Prof Ian Kessler of the NIHR Policy Research Unit in Health and Social Care Workforce is Professor of Public Coverage and Administration at King’s Enterprise College. He introduces a brand new analysis from the Unit: International Nurse Recruitment and the Use of Memoranda of Understanding: The Kenya and Nepal Pilots. (1,447 phrases)
With rising well being and care wants as nationwide care programs search to deal with growing older populations, the rising incidence of persistent circumstances, and the shock of the Covid pandemic, there was rising strain on the worldwide provide of healthcare employees. Historically drawing upon abroad workers, this raises new and necessary questions for the NHS about how such staff are accessed and managed. The latest NHS England’s Lengthy Time period Office Plan, 2023, for instance, cautions towards an over reliance on any particular supply of labour. Extra profoundly, the strain on the availability of abroad healthcare employees prompts renewed considerations in regards to the ethics of worldwide recruitment as a apply.
There was longstanding debate on the ethics of abroad recruitment by the NHS and different excessive revenue international locations. That is mirrored in worldwide makes an attempt to control the apply by way of, for instance, the World Well being Organisation World Code, 2010, designed to ‘set up the moral worldwide recruitment of well being personnel, accounting for the rights, obligations and expectations of supply international locations, vacation spot international locations and migrant well being personnel.’ Debate on the ethics of the method has deepened with the brand new labour provide facet pressures, and in response, government-to-government, or bilateral, agreements, whether or not within the type of Memorandum of Understanding (MoU) or tighter, extra formal treaties, have emerged as a possible automobile for addressing moral considerations.
Bi-lateral agreements set up reciprocal preparations between the companion international locations engaged within the abroad recruitment of healthcare workers, looking for to make sure that their respective pursuits are accommodated and addressed. Specifically, such agreements could be designed to show sensitivity to the wants of the supply nation, usually a creating nation with comparatively modest healthcare capability and useful resource. Such agreements are in no way uncontentious. Consultant our bodies such because the Worldwide Council of Nurses have cautioned that they may be utilized by vacation spot nations to open up a brand new supply of labour from international locations protected by worldwide regulation from energetic abroad recruitment of their healthcare workers.
Late final yr the NIHR Coverage Analysis Unit for the Well being and Social Care Workforce was requested by the Division of Well being and Social Care to guage the implementation of two new MoUs, one reached with Kenya in 2021 and the opposite with Nepal in 2022. These MoUs have been distinctive in varied methods. As a rustic internationally categorised as Pink Listed, Nepal has been shielded from energetic recruitment from healthcare suppliers within the NHS. Kenya was, in contrast, a Inexperienced Listed nation with energetic abroad recruitment permissible. Underneath the MoUs each international locations grew to become Amber Listed, with energetic recruitment allowable however managed in accordance with the ideas of the settlement.
The Unit analysis centred on the recruitment of nurses from Kenya and Nepal underneath the respective MoUs, initially looking for to look at the experiences and classes of implementation from the angle of the completely different stakeholders: the NHS trusts concerned; the nurses recruited; and the officers from the federal government and the regulatory our bodies within the two supply international locations. For varied causes it was not doable to interact with the federal government officers in both supply nation, whereas nurses from Nepal had but to be recruited. Undertaken on the finish of 2023, the research did, nonetheless, safe knowledge from: 17 interviewees, akin to recruitment leads and nurse educators, drawn from 4 of the half dozen or so NHS trusts concerned within the MoUs pilot, together with the one belief recruiting nurses from Nepal; a dozen Kenyan nurses taken on by these trusts underneath the MOU; and 6 different abroad nurses employed by NHS trusts, whose experiences supplied a helpful level of distinction with the Kenyan MoU nurses.
For the assorted the stakeholders concerned the distinctiveness of the MoU preparations primarily kicked-in on the entrance finish of the recruitment course of. Officers within the supply international locations, Nepal and Kenya, took the lead in managing functions and producing a pool of candidates then forwarded to the trusts who took over and chosen based on their very own procedures. Certainly, as soon as becoming a member of their trusts, these MoU nurses have been handled very equally to every other internationally recruited nurse. Within the case of the Kenyan nurses, as soon as chosen and arriving within the UK, the trusts: supplied preliminary assist with lodging; ready them for the Goal Structured Scientific Examination (OSCE) taken in matter of weeks after arrival and with a cross required to safe NMC registration; undertook employment checks; and allotted and inducted into medical groups.
Inspired to particate by and dealing with the DHSC as pilots, the trusts involved noticed the MoU preparations as having sensible organisational advantages. The schemes supplied a brand new and manageable channel for worldwide recruitment: trusts had discretion over what number of nurses they recruited underneath the MOUs, with some taking up only a handful of Kenyan nurses to this point, and one belief into the third or fourth cohort of such recruits. With supply nation authorities officers and regulatory our bodies concerned in managing the functions, trusts additionally felt there was a component of high quality management within the nurses forwarded to them for choice. As a belief interviewee pressured:
“It’s having a devoted authorities hyperlink; that’s one of many greatest benefits… it’s like they’ve nearly chosen the nurses who need to go, and in addition can go. They’re assessing their labour market and really offering the nurses that may be surplus to that labour market,”
As well as, recruiting alongside the supply international locations underneath the MOU, trusts felt there was the next diploma of moral assurance. Potential nurses from Pink Listed or certainly any creating nation have been free to instantly apply for posts in NHS, leaving trusts unsure as as to whether or how this impacted on supply international locations. Underneath the MoU, and significantly its entrance finish preparations, there was better NHS belief confidence that supply nation pursuits and desires had knowledgeable the nurses offered to them for choice. As one belief interviewee famous:
“We get loads of candidates coming to us eager to be recruited however they’re from a Pink-Listed nation the place we’re not allowed to recruit until it’s a direct utility. The place you’ve received an MoU you’ve received the reassurance… the approval to say, “Completely, it’s tremendous to recruit.”
For the Kenyan nurses the MoU preparations had worth in offering an ordered course of, managed by a trusted level of contact within the type of the federal government, in a position to present info, recommendation, and assist. As one such nurses acknowledged:
“Every little thing is structured. You’ve a degree of name the place you may go to as a result of it’s been by way of the federal government… (in case you) utilized by yourself, then you definately felt that you just had no person to fall again to you, you needed to struggle your personal battle.”
Recruited as cohorts, the Kenyan MoU nurses additionally welcomed the mutual assist and safety supplied by such a set -up, as they got here to the UK and their NHS trusts in unfamiliar, sometimes difficult circumstance. It was an expertise in sharp distinction to that of our research’ s non-MOU abroad nurse interviewees, who usually felt remoted and with out peer assist on arrival within the UK.
The challenges of the MOUs tended to revolve across the front-end administrative preparations. For the trusts there have been often procedural delays in managing candidates, as supply nation authorities officers ‘juggled’ completely different tasks. Such delays have been additionally skilled by the Kenyan nurse candidates, with one noting, ‘I attempted to use, however they took their time.’ These nurse considerations have been compounded by a perceived lack of procedural transparency on the front-end, creating uncertainty in regards to the rationale for the selections made by authorities officers. These normal administrative issues mustn’t distract for the substantive challenges confronted by the Kenyan nurses on arriving within the UK, and being handled by the vacation spot UK NHS trusts: the difficulties find long run reasonably priced lodging; adjusting to a brand new work and healthcare tradition, with its unfamiliar standing hierarchies; dealing with the residual prejudice, often discrimination, nonetheless sadly evident on the office. These have been, nonetheless, challenges confronted by many an abroad nurse coming to the UK, and never attributable to the MOU preparations.
It stays early days within the implementation of the MOUs with Kenya and Nepal, and certainly underneath the latter the nurses are but to reach. Furthermore, the absence of views on the preparations from the supply nation officers, stays an necessary ‘piece of the jigsaw’ nonetheless to be supplied. Nevertheless, on the proof of the NHS belief and Kenyan nurse interviews carried out as a part of the Unit analysis, the MOUs look like producing mutual advantages. They’re based on a sensitivity to the wants and curiosity of various stakeholders within the supply and locations international locations, contributing to the ethics of the method.
Prof Ian Kessler of the NIHR Policy Research Unit in Health and Social Care Workforce is Professor of Public Coverage and Administration at King’s Enterprise College.
This publication
Kessler, I., Samsi, Ok., & Moriarty, J. (2024). Worldwide Nurse Recruitment and the Use of Memoranda of Understanding: The Kenya and Nepal Pilots. NIHR Coverage Analysis Unit in Well being and Social Care Workforce, The Coverage Institute, King’s School London. https://doi.org/10.18742/pub01-175
