sorry for cnp and for copying whole post from another thread!!
http://society.guardian.co.uk/commen...485880,00.html
The NHS goes global
Poaching doctors and nurses from poorer countries will have dire consequences, says Malcolm Dean
Wednesday May 18, 2005
The Guardian
The numbers are hard to believe. Six years on from the health service's ethical recruitment code, more than a third of new nurses (11,500) and two-thirds of new doctors recruited last year were overseas trained, many of them poached from poor states. Cynics may dismiss the new joint campaign by the British Medical Association and the Royal College of Nursing to put more pressure on ministers to plug the brain drain from developing states. They may see it as an act of professional self-protection. But they are wrong.
They should heed instead the appeals for help at last year's RCN conference from the leader of the South African nurses association, who was still watching 300 nurses a month moving overseas, despite the appeals from Nelson Mandela to the developed world to stop it. Some 6,000 nurses in four years came to the UK alone.
Or they could talk to the head of Kenya's nursing union, who complained even earlier about their most experienced nurses being poached by British private nursing agencies.
The government has committed the UK to a code of ethics that bans recruitment from developing countries except where there is an inter-governmental agreement permitting it. Yet of the top 20 countries from which the UK recruits, 12 are on a banned list.
Some 7,000 South African doctors were already on the permanent register of the UK's General Medical Council by 2003 - equivalent to half the number working in South African public hospitals - when Britain launched its plan for private independent treatment centres that were required to recruit from overseas. The South African Medical Association responded: "You are increasing your ability to poach by opening these centres that you cannot man yourself." And, indeed, one of the half-dozen overseas corporates that won a contract was South African.
Ghana is in even more serious trouble, with just 1,500 doctors for a population of 20m. Two-thirds of its young doctors leave the country within three years.
A new report, commissioned by the RCN from James Buchan, of Queen Margaret University College, Edinburgh, shows the startling rise in non-EU overseas trained nurses registering in the UK in the last decade. It grew from fewer than 2,000 in 1994/95 up to 15,000 in 2001/02. In the last five years, more than 50,000 overseas trained nurses have been registered here - most from "banned" African countries.
The chairman of the BMA, James Johnson, was right to talk of the "devastating consequences" on developing nations of the failure of developed states to train sufficient medical staff.
A report produced by Medact, the international health charity, estimated the cost to Ghana alone from the loss of medical staff came to £100m. The gain to developed states was much bigger. It costs almost £250,000 to train a doctor in the UK.
True, the picture is more complicated than some statistics suggest. Three countries - the Philippines, India and Indonesia - have an intergovernmental agreement with the UK because of surplus numbers. The Philippines deliberately produces a surplus to attract remittances from abroad. Nurse numbers from there peaked at 7,000 in 2001-02 but have fallen since. Remittances (from all sectors) are now providing developing states with almost twice as much as international aid, more than £75bn a year.
Yet, as the UN Commission on Migration has warned, too high an expectation has been placed on these financial flows. Socially, they break up families while economically, they deprive the developing countries of entrepreneurial talent.
Then, as Hilary Benn, the international development secretary, wrote in our letter columns last week, the shortage of health workers in developing states has other causes apart from migration. He listed inadequate investment in health services, poor working conditions, poor pay and lack of career development. He pointed to the UK's aid programme that is helping to meet these shortfalls - more than £560m to Africa in the last five years. But divided equally, that would come to little more than £2m for each African country each year.
The current code was tightened in 2004. A loophole under which overseas staff could be taken on by the NHS as locums on renewable short-term contracts that could be extended indefinitely was blocked. But it should be tightened further. There is nothing to stop private hospitals, private nursing homes or 250 private recruitment agencies from poaching.
What is needed even more urgently is a debate about how developed nations which use overseas trained staff should compensate the developing nations for their loss. Some 22 Commonwealth countries have signed up to such an approach, but not the UK. It would not just be ethical but in our own self-interest. An RCN survey of overseas nurses working in London, published today, suggests four in 10 are considering a move to another country that offers better pay, such as the US. As the RCN asserts, the NHS expansion is "being built on sand".
