Recruiting Foreign Health Staff

by Michael Patrick O'Leary

Every foreign nurse gained by the NHS is a nurse lost to a poorer country.

On November 8, 2022, in her column in I-News, Yasmin Alibhai-Brown took strong exception to comments made by Keir Starmer on BBC Scotland’s The Sunday Show.  Starmer had said that the NHS is “recruiting too many people from overseas” and we should be “training people in this country”. Ms Alibhai-Brown took this as an indication that Starmer was racist and described him as “a Labour leader who seems to walk only rightwards even when the party is way ahead in the polls.” She mentioned that the SNP MP Stewart McDonald tweeted about a “grubby dog-whistling for votes.”

In an interview on November 6, 2022, with BBC Scotland’s The Sunday Show, Sir Keir said he would like to see immigration numbers go down in some sectors – including in the NHS. “We need a long-term plan.”

According to Adam Bychawski on Open Democracy, “Since 2017, 50,000 of the nurses who registered to practise in the UK were trained in countries that have too few of their own nurses to provide the standard of healthcare recommended by the United Nations.“

The latest NHS Digital shows the NHS in England faces a shortfall of 46,828 nurses and midwives as of June 2022, which is a vacancy rate of 11.8%, while NMC (National Midwifery Council) data from October revealed that international recruitment has increased 135% in the last year. According to a Nuffield Trust report, foreign nurses are contracted to work longer hours.

I have lived in Sri Lanka for over 20 years. When I told English friends that I was moving to Sri Lanka one said: “How can you risk leaving behind the National Health Service?” As it turned out, I found the Sri Lankan health service to be excellent whenever, which fortunately was not often, I had to use it. When I lived up in the mountains, I received first class treatment free of charge at Bandarawela Cottage Hospital when I slipped and cracked my head open. In similar circumstances in England I would have had to wait for hours in Accident and Emergency in the company of violent drunks (patients not doctors) and screaming children.

The Sri Lankan authorities responded far more effectively to the 2004 tsunami than did US authorities to Hurricane Katrina. Sri Lanka’s past investments in a broad-based public health system and community awareness of basic sanitary and hygienic practices ensured that there were no disease outbreaks. Essential medical aid, emergency food, and other relief supplies were mobilized within a day. We made several visits to Hambantota and witnessed the relief operation.  It was possible to feed, clothe, and shelter survivors; provide the injured with medical attention; and ensure that the thousands of bodies were quickly cremated or buried.

Despite international criticism, the health services coped well in 2009 with the closing stages of the war against the LTTE (Liberation Tigers of Tamil Eelam) and the aftermath of the 300,000 internally displaced persons (IDPs). The extremely dire outbreaks of disease in the IDP camps predicted by foreign NGOs just did not materialize thanks to an efficient health service.

The then prime minister, Prime Minister Wickramanayaka claimed that public financing for healthcare began in Sri Lanka more than 2,000 years ago when Buddhist kings established public hospitals and maintained them with royal revenues. Ancient records show that 18 hospitals were established by King Dutugemunu in the second century BC This tradition was strongly influenced by Buddhist culture which accords high priority to actively caring for the needy, the poor and the sick.

According to the World Health Organisation, a modern health service can be said to have started in Sri Lanka in 1858 with the creation of the Civil Medical Department under a Principal Civil Medical Officer (PCMO). The department initially concentrated on the establishment of new hospitals in large towns. Primary care facilities at village level were initiated in 1877. Initially, preventive medicine was confined to measures aimed at preventing the spread of major communicable diseases. Sri Lanka has long had a very good record (which compares well to western countries, particularly to places like Louisiana and Detroit) of steady improvements on health indicators such as infant mortality and life expectancy.

Sri Lanka is far superior to England in the matter of diagnostic tests. There are diagnostic centres in all localities and it is easy to get the tests done (without an appointment or waiting list) at a reasonable cost and get the results quickly on home PC or mobile phone.

Reintroduction of private practice for government doctors and liberalization of drug imports resulted in the growth of private hospitals in urban centers. There is a thriving private health sector, particularly in Colombo, which boasts a number of modern, well-equipped and well-staffed hospitals such as Apollo, Asiri, Nawaloka and Ninewells Gynecological Hospital. There have been efforts to encourage foreigners to come to Sri Lanka for treatment.

In Colombo, there is an excellent service where one can pay an annual membership fee to have an ambulance with doctor and paramedic call at one’s home when the need arises. They also call at one’s home to take blood tests and deliver the results. The doctors operating this service also work at the government general hospitals. In Badulla, the provincial general hospital (free care to all) is a fine modern building with the latest in modern technology. A new private hospital recently opened in Athurugiriya, where we now live. Way back in the 1990s, I found it difficult to get affordable dental treatment in London. I have had no problem in Sri Lanka.

The Sri Lankan health service took a battering when Covid struck. Initially, Sri Lanka coped far better than many western countries, including the UK and the USA. The armed forces played a big part in organising tracing and testing and roll out of vaccinations. Things went wrong later when the authorities took their eye off the ball.

The economic meltdown in 2022 severely pummeled a health service already undermined by the pandemic. The previously excellent universal health care system is on the point of collapse. Hospitals are short of essential drugs and urgent operations are being cancelled. Doctors and nurses working in bad conditions in Sri Lanka might well be tempted by the siren call of the NHS and might think they will have a better life in the UK – if they ignore the news about strikes in the NHS and impending severe recession. I am all for the free movement of people but I do not think it is racist to point out that poaching trained staff from other suffering nations might not be wholly  ethical.

On May 29, 2022, the Sri Lankan Sunday Times reported on a Memorandum of Understanding, between Sri Lanka and the UK, initially for four years, but to be renewed automatically, under which, “The governments would undertake a recruitment project to develop a sustainable recruitment pathway for nurses and other healthcare professionals from Sri Lanka to the UK; intensify bilateral exchanges of policy thinking with regard to nursing and healthcare workforce development and best practices in the delivery of healthcare; involve professional staff and healthcare managers in the project, particularly in relation to the education and training of Sri Lankan nurses and other healthcare professionals and draw up an action agenda to implement the project–especially with respect to addressing any gaps in the entire process of the recruitment of nurses and other healthcare professionals.”

A Department of Health and Social Care spokesperson said: “It is misleading to suggest that the UK actively recruits nurses from countries where there is a shortage of nursing staff.”

Why is Ms Alibhai-Brown condemning Keir Starmer when the blame clearly lies with successive Tory governments?  According to Adam Bychawski, “The number of foreign-trained nurses registering to work in the UK has increased sixfold since the government axed a fund for training NHS nurses in England in 2016. Then-chancellor George Osborne scrapped £800m worth of bursaries that covered the tuition fees and part of the living costs of students training to be nurses.”

Matthew Taylor, chief executive of the NHS Confederation, said the problems stemmed from “the failure of successive governments to provide a fully funded workforce strategy to help tackle the NHS’s 132,000 vacancies, to address the maintenance backlog of £10 billion, and to provide proper support for social care, with local communities and frontline staff all paying the price”.

Sylvia Watkins DM FRCP has written a paper called Migration of healthcare professionals: practical and ethical considerations for the journal Clinical Medicine. “Recruitment of healthcare professionals from developing countries to the UK is escalating rapidly and is severely damaging the fragile healthcare systems of the countries involved. This is happening in spite of the Code of Practice of the Department of Health, which, although voluntary, was supposed to restrict such migration; unfortunately it has not proved effective so far. Steps are now urgently required to reverse this trend, in order to prevent the total collapse of some overseas health services.”

Is Dr Watkins being racist when she writes, “Other measures, including promoting the retention of locally trained staff in the UK, are urgently required”?