Just over 10 years ago, in a major speech to a nursing conference in Brighton, Tony Blair promised to boost a desperately short-staffed NHS with 20,000 extra nurses. Not even Blair, though, could claim to be able to magic up that many British nurses – training takes at least three years – so instead, the NHS began importing them in huge numbers from across the globe.
They came in droves – particularly from India and the Philippines, where hundreds of private nursing schools were set up to meet this new demand from the UK, and also the US. Before long, every Philippine higher education institution had to have a nursing school or face closure from lack of business. A multitude of recruitment agencies were spawned there too, offering to sort out job, travel and visa for nurses lured by the promise of a lucrative salary on the other side of the world.
A decade later, however, the picture is very different. Britain has retrenched. Cutbacks, coupled with the European Union’s rules on free movement of labour, mean few nursing vacancies for anyone from outside Europe these days.
Yet in the Philippines the production line continues to roll. Last year an estimated 100,000 nurses were in training there, the vast majority attracted by false promises of jobs in the west. Many of the country’s recruitment agencies – often employing British advisers – are flirting with, if not flouting, the law, taking a fat fee for the promise of a job they cannot deliver.
One case, in particular, has gained national attention there. Two Britons, Simon Paice and Nicholas Vickers, have been charged along with four Filipinos with running an illegal, unlicensed recruitment agency and making false promises to clients – allegations they all deny.
Locked up in Camp Crame, the police detention centre in Quezon City (part of what is known as Metro Manila), the six stand accused of making 1.7 million pesos (more than £24,000) in job placement and visa arrangement fees from 12 student nurses who say they were promised places in care homes and domestic work, but got none.
NSN Worldwide Advisers – a recruitment agency said to be owned by the two Britons – has its office in Makati, the upmarket business district of Manila. When the Guardian visited recently a concierge confirmed that NSN had closed. Asked why, he chuckled and said the owner had been arrested. But hundreds of recruitment agencies are still offering to help Filipino nurses get to the UK.
The NSN investigation had been carried out by the Philippine government’s taskforce against illegal recruitment, headed by the country’s vice-president, Jejomar Binay. “Let this serve as a warning to illegal recruiters and those who intend to take advantage of our OFWs [overseas Filipino workers] through illegal recruitment,” Binay was reported to have said. “Remember, your days are numbered.”
Of the 50,000 or so nurses who qualified in the Philippines last year, no more than 13,000 are thought to have found a job abroad. “That leaves 37,000 nurses who are qualified with a big uncertainty, as there is no shortage of nurses in this country,” said Henk Bekedam, regional director of health service development at the World Health Organisation’s Manila base.
“Worse, about 100,000 families on an annual basis are putting their daughter – usually a daughter – into training, with the big hope that in four years she will get a job. This costs a family an average of $10,000. Your daughter is your hope for the future; many of them will be disappointed.”
Unable to secure jobs for nurses in the UK, many Philippine recruitment agencies – often unregistered – have reinvented themselves as education consultancies. Typically, the thousands of trained but jobless Filipino nurses are encouraged to study top-up courses in the UK, which, they are led to believe, will get them jobs afterwards. The reality is different.
According to Michael Duque, president of the Philippine Nurses Association of the UK, many Filipino nurses arriving on a student visa struggle to cope. If their family cannot send money to support them, they end up breaking immigration rules which used to allow 20 hours work a week for students, but have recently been changed to permit only 10.
“Most would be working more than the 37 hours of an average working week, doing extra housekeeping jobs, cleaning jobs,” he said, adding that if the nurses can find a nursing home prepared to give them illicit out-of-hours work, they will do that – but such an arrangement can put the employer at risk too.
Some end up on the streets. “They don’t have any place to live. They can’t pay for accommodation,” Duque said. Although the Filipino community is supportive and will take people in, there are those who just disappear. “Some, when their visa has run out, will go underground instead of going home. Some even end up in prostitution. They can’t go back because they owe a lot of money back home.”
Duque would like to open a “halfway house” where Filipino nurses who get into real difficulties can stay until they sort themselves out, but his voluntary organisation doesn’t have the funds.
On NSN’s locked glass door in Manila, a poster still claims that “your dreams are our responsibility”. In another agency in the same office block display panels in the smart reception area are covered with posters for British universities and colleges.
Melissa Dujali, a bright, 32-year-old woman living in Manila, has been brought up to understand her destiny. The second of four children, she has the brains and aptitude to secure a good nursing job overseas and support the rest of the family. So far though – and her story is very familiar in the Philippines – her efforts have led only to debt and disappointment.
“I’m the breadwinner. I took nursing to support my family,” she explained. “My father is a diabetic patient so our business is not doing well. We are not a well-off family.”
In April 2009 Dujali went to one of the many agencies that call themselves education consultancies. She was told she could take a two-year course in the UK, which she could fund from the 20 hours’ work she would be permitted to do while she was there. The agency fee, for arranging her application to a British college (a BTEC higher national diploma in health and social care) as well as her student visa, was 75,000 pesos (£1,065). The college offered her a conditional place and asked for a down-payment of £1,000 towards the tuition fee.
The agency told her she would have to give the British embassy proof that she could afford the tuition fee and living costs, which would be an estimated £350-£500 a month. “I provided all the requirements,” Dujali said. But in November 2009 she was told her application had been declined. Embassy officials did not believe she had sufficient funds.
“The agency said it would be OK,” she said. “They showed me the many approved visas, so I asked them to appeal.” But nothing had happened by January 2010 when the course was due to start, so Dujali pulled out. The agency fee was non-refundable. She has been told by the agency that she will get some – though not all – of the £1,000 paid to the college, but as yet, a year later, has had nothing.
Such stories, and the promises made by the agencies – which are legal, according to the UK Home Office, but not within “the spirit of the law” – are one reason for the British government’s recent promise to crack down on student visas, making it much harder for overseas jobseekers to get into the UK through the student route.
For her part, Dujali now realises the rosy prospects that were painted of earning good wages in the UK to cover her costs and send money home were false.
A survey in 2006 by Professor James Buchan of Queen Margaret University, Edinburgh found that about half of Filipino nurses in London were sending between 25% and 50% of their income back home to their families. Most were the major or sole breadwinner in their family. Almost all (96%) had used a recruitment agency in their home country and nearly three-quarters had paid for their services.
Ira Pozon, legal counsel and international relations officer in the vice-president’s office, is a key player in the crackdown on such agencies – which are, he said, involved in “under-the-radar illegal recruitment. Their promise is a student visa, but face to face they say we can help you get a job.”
Pozon, who is in his early 30s, estimates 40% of his classmates went into nursing. His advice to compatriots interested in such a career now? “If an agency is asking for a lot of money, walk away,” he said. “But the poorest of the poor believe them. They sell their property, thinking in six months I will have earned back everything I spent. They never get deployment. It is a basic scam.”
Sisters in, sisters out
While the word will, eventually, filter through to Filipino families that nursing in the UK is no longer a good option, Britain’s training and recruitment policies for nurses make it likely that the same saga of raised, then dashed, expectations will happen again.
A review by Professor James Buchan of the 2010 labour market for the Royal College of Nursing encapsulated the UK’s boom-and-bust approach to nurse education and recruitment.
According to the review, funding for training places is increased when there are shortages, and cut when the supply is good and the country is in economic difficulties. Because it takes three years to produce a trained nurse in the UK, overseas recruitment surges to fill shortfalls, and then is slashed again.
In the early part of the last decade, between 10,000 and 16,000 international nurses were being added to the UK register. By 2009, that had dropped to 2,700.
Buchan talks of “the massive pendulum swing” in a 10-year period, from low-level international recruitment in the late 1990s to very high levels in the start of the 2000s following the Blair announcement, back down to low levels in recent years.
Now, in fact, the UK is losing nurses rather than importing them. Australia is the prime destination, followed by the USA, New Zealand and Canada. In 2008, less than 200 Australian nurses registered to work in the UK, whereas more than 6,000 UK-registered nurses had their qualifications validated to move down under.