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23 Apr 2001 : Column 140

Overseas Nurses

Motion made, and Question proposed, That this House do now adjourn.--[Mr. McNulty.]

12.8 am

Mr. Paul Burstow (Sutton and Cheam): I am grateful for the opportunity to raise the recruitment of overseas nurses to the United Kingdom. There is no doubt that we need to recruit nurses and midwives from overseas. Indeed, the demographic time bomb planted by the previous, Conservative Government means that there is a serious shortage of home-grown nurses and midwives. With something like one in four nurses on the register of the United Kingdom Central Council of Nursing, Midwifery and Health Visiting aged over 50 and the average retirement age at about 55, the shortage of nurses is likely to get much worse before it gets better. Over the next four years, it is estimated that the shortfall of nurses will range between 20,000 and 60,000. It could be even more, depending on how the independent sector develops in the next few years and what implications the new standards for care homes and other institutions will have for additional staffing requirements.

Last year, 10,000 overseas nurses were recruited to this country and registered with the UKCC. I want to make it clear from the outset that I very much welcome the contribution that those nurses and midwives make to this country's health care system, whether in the independent sector or the NHS. Nursing is an international profession, and nurses should have the right to broaden their experience by working in other health care systems.

My purpose in this debate is to highlight two concerns and to try to offer solutions. First, there is growing evidence that for some overseas nurses who come to this country to do a job and provide support and care in our health service, particularly in the independent sector, their experience is one of exploitation. Secondly, despite clear requests from a number of developing countries not to recruit their nurses, the UKCC's figures reveal an accelerating rate of registration of nurses from those countries.

I shall deal first with the exploitation of overseas nurses. There is growing evidence from Unison and the Royal College of Nursing of appallingly poor employment practices in this country. I stress that the problem appears to be concentrated largely in the independent sector and, on the evidence that I have seen, particularly in care homes. Unison tells me that even before arriving in the UK, nurses from the Philippines and other countries find that the recruitment agency that they use to find jobs in this country charges them to be recruited. On top of that, if the recruitment is ultimately to an NHS trust, the trust is asked to pay the agency as much as £1,500 per nurse. The nurses themselves can pay nearly double that, and may be asked to sell their homes, land and other property to finance their move to the UK.

In some cases, agencies charge nurses for UKCC registration guidance, which is free. That is appalling exploitation, and it clearly breaches the Department of Health's guidelines. In some horrific cases, employers go even further, holding on to passports, work permits and UKCC registration cards. They offer misleading and even intimidating immigration advice, such as saying that nurses cannot change employer and will be deported if

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they do. In addition to those practices, overseas nurses suffer restrictive contract terms and conditions that are less favourable that those of their UK counterparts. They are paid less than UK nurses in the same institutions.

Worse still are misleading contracts. The RCN has examples of cases in which nurses have been sent contracts for prestigious specialist acute hospitals in London, but when they arrive they are carted off to work in an elderly persons' care home. They do not necessarily have the experience of providing geriatric care that is needed for that job. That is a cause for concern. It exploits not only the nurses but those who are receiving care. Both parties lose out. Finally, it takes some overseas nurses an unacceptably long time to secure their registration. They find themselves stuck in limbo, working without registration, particularly in the independent sector, and as a result there is even more pressure on them and they are further exploited.

My second concern is the criticism by the World Health Organisation and several Governments of developing countries that the UK is damaging their health care systems through its recruitment of health care staff. Last year, almost one in five new overseas registrations were from South Africa and the West Indies. The Minister will know that there are serious shortages of nurses and midwives around the world. That was the subject of a seminar organised by the World Health Organisation last November that examined the problem of nurse shortages not only in the UK but throughout the world, in developed and developing countries.

One of the factors identified as driving the problem is the demographic time bomb ticking away in many developed countries' nursing systems--not only our own, but those of countries such as Canada, the United States of America and Australia. In a statement about the shortages, WHO says:

In a report on the globalisation White Paper published last month, the Select Committee on International Development states:

It quotes the Secretary of State telling the Committee:

The Committee added:

In her evidence to the Committee's inquiry, the Secretary of State for International Development confirmed that private nursing agencies cannot be prevented from recruiting overseas nurses from developing countries that are experiencing acute shortages. However, she said:

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Given the high rates of registration from developing countries, the NHS self-denying ordinance not to recruit actively from such countries is clearly not sufficient. It leaves a loophole through which nursing agencies can drive a coach and horses. The UK is the only country that has a director of international nurse recruitment. That role has the potential to be very positive and I welcome the establishment of the post. It could and should be used to stamp out poor practice and ensure ethical standards of recruitment, but that would require a more ambitious approach on the part of the Government. I shall propose some potential solutions that I hope that the Minister will consider. I believe that we need an ethical recruitment policy that covers not only where we recruit nurses, but how we recruit them.

First, I join Unison in calling for action to tackle the exploitation of overseas nurses by establishing some sort of taskforce comprising representatives from the Department of Health, the Department of Trade and Industry--which has a clear interest in terms of the registration of employment agencies generally--the Home Office, the Overseas Labour Service, the UKCC, the RCN, Unison and independent sector organisations, and others. The taskforce should work to ensure that consistent practice is adopted throughout the entire UK health care system--not only in the NHS, but across the piece. That is not least because of the fact that in our care homes, more than 53 per cent. of all placements are state funded. Public money is being used to pay for the nurses who come to work in those homes and who, all too often, are exploited. It is appropriate that the state is involved in ensuring that good practice and standards are applied.

Secondly, the Department of Health should issue clear instructions to trusts that no agency that charges the individual nurse who seeks to be recruited to work in the NHS should be used. It is one thing to charge the NHS for the use of its service, but quite another to charge the individual nurse for it as well.

Thirdly, the Department should implement a kitemark scheme for nurse agencies, so that the NHS is in no doubt that agencies are in compliance with NHS guidance on recruitment. Those measures would go some way toward addressing the International Development Committee's proposals that guidance should be made broader to include the independent and private sectors.

In conclusion, overseas nurses make a valuable contribution to our health care system. However, there is undoubtedly growing concern not only about the exploitation of nurses, but about the way in which this country is doing harm to developing countries, which have told us clearly that we should not actively recruit from their health care systems because of the damage that that is causing. Recruitment of overseas nurses is not a new phenomenon; what is new is the sheer scale of the recruitment that is taking place and the dramatic increases in the numbers that are being recruited. Given the worldwide shortage of health care professionals, overseas recruitment cannot be a long-term solution to the UK's nursing shortage. At best, it is a sticking plaster and a stop-gap measure while we establish the extra training places and grow our own nurses so that we can fill the vacancies in the NHS. I hope that Ministers will not

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lightly dismiss the Government's responsibility to ensure ethical recruitment practices and zero tolerance of exploitation of health care workers in this country.

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