Issue no. 1 – Bye, bye Dubai – Hello Bedminster!

I was sitting in Queens Square last summer, enjoying a cold beverage at the small festival. A woman with her two daughters entered the stage. She told us that she worked as a nurse at Southmead and that she is from Tibet. She spoke out against oppression and the three performed a traditional dance.

Health workers are often at the forefront of movements against war and state violence. From Myanmar to Sudan to Gaza to Iran. Some of these workers end up working on the wards with us. Colleagues have made long journeys and worked in many different settings, from small towns in Kerala to Delhi, to Dubai or Durban to end up in Bristol, of all places. The fact that a small country like the UK can hoover up the nurses of the rest of the globe is not a coincidence. It has a lot to do with colonialism in the past and current military operations, from Iraq to Yemen, at the side of the US state. It is not that health workers are not needed in rural India, the Philippines or Nigeria, the opposite is true, but the global market pushes us around. We have to go where the jobs are, where the money is. We can see this as a tragedy or as a chance to learn from each other, how to build a world where human needs are at the centre, not money. Nurses in Kerala have a tradition of struggle, for example against temporary contracts. And international health workers in the UK are organising themselves – check out PAWA for example.

The UK is still a relatively rich country, but that doesn’t mean that nurses here are rich. As you can read in the report from a trainer of international nurses below, a lot of colleagues are not told how expensive things are here, especially the rent or to renew a family visa. Once you are here, your contract makes it difficult to change jobs. I remember a conversation with a colleague from Ghana who said that now she has to ask her family back home to send money, while it should be the other way around really. We want to hear from you how your journey has been! 

Conversation with a nurse who trains overseas nurses

I worked for a Community Interest Company (CIC), training foreign community nurses. The CIC had a big deficit of community nurses, they were struggling to recruit from the UK. They received funding from NHS England to recruit 20 international nurses. Most of the recruitment of foreign nurses in Asia and Africa is done by one specific NHS trust in our area, they have created a particular recruitment centre. They have a kind of monopoly, because they have been doing it for a long time. They do that work for lots of hospitals in the region. I think they are being paid for that. They would go out to the Philippines, India, Dubai, doing job interviews and offering people different jobs in the UK. 

In the work contract of the new recruits it said that they would have to stay with the organisation for three years, otherwise they would have to pay back the recruitment costs. I went to a Unison talk and they said the organisation cannot actually enforce this. But then the visa is attached to employment in a particular trust. The visa is given only for certain job categories where there is a local shortage. It is for one person only, but workers can get a spousal visa. One nurse left her very young son with her sister, she thought they could both move to the UK later on, but unfortunately it has to be a spouse. She looked at childcare costs and shift-patterns and realised that she couldn’t bring her son here. 

It took ages to get the visas, and finding accommodation in the area was also very difficult. This would take months. There is also the issue of so-called ‘red countries’. There are countries that are red-listed that we cannot actively recruit from, because they don’t have enough health care professionals. But if you put a job vacancy out and someone from these countries applies, that’s fine. Nigeria is one of these countries, Zimbabwe, too. One trust developed an e-learning program that nurses were supposed to go through before arriving in the UK. But many nurses work 12 hour shifts in their home countries and have little time for extra work, in particular if that work is not paid for. There is also a problem with middleman culture, for example when it comes to Objective Structured Clinical Examination (OSCE) training or English training. I met several nurses who paid private companies in their home countries for extra training. 

Once the recruits arrived they would have a mix of education and working as supernumeraries on the wards, and they were paid as Band 4. The nurses had to have passed their English exam and CBT (Computer Based Test) before arriving in the UK and they would then pass their OSCE. They wanted the nurses to pass the OSCE within three months, but there were no slots at the five test centres in the UK, which are linked to universities. The only place where we could get places was in Newcastle, which is miles away, so they had to fly there for the test. 

The OSCE that they have to pass is phenomenally difficult. They had to go through ten stations, which could be a multitude of different skills. Skills that many qualified nurses wouldn’t pass. It’s different from your normal nursing degree; I didn’t have to pass any OSCE. We, as an organisation, paid for their first attempt. It’s £700 for the first test and £300 for the following attempts, which the nurses would have to pay themselves. The £700 are for an individual slot, for a one day exam. The money goes to the exam centres. The failure rate has gone up. If you fail less than seven stations you only have to retake the ones that you failed. So we had cases of people who had to travel back to Newcastle for a six minute test. Another problem was that as a community nurse in the UK you have to drive. I think it said in their contract that they would have to own a car within six months. Workers, on one hand, didn’t know how expensive a car, insurance, emission charges, taxes and so on are in the UK. I know that several nurses felt hood-winked around the car situation.

Some of the nurses, in particular from Africa, had to face a lot of micro-aggressions in the rural areas, for example on public buses, in their accommodation or in local stores. In one case we had to move a nurse out of that situation, because it was detrimental to her health. She was grateful, but it was us who got her in that situation in the first place. We are not doing her a favour by recruiting her for positions that we can’t fill. Still, the official rhetoric is: “we brought you to the UK, we will provide you with all these things, aren’t we great”, and so on. Most of the nurses arrive without any local connections, they don’t have friends or relatives here. Men are even more isolated than women, because they are in the minority in nursing. A couple of our nurses knew some people in a trust nearby though. I know that there is a big Filipino nurses’ Facebook group where people share experiences. But there are also formal organisations. There is a Zimbabwe nurses’ association, but it is not that big in this area. There are churches, as well. 

I left the job because it became slightly uncomfortable. I felt they were trapping international nurses and I felt that I didn’t have any power to change that. There is pretty much a picture painted that the streets here are paved with gold. When they turn up the reality is extremely different. The whole discussion around the red list country thing also became difficult. I also saw that they were not really recruiting. It also didn’t make sense business-wise, as a model. Last year 9,000 international nurses left the UK again to work further afield, together with 4,000 local nurses, because local wages are low. You were recruiting against the tide, that’s how it felt. I saw that this project would end at some point. I also missed working with patients.

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