UK agencies hiring poorest nations' nurses

Thousands of nurses and midwives are still being hired from the world's poorest countries to work in the UK in spite of government attempts to restrict recruitment by private agencies, the Guardian revealed.

The Liberal Democrat MP Andrew George said the practice of hiring from Africa and other underdeveloped countries was destroying efforts to fight Aids, tuberculosis and other epidemic diseases. Losing trained medical staff can have a huge impact on poor countries that have high burdens of disease and chronically understaffed hospitals.

In Swaziland in the last two years, 200 nurses have been trained, he said, and 150 have moved to the UK. To add to those losses, in 2003-04, 300 nurses died of Aids in the kingdom which has the highest HIV prevalence rate in Africa.

The code of practice bans the NHS from recruiting from poor countries. In December last year, it was tightened by the government to ban private agencies from recruiting if they supply nurses to the NHS.

But Mr George says nurses are still being hired and often end up working in badly paid jobs with poor working conditions in private nursing and care homes. Figures collected by the Nursing and Midwifery Council show that a total of 3,301 nurses, including a handful of midwives, who registered with the council last year were from 16 countries on the "banned" list.

"The government must close this loophole," said Mr George. "The efforts of many developing nations to create and maintain health services are being seriously undermined by a skills drain the code has failed to prevent."

The intention behind the code was honourable, said the MP, but the government should be doing more to fix the gaps in the NHS through local training and recruitment.

The prospects for the nurses brought in by private agencies were not always rosy. "It is perfectly reasonable for skilled people to want to move in search of a better paid job," Mr George said.

"But many of these trained health workers are brought in by private agencies which are not constrained by the code. They end up working in low paid, lower skilled jobs instead of getting training and specialist work which would suit them and better prepare them for returning home, if they wish, to help the fight against diseases like Aids and TB."

Jim Buchan, professor in the faculty of health and social sciences at Queen Margaret's University College in Edinburgh, who is an expert on the overseas nursing issue, said that the private sector jobs were sometimes only a stepping stone to the NHS.

"Quite a number, particularly from sub-Saharan Africa, have come into the NHS through the back door," he said.

"They are recruited for private sector nursing homes but work for them only a small period of time - sometimes only a matter of weeks - before going to work in the NHS.

"Some of the nursing homes are making money by charging a fee to put the nurse through the required adaptation period in the UK, which they are required to pass in order to register. Then they are free to move on to other jobs."

The government is understood to have doubts about the usefulness of the code of practice.

The health minister, Rosie Winterton, who recently went to Africa on a fact-finding tour, acknowledges that attempting to prevent doctors and nurses from coming to work in the UK could infringe their human rights.

There is a growing view twithin government that the UK should try to help Africa develop its health services through nurse exchange programs and other supportive schemes.

Breaching the code

The numbers of nurses and midwives trained in countries from which recruitment to the NHS is banned, who joined the UK register in 2004-05:

South Africa 933

Nigeria 466

West Indies 352

Zimbabwe 311

Ghana 272

Pakistan 205

Zambia 162

Mauritius 102

Kenya 99

Botswana 91

Nepal 73

Swaziland 69

Malawi 52

Sri Lanka 47

Lesotho 43

Sierra Leone 24

Total 3301

Source: nursing and midwifery council