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Are we failing overseas nurses?

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The lure of working in the UK has led to some overseas nurses becoming exploited by rogue international recruitment agencies. Jennifer Taylor investigates

Becoming a registered nurse in the UK is a big draw for many overseas nurses and one which can lead to them knowingly, or unknowingly, being exploited. In an effort to address this issue, the NMC has decreed since September 2005 that the only route to registration, for those from outside the European Economic Area, is through the Overseas Nurses Programme (ONP).

This standardised programme is provided at 35 higher education institutions (HEIs) in the UK and includes 20 days protected learning time and, for some nurses, a period of supervised practice.

‘Prior to the ONP there was no set standard for adaptation programmes and each programme was organised and formulated on a local level,’ says Darren Shell, international registrations manager at the NMC.

However, since nursing was taken off the occupation shortage list in 2006, the numbers of clinical placements for
ONPs has significantly reduced, with the result that overseas nurses have found it increasingly difficult to become registered nurses in the UK.

‘We do make it clear during the application process that places on an ONP or midwifery adaptation can be difficult to find, and not to travel to the UK without first having secured a place,’ says Mr Shell.

However, undeterred by this advice, many overseas nurses secure work permits to do unregistered work in private care homes in the hope that they will then be able to gain a place on the ONP, followed by employment as a registered nurse.

However, with fewer ONP places available to overseas nurses, staff are increasingly finding that they become
stuck in a private care home, where many of their nursing skills can be underutilised. Indeed, in many cases, overseas nurses end up doing basic care assistant work, which can include making the tea and carrying out the cleaning.

Howard Catton, head of policy at the RCN, says: ‘It’s why we’ve been campaigning for a long time about the ethical dimensions of recruitment – that people need to be given clear, accurate, upfront, honest information about what their prospects are.’

While it is true to say that some overseas nurses come to the UK with blind optimism of finding registered nursing work, others have found themselves duped into this scenario by rogue international recruitment agencies promising easy-to-find work.

Such ‘middlemen’ are causing the problem, says Michael Duque, president of the Philippine Nurses Association of
the United Kingdom. He advises that in the Philippines, for example, nurses who wish to work in the UK should use thegovernment organisation, the Philippine Overseas Employment Agency, to ensure a legitimate process.

He explains that there are many potentially exploitative agencies that ‘bolt on’ extras such as English lessons and video interviews as a way of trying to make money out of the applicant. He points out that it is easy to set up a recruitment agency and that regulation is virtually impossible because there is more than one country involved.

Also adding to the problem, however, are the independent and private organisations in the UK that are not signed up to the
DH’s code of practice for the international recruitment of healthcare professionals.

The code, launched in December 2004, specifies both principles and standards for organisations to follow but because it is optional for those in the independent and private sectors, there are some who choose not to recruit from its list of approved recruitment agencies.

They are also able to ignore guidance that states organisations in the UK must not actively recruit from a host of developing countries such as Brazil, Egypt and Nigeria.

Mr Duque adds that in his experience, some Filipino nurses end up working well below their capabilities in private care homes.

He says not only is this due to an onus on trusts to recruit locally but there is also a laborious amount of paperwork required for UK organisations to put people on the ONP, which is a disincentive to employers to take on these nurses.

And now that nursing has been taken off the occupation shortage list, Mr Duque says certain recruitment agencies in the Philippines – which call themselves visa consultancies – have resorted to bringing overseas nurses into the country on student visas, which allow them to work 20 hours a week while studying.

Despite these agencies charging nurses a fee to arrange university courses and clinical placements, Mr Duque says some arrive to find that either there is no college or placement, or they are enrolled with a college but have to pay full tuition fees.

Mr Duque says some nurses just sign their attendance sheets before taking jobs distributing newspapers in the street, or
as domestic cleaners in a nursing home. Others have just gone home empty-handed after three months.

‘It’s a fishy scenario’, he says, but it comes back to individuals.

‘They know that they are being conned, they know that they are being cheated but, because they want to leave the country, with the hope that they will get a better job, they take the risk.’

How overseas nurses can avoid being exploited

  • See the NMC website ( for information on how to become registered as a nurse in the UK. It gives a realistic picture of the potential barriers

  • Deal first hand with the NMC when it comes to becoming registered

  • If you are using a recruitment agency, use one from the DH’s recommended list

  • Do background checks on potential employers

  • Don’t part with significant sums of money in advance

  • Use the Overseas Nurses Programme provider list on the NMC website, and contact the admissions offices of each higher education institution to discuss entry to programmes

‘I was asked to pay £2,750 for the adaptation course – but I’d already paid for it back home’

Ms X was a public health nurse in the Philippines when she decided to come to the UK. She was supporting two children after a separation and a friend from the Philippines, who had become an NHS nurse, persuaded her she would be better off in the UK.

A recruitment agency in the Philippines gave her two options: apply as a senior healthcare assistant and pay nearly £2,000; or, apply to practise nursing, pay £4,000 and receive an adaptation course. She chose the latter and was told the fee included airfare, papers, processing, and so on.

Ms X paid 25% of the fee, then after six months had to do a video interview which cost an extra £200. She waited a further four months for a work permit, during which time she had to take English lessons for another £100. ‘I thought it was included,’ she says. ‘Fortunately my ex-husband comes from a rich family [and] they were helping me.’

Before receiving the work permit, visa and air ticket, Ms X settled the balance of the £4,000 through a salary advance.

In May 2005 she went with a batch of nurses to Dorset to work as a healthcare assistant in a private nursing home. They were asked to pay £2,750 for the adaptation course. ‘All of us were speechless because we didn’t know where to get the money because we paid for that back home,’ she says, and went to the bank to get a loan.

After a three-month course, Ms X registered with the NMC and now works as a nurse in a private nursing home in Kent. ‘I’ve tried so many times applying to the NHS but each time without success,’ she says.

She wants her two sons to join her. ‘If I didn’t have my bank loan they might be here with me now. But I didn’t have the choice, I had to pay my debts first,’ she adds.’

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