring in Europe it is likely this is occurring to an even greater extent in these countries with less developed regulatory institutions.
The NHS recruits significantly in Asia and Africa. Often lower and middle income nations within these regions make comparatively large investments in medical training in an attempt to redress local skill shortages. There are obvious ethical implications when the NHS, funded by an affluent nation, but unwilling to train sufficient numbers of staff, attempts to headhunt this emerging workforce.
Civitas has recommended in a recent report that it would be cost effective for the NHS to invest in training more UK-based personnel, with the requirement that they agree to work for the NHS for a minimum period in return for their publicly-subsidised training. Such a move would increase competition within the service for positions, meaning that agency staff might find themselves in less demand and instead look for permanent posts.
Considering the sacrifices individuals from lower income countries often have to make to come to this country, in terms of visa applications, air fares and the financial support they frequently give to relatives back home, a decision to emigrate may mean that these individuals are less able to return home when they discover much poorer conditions in England than they were led to expect by recruiters.
Individuals, when finding themselves in a situation of decreasing benefit for themselves, be this in a relationship, a job or as the citizen of a country, can, according to economist and political theorist Albert O. Hirschman, ‘voice or exit’. That is, they can either exit the situation or voice their criticisms in the hope of remedying or improving it.
However, for those from lower income countries, the exit choice is usually not a viable option. Employers, whether agencies or the NHS, are likely to know this and thus be far less willing to listen when, instead of exiting, they attempt to voice their discontent.
Edmund Stubbs is Healthcare Researcher at Civitas, @edmundstubbs1