Examination of Witnesses (Questions 200
- 219)
TUESDAY 9 MARCH 2004
PROFESSOR JAMES
BUCHAN, MR
WINSTON COX
AND MR
DUNCAN HINDLE
Q200 Tony Worthington: Can I welcome
you all to this meeting. I have apologies to put forward from
the Chair, Tony Baldry, who is in Sierra Leone today. So apologies
because he cannot be with you, but a particular welcome to our
witnesses on this investigation we are doing into the link between
migration and development. We are turning today to a particularly
interesting area, about what, in colloquial terms, is called the
"brain drain" associated with developing countries.
Can we leave it to the witnesses not to feel that they have to
respond to every question that we put—each one of you—otherwise
we will not get through everything we have to do. Can I start
off by looking at this issue of the impact of highly skilled migration
on the ability of developing countries to be able to meet the
Millennium Development Goals. One of the really distressing situations
is to see that a minority of people get up to secondary and higher
education standard and then you hear very dramatic statements
like "There are more Ghanaian doctors in New York then there
are in Ghana" or some statements such as that. Can you, as
an opener, give us your reaction to the impact of migration in
terms of the intellectual capacity of countries and the ability
to reach the Millennium Development Goals? Can I start with Mr
Cox?
Mr Cox: Thank you, Mr Chairman.
I think the answer to your question is not a simple one. Probably
the direction of causation goes in two ways: first, on the face
of it, outward migration will certainly reduce a country's capacity
if the migrants are drawn from the skilled groups that are in
short supply, and the smaller the country the greater the burden
on capacity. To some extent, however, countries are also recipients
of migrants, and in the example that you quoted about there being
more Ghanaian doctors in New York, another way to phrase the question
is: is the supply of doctors in Ghana sufficient to take the Ghanaian
health system across the threshold? I think that really is the
problem. When migration threatens the integrity of the systems,
whether it is the health system or the education system, then,
yes, indeed, it will have an adverse impact on the country's ability
to meet whatever targets it sets itself, and in the international
development context the Millennium Development Goals are the operative
targets. Can I stop there?
Professor Buchan: Just to reinforce
what Mr Cox has said, I think it is important to look at the overall
issue of capacity to meet the MDGs, or any other particular targets,
and if the assessment is that the country will not have the capacity
to meet targets the question then is to what extent has migration
contributed to that lack of capacity? It is difficult enough,
I think, to assess that just in terms of numbers, but if you try
and get into skills it becomes even more difficult to assess the
relative impact of migration against other forms of outflow from
the health workforce, for example.
Q201 Tony Worthington: It would be
helpful if each of you could give specific examples of where out-migration
has been a particular factor in hindering the progress to the
Millennium Development Goals in your response—particular
examples of where it has been severe or is particularly affecting
certain service sectors.
Mr Hindle: I am from South Africa,
from the education sector, and let me say that it is perhaps fortunate,
at this stage, I do not think the migration patterns have reached
a stage where they are likely to compromise the Millennium Development
Goals within the context of South Africa. It is perhaps edging
closer, certainly in regard to some specific skills, particularly,
obviously, maths, and the science and technology areas. Those
are the people who are, obviously, eminently recruitable elsewhere
and do tend to move. Should that start to affect numeracy and
literacy levels in the country we would be concerned about that.
At this stage I do not think it is the case and I think it reinforces
Mr Cox's point that it is obviously related to the context in
the country, the current supply and demand equation, in any professional
field.
Mr Cox: I would have quoted very
much the same example from education that Mr Hindle quoted, but
I would also say that in the health field meeting the Millennium
Development Goals with respect to maternal mortality, for example,
can be severely hampered where the recruitment of maternal nurses
is particularly heavy. We have found from consultation with a
number of partners in the health sector that health education
and health care delivered by the nursing—I almost said fraternity,
but I suppose that is probably quite correct too—can have
a major impact on rates of maternal mortality.
Q202 Tony Worthington: Can I respond
to that? We have recently been to Ethiopia which has something
like a $2-a-person-a-year health service, where the figures we
were given—and they were old figures, for 1995—show
that only 5% of births were attended by skilled, trained people.
Five per cent! For Ethiopia to lose any nurses must be very, very
bad news, in terms of meeting goals on infant mortality or maternal
mortality and so on.
Mr Cox: Indeed. However, at $2
per head per year for health care there must be lots of other
critical components that are missing as well. So the nursing care
is only one. Obviously, it is the focus of our attention here
but there would be other critical components that would be missing
at that level of expenditure per capita on health care.
Q203 Tony Worthington: Another area
that we have got very interested in is the business of remittances.
Certainly a point that had not occurred to me before was that
I think we were all astonished by the scale of remittances, dwarfing
in some cases the amount of development assistance going to those
countries. We have heard it put forward that if you are exporting
skilled labour, going to developed countries, earning wages in
those countries, that is an effective way or it is an important
contributory way towards giving development assistance to those
countries. Have you any views on that? Can you think of any countries
where, in fact, that has been a major contribution to their development?
Mr Cox: Yes, Mr Chairman. There
is a particularly interesting issue of comparative advantage in
training that could be applied to provide an answer to your question.
Let me begin by saying that I think there are very few developing
countries that train skilled people for the export market. I think
India is probably one country that comes to mind where there is
a fairly conscious policy of training large numbers of individuals
with the export market in mind. However, in many developing countries
the resources to be applied to the training of skilled individuals
are scarce resources and the training is not done with remittances
as the objective. In the teaching profession, for example, the
training is done with the objective of delivering quality education
to the citizens, and similarly in the health sector. There are
other ways of exporting those services where, for example in health,
tourists may visit a country and have certain procedures done
there. That is virtually the same as remittances; that is there
are substantial earnings from non-residents, but those services
are delivered in the country where the professionals have been
trained and where they reside, so they are not lost to the system,
they are serving a much larger community. There have been times
in the development cycle of many countries—small countries
in the Caribbean are a good example of this—where a number
of skilled workers have left and have provided substantial remittances.
However, these were not, very often, people who had been trained
to the skill level where they were teachers and nurses, doctors
and engineers and the other types of professionals that any developing
country needs if it is to move forward at this stage in the cycle
of development; these were very often mechanics and other types
of workers, many of whom migrated to England, provided remittances
back to the Caribbean and helped to build up an economy, improving
the quality of housing and improving the quality of education,
in particular. Therefore, there is indeed a strong link between
remittances and development impact. I know that there is a debate
about the quality of expenditure, whether it is conspicuous consumption
or whether it is productive investment, and there is debate about
how such remittances can be harnessed better to ensure that they
are spent on productive investment. In the training of health
service workers and in the training of education system workers
I think the fundamental issue for most countries is the integrity
of the systems to meet the commitment to the local population
rather than a source of remittances. There are other areas where
this is very important. I believe on an earlier occasion reference
was made to the work of Professor Winters on Mode 4 in the WTO,
which can provide—as demonstrated by his work—substantial
benefits to the countries from which people employed in industry—in
the service industry, the hotel industry and various other types
of activities—can make a substantial contribution. So it
is, perhaps, a bit of a two-edged sword, one could say. Yes, there
are benefits but they have to be very carefully calibrated and
we have to be sure that they do not undermine the integrity of
the systems from which the individuals are drawn.
Mr Hindle: Can I add on that,
I think one of the questions would be about the status of the
migrant, as it were. Clearly, where they are a breadwinner and
they have left a family, perhaps, back in the home country, remittances
probably would go back, but to a large extent many of the young
professionals that are recruited tend to be single individuals
and, therefore, very little of that income is remitted back to
the source country. Certainly in the case of teachers, dominantly
they are coming here straight after training, mostly for a two-year
period, but very little of the income earned in that period is,
in fact, coming back. Some might come back with them when they
return but not during the course of their service in the host
country.
Professor Buchan: On the issue
of training for export, I think, there is one other obvious example,
which is the Philippines. In many ways it is unusual, if not unique,
in the sense that the nurses are trained in the private sector
and pay for their training. So that, unlike most other developing
countries, it is been very much established as a mechanism for
export. I think the other point to make, reinforcing what has
already been said, is that I do not know of any detailed work
that has been done on the issue of remittances from health workers.
The World Health Organisation has currently commissioned some
work in Ghana to look at that issue, but the evidence I have seen
suggests that, for example, doctors are more likely from Ghana
to move and take their families with them and, therefore, the
remittances back to the country may be less than is anticipated
compared to nurses, who are often moving but leaving their family
and, therefore, more likely to remit.
Q204 Tony Worthington: It is an interesting
point about the private sector. Given all the publicity nowadays
about falling populations in Europe, for example, and the lack
of skills in some areas, do you see a situation occurring where
the private sector would say "What we will do is we will
go and train in the developing world in order to meet the labour
needs of the developed world"? Is that something that might
happen or is happening?
Professor Buchan: I think certainly
it is being discussed with some countries. There are issues to
consider in terms of regulatory environments and what could be
called the cost of entry into the market, and it is from that
point of view going to be more profitable to train nurses because
they take a lot less cost and time to train before they can then
be moved to the destination country. Clearly, if they were looking
at training doctors it is a much longer and more time-consuming
and costly process.
Q205 Tony Worthington: A final question
I would like to ask, at the moment, is, people might say "Well,
of course, skilled personnel will move away from developing countries
because of the conditions in which they have to work"—either
their wages or the lack of professional satisfaction about having
to be in health work without a pharmacy, for example. What do
you think happens to migration as countries develop? Does there
get to be a slowing down point, or do we need to accept, in fact,
that migration, regardless of the state of the country, is something
that will be happening for the rest of time, as the world it is?
Mr Cox: I would say that I would
accept that migration would continue irrespective of the state
of development of a country. There are times when what one might
describe as the "push" factors—ie the domestic
conditions in the country from which the migrant comes—may
be more predominant (as you described it, their working conditions),
and they may deteriorate to the point, also, where the civil liberties
etc switches one from being a migrant to being an asylum seeker.
So those are the "push" factors operating. However,
there will always be "pull" factors as well. So irrespective
of the position of a country there will be "pull" factors
from other countries. Indeed, the "pull" factors may
well be the challenge of working in an under-served community,
and that is why you have people who are prepared to work in developing
countries and work in development. Another "pull" factor,
obviously, may be a more sophisticated laboratory and better equipment
with which to work and carry on one's experiments. Nor would I
like to see a world in which there is no migration, quite frankly.
Mr Hindle: I think one would have
to say that the circumstances would have to be pretty bad within
a country for those "push" factors to be dominant. These,
in the end, again, are professionals; they are pretty well at
the top of whatever pile there is within that country, so unless
the circumstances are really disastrous (and, obviously, in some
countries they are) certainly for us, I think, the dominant factor,
undoubtedly, is the "pull" factor. In the end, honestly
and obviously, it is related to exchange rates and related to
the amount that they are able to earn in these countries, I think,
more certainly at this stage than the "push" factor.
Professor Buchan: Within the health
sector we also need to factor in that it is evident that most
developed countries are projecting a significant increase in requirements
for health care provision over the next 10 or 20 years. That means
more health care staff. The question then is, to an extent, can
these developed countries meet that need from their own sources,
or do they take the perspective that recruitment from other countries
is actually the most cost-effective way of doing that?
Q206 Mr Robathan: Can I just tease
out something further, Mr Cox? Going back to one of your earlier
responses about the Millennium Development Goals, Mr Worthington
mentioned Ghana, specifically, and we went there a couple of years
ago. We went up to the north of Ghana—and without a map
I can't tell you exactly where it was—and I do remember
being told in a city in the north that there was one doctor to
cover X-number of thousand square miles, which was not satisfactory
in a country with a growing population. I particularly remember
a minister saying to us as well "We do wish that you would
stop shipping"—and I quote—"jumbo jet-loads
of nurses to the UK." This was not NHS recruitment, this
was something else. It seems to me this must be having a huge
impact on MDGs in Ghana, specifically.
Mr Cox: It would have a very huge
impact. The impact would vary from country to country, indeed,
but the whole issue of being in an under-served area of Ghana,
for example (as you identify) is that these absences will affect
the country's ability to achieve Millennium Development Goals.
This is why health ministers and education ministers in the Commonwealth
have been concerned about recruitment, in the one case, of health
service professionals and, in the other case, of teachers, because
they recognise that a large outflow of these types of professionals
will indeed widen the gap. So I am quite in agreement with you
that it will have an adverse impact on a country's ability to
meet the Millennium Development Goals. There are also other factors
that are important. In the case that the Chairman mentioned, the
level of expenditure would obviously imply that there are things
other than personnel shortages which are at work as well.
Q207 Mr Robathan: If you increased
expenditure you might be able to pay your doctors and nurses.
Mr Cox: You might be.
Q208 Mr Robathan: This leads us straight
into recruitment. One of the submissions to our inquiry has referred
to this sort of recruitment and the "brain drain" of
professional people, particularly public sector workers—doctors,
nurses and teachers—as "immoral and imperialistic".
Whether or not one agrees with that, would you, or any of the
panel, say that developed countries should compensate developing
countries that have trained nurses, teachers and others for their
loss? If so, how would one estimate that? Do you think there is
a moral case for it?
Mr Cox: Given my history and background,
I am not sure I would be quite happy with the term "compensation".
I think that a case can be made for countries to arrive at mutually
acceptable ways of mitigating the adverse impact of recruitment
in the case of developing countries by their more developed neighbours.
I think that there are very good grounds for looking at mutually
acceptable ways of mitigating the impact. To call it "compensation",
I am not exactly comfortable with that term. How can it be done?
It could be done by strengthening institutional capacity. There
is a suggestion that it may be cheaper and, therefore, there may
be a greater comparative advantage, to train some types of professionals
in developing countries because it is more cost-effective. If
that, indeed, is the case, and an industrial country wishes to
take advantage of that situation to supply some of its own shortages,
I think that that would be an appropriate situation in which to
discuss a mutually acceptable way of strengthening the capacity
of the country to produce—ie, if it were teachers, how could
the recruiting country help the source country to build up its
capacity to train teachers or whatever other type of workers were
required? The advantage in helping to build up that capacity would
be seen in the level to which the professionals were trained.
You could, through that mechanism, ensure that they were trained
up to the standard that you expected, which very often is higher
than the standard in the source country, but it would automatically
also lift the standard in the source country, so that would be
a possible spin-off apart from the assistance with capacity building
and the strengthening of the institutions. I think those would
be more constructive ways of addressing the issue that you define
as compensation rather than trying to calculate a monetary amount
per head.
Mr Hindle: Can I just add to that,
for a moment? Firstly to say that I think the nature of the recruitment
is very important. Your example of the jumbo-loads of nurses is
surely an exaggeration but I think—
Q209 Mr Robathan: It is a quote.
Mr Hindle: It is different from
a case where an individual has made a very definitive career choice
and this is part of it, as compared to what we have seen—recruitment
agencies effectively camped outside a faculty of education and,
on a pretty wholesale basis, taking large numbers. That would
be different. On compensation, I think (very much like Mr Cox
is saying), that is the wrong word. Certainly I think it builds
the wrong sort of expectations. To support the idea of building
capacity within the source country is correct. Part of that capacity
itself might be the very capacity to, in fact, monitor the supply
and demand situation. We have not got very good models for doing
that even in South Africa and I am sure many other developing
countries are not able to do the planning that would then enable
them to manage that better. The other one that I think we have
kept on the agenda is the notion that when people are brought
across to a developed country what opportunities for professional
development do they face within that country? That is perhaps
the level at which we can look at seeing how both countries can
really benefit from that kind of international movement.
Q210 Mr Robathan: I have to say I
sympathise with your position on compensation, and was interested
to hear what you had to say. Leading directly on from what both
of you have said, is there anything further that developed countries
can do to ensure that recruitment of public sector professionals
does not undermine the developing countries' abilities to provide
services? Do you think there is any scope for further codes of
practice, bilateral agreements or whatever?
Mr Hindle: Certainly within the
Commonwealth we are trying to develop one for education, similar
to the health professions, and I think that is necessary. Certainly
we appreciate what has been done in the UK here, the development
of the quality mark for recruitment agencies to ensure that they
act in a more disciplined and proper fashion. I think there are
a number of steps like that. I understand, also, that the situation
around work permits and the ability to get a work permit while
you are employed by an agency is now being cut out. Those sorts
of steps can help, but I think it is also a requirement that we
give the source country also some form of engagement with these
agencies. At the moment, essentially, they operate outside of
any sphere of regulation or anything else, and at the very least
I think we would ask that, firstly, they effectively announce
themselves when they are coming into a country so that we know
they are there and that it is their intention to recruit. I do
not think it is unfair to ask them to at least report on their
success so that we know that so many got recruited in this year
and this is who they were. I think it is also about developing
that sort of relationship between a country and the agency. There
is a debate about whether a source country should ever be able
to refuse an agency the right to, in fact, recruit in that country.
That is probably a lot more contentious, and I am not sure we
can easily continue on that one. Some would certainly argue that
there needs to be a right of refusal, almost, to allow that sort
of active recruitment. In the end, passive recruitment is going
to take place, jobs are advertised on the Internet and elsewhere
and people will pick up those options and go, but whether it should
involve an agency actively working in a country to pick up professionals
is, maybe, another question.
Mr Cox: I would like to endorse
what Mr Hindle has said on this issue, in that we are working
very hard to develop a Commonwealth code of practice in the education
profession, as we have done in the health profession.[1]
On the whole issue of agencies, right now there is a sort of voluntary
pressure on agencies to conform to certain types of certain standards—the
quality mark, which the UK has introduced. What happens if they
are not adhered to on a voluntary basis? I would like to raise
the issue, could these be made into a compulsory regulatory framework
within which recruitment agencies would operate, as there are
other regulatory frameworks for other sectors of the economy,
because of the havoc they could cause? I believe that the preference
right now is to have this as a voluntary way of behaving which
conforms to certain standards. If that can be guaranteed, fine,
but if it cannot be then what is the next step?
Professor Buchan: The first point
I would make, and you mentioned it in relation to the public sector,
so it is the government as employer or its agencies as employer,
is that the government is following good practice in terms of
its broad range of recruitment and retention initiatives, so that
if it is doing that well it should not have to be over-reliant
on active recruitment from other countries. That is placing migration
in a broader context. The second point, I think, is in relation
to being able to assess how reliant the country is on international
recruitment. For example, it is unfortunate that at the moment
the NHS cannot say how many internationally recruited nurses it
employs. Until we have a clear sense of the proportion and relative
importance it is difficult to develop policies beyond that. In
relation to the codes of conduct, in terms of the Department of
Health code and the Commonwealth one, I think there are at least
three aspects to consider. What is its content? What does it say?
Secondly, what coverage does it have? Thirdly, what are the issues
around compliance? In terms of the Department of Health code,
I think the limitations it has are rather in terms of coverage;
it does not cover the private sector, which perhaps employs one
in four nurses in the UK now. It is only actually the Department
of Health in England, so one reading is that the other three UK
countries are not covered. In terms of compliance, as I said,
it is very difficult to assess. There are, clearly, large numbers
of nurses coming into the UK from countries that are on the proscribed
list of the code, but it is not possible to demonstrate who actually
is recruiting them; the assumption is it is the private sector
but we cannot actually prove that.
Tony Worthington: I am going to ask Quentin
to come in now, but I am very conscious that in our responses
we are fixated on the public sector, at the moment. That may be
because of the questions we have been asking but I do think we
ought to, at some stage, be looking at the fact that probably
the great majority of migrants work in the private sector in one
way or another. So perhaps we could think about that to make it
more balanced.
Q211 Mr Davies: I must say I think
we have made a lot of progress this afternoon, because I think
the task of this Committee, so far as migration is concerned,
was really two-fold: one was to look at the controversy between
those who say that migration is a net benefit to the source countries
because of remittances and because of the increase in skills for
those who return, and those who say that it is actually a net
cost to the developing countries, and they are exporting rather
cheaply their precious human capital. I think we have made a lot
of progress on that, and your views on that have been absolutely
plain: you think it is actually a liability rather than an asset
for source countries taken as a whole. The second task of this
Committee was to decide whether there should be any policy implications
from that analysis, whether we should look at legislation, regulation
or other policy initiatives. Here we are right into the suggestions
you have made this afternoon. You have made a novel one, I think,
which is that we should look at investing in training capabilities
in the source countries so that there is some benefit from our
point of view and from theirs. Then we have looked at the whole
business of the regulatory framework, codes of practice, codes
of conduct and so forth, and here you seem to be suggesting the
idea, at least, of making them potentially compulsory. Can I raise
immediately a possible difficulty about that? Supposing you, on
a bilateral basis between Great Britain and South Africa, or on
a multilateral basis within the Commonwealth or any other regulatory
framework, had such an agreement or such a code of conduct that
actually became formalised and, maybe, compulsory—a tight
regulatory framework. Would that not just displace the problem
elsewhere? In other words, if there were strict conditions on
which we could recruit teachers from South Africa, would it not
simply mean that we would recruit more from elsewhere, from outside
the framework of that agreement? Would it be possible for South
Africa to replace some of the deficit in teachers by taking teachers
from less fortunate countries on your borders? There must be some
very good teachers in Zimbabwe but I cannot imagine it is much
fun to teach there, any more than doing anything else there, at
the present time. When you start looking at regulatory frameworks
you immediately want to look at the anomalies that may be created
and at the vacuum which may be created outside that particular
framework. Have you got any comments on that?
Mr Cox: I will leave the specific
issues on South Africa to Mr Hindle, but I say you are absolutely
right, it is like squeezing a balloon when you get into the business
of regulation. You can always fall to the lowest hurdle, that
is the one on which you concentrate and that is where you get
your skills. However, it seems to me that there is an express
preference for teachers from certain regions in the education
sector—the Caribbean and South Africa; ie, from English-speaking
countries. Therefore, that is where the Commonwealth comes together.
We exclude from that framework that other large, English-speaking
country, the United States, and that in itself is a problem. Regulation,
of course, is never the complete answer. It certainly has to rely
on the goodwill of the people operating the system. Irrespective
of regulation, if there is goodwill to make it work and if there
is a sense that there are mutual benefits to be obtained then
a lot more will be invested in making the system work, which will
take you beyond the confines of regulation. If there are strict
regulations and there is considerable doubt about the goodwill
of those operating the system, then the level of investment will
diminish, the willingness to be at the table and to have discussions
that lead to win-win situations will disappear because you are
always looking over your shoulder wondering what is the next trick
that is coming down the pipe. You certainly do not want that kind
of situation, and you cannot eliminate that by regulation. You
can control it to some extent but I think a much better approach
to the problem is to have a situation in which both parties are
satisfied that there is mutual benefit to them in the process
of international recruitment.
Mr Hindle: I would certainly concur
with that. I think we have to be very careful of what could be
unintended consequences, and these sorts of things might flow
out of it. I think this debate is almost characterised by that
recognition, in the sense that perhaps two or three years ago
the automatic response of, certainly, any developing country—certainly
that of South Africa—would have been a very negative one:
"No. Stop this. We don't like it, it is debilitating our
country and the sooner we can put a halt to this thing the better."
I think the debate has moved on since then. I think there is a
recognition that there are indeed potential benefits to be derived
from it. Certainly for us the undoubtedly dominant pattern is
that our teachers are coming here, as I said, recruited mostly
at the beginning of their career. They tend to come on two-year
work holiday permits and then come back.
Q212 Mr Davies: What proportion come
back?
Mr Hindle: We do not know. That
is part of the difficulty. The difficulty is because they are
leaving straight from university they never come on to our books,
as such, so the first time we see them, in fact, is when they
come back and apply. I think that is part of the need to develop
capacities within countries to better monitor this information.
Anecdotally, a high proportion of them do indeed come back, partly
because they have to after the two years anyway, and without doubt
they come back as better teachers; they have experienced the world
and, with respect, some of them, I think, come back saying "Our
schools look pretty good in comparison, too". There is that
unintended consequence that we get. You mention the case of Zimbabwe,
and undoubtedly there are good teachers there; they are lining
up on the border, they are keen to come and teach in South Africa,
they are well-trained in maths and science, apart from anything
else, but we are a little bit hands-off at this stage because
we do still have some unemployed teachers in our country so we
are holding off. I think it is an understanding of this as a bigger,
global migration of teachers and not just a one-way flow out of
developing countries into developed countries. Certainly, if we
can mutually benefit from that kind of exchange of teachers, that
must be a good thing. I think that is where we are now.
Q213 Mr Davies: Just so there is
no misunderstanding, I think perhaps I misrepresented you earlier
because you now seem to be saying that you see the present situation,
so far as South Africa and teachers are concerned—your particular
field—as being of net benefit to South Africa, in other
words a net asset and more of a helpful solution than a problem.
Is that right? I misrepresented you, perhaps, in suggesting that
you were drawing the reverse conclusion.
Mr Hindle: I do not know that
we can conclude that it is a net benefit. I believe there are
potential benefits that can be derived. Whether the loss is more
than the gain, as I say, we do not know.
Q214 Mr Davies: There can be nobody
on the face of the earth better able to assess this matter in
relation just to South Africa and just to teachers. If you cannot
come to some conclusion as to where the weight of the argument
lies in that particular matter, what hope is there for us as a
Committee to try to reach a kind of global sense of where the
balance of advantage lies?
Mr Hindle: Then I would be forced
to the side of saying there is value in it, but again to recognise
that, because of the circumstances, we do not have a shortage
of teachers at the moment. If that were to change then certainly
the cost would be much greater.
Professor Buchan: I think the
issue of which countries are covered or not covered by a code
is important. Clearly, the question is, are most that are interconnected
covered by the code or are they not? I think the Commonwealth
code, if it was fully applied and signed up by all the countries
in the Commonwealth would be fairly near complete coverage in
terms of the English speaking labour market for health professionals,
other than the United States. Clearly, I think there will continue
to be an outflow to that one country. On the particular question
about whether or not there is a shift of focus in recruitment
activity towards countries that are not covered, I can think of
one possible example, which is the initial guidelines introduced
by the Department of Health in 1999, stipulating there should
not be active recruitment from the West Indies or South Africa.
In the year after there was a much more significant increase in
recruitment activity in other countries in sub-Saharan Africa
and in the Philippines, as measured by the number of new nurses
being registered by the UK. So it does suggest, perhaps, that
there was, if not a complete displacement, at least some refocusing
on countries that at that time were not covered by the guidelines.
Q215 John Barrett: It sounds as if,
in theory, the codes are good things, but in practice there are
so many loopholes that there is going to be this general knock-on
effect in neighbouring countries, and the effectiveness of the
code of practice for health employees may be extending to education
employees. If this does not cover private agencies—although
there may be no active recruitment there is almost inactive recruitment—this
recruitment will go on anyway. Is it almost wishful thinking that
the codes of practice are going to have the desired effect, or
in practical terms there is going to be far freer movement of
skilled staff to neighbouring countries—south/south migration
and north/south migration as well? Are we whistling in the wind
as far as codes of practice go, because there are so many loopholes,
and so many agencies that will not be covered by them?
Mr Cox: I would prefer to operate
in a market where there was a code of practice, even if it were
honoured more in the breach than in the observance, because at
least you have some sort of moral authority to ask for it to be
honoured by its observance, rather than to be in a market where
there was a free-for-all. In these kinds of issues you always
want to be sure that the best does not become the enemy of the
good. Therefore, while a code of practice is good, to strive for
the best you may have the unintended consequences of pushing a
lot of the trade below the scrutiny of the public sector, below
the scrutiny of careful regulation and good practice. That is
the last thing that you would want to do.
Q216 John Barrett: Is the follow-up
from that and from Quentin that if teachers are coming over, gaining
skills and going back, and if nurses are coming over for a relatively
short term and then going back to the source country, is the traditional
view of this that this is a loss to the developing countries?
Is this now changing and more and more people are saying it will
depend on whether it is a single individual, or whether it is
a head of household? It is a more complicated matter and people
are now finding that it is difficult actually to say whether this
has been a drain on a developing country or whether it may be
a drain for the next two or three years but in the next five or
ten years it may actually be a net plus. So that the code of practice
you were talking about earlier on may be fine in theory in but
practice the codes may have to change in years to come.
Mr Cox: Sometimes, I suppose,
the separation of short-term and long-term effects has to be done,
and because you may have waves of recruitment there will be periods
in which the short-term effects will be aggravated very severely.
You cannot really move to the long term unless you are able to
survive the short-term context. So that is part of the problem,
that sometimes the short-term impact of heavy recruitment may
seem almost capable of overwhelming the system so that it will
not survive to benefit from the long-term returns. That is the
danger that one wishes to avoid. Therefore, you would ideally
like to have a more steady flow in both directions.
Mr Hindle: I think there is no
doubt that these codes need to be supported by rigorous research
and monitoring. I think the truth is that that is not on the table
at the moment and we do not know the extent of these flows either
way, and certainly the more data we can get, I think, will help
us understand it. It is more complex, as I say, than we thought
it was three years ago, and I think that is the truth. Just to
say that our understanding is that the code would certainly cover
the private agencies. The country would be expected to put pressure
on them to abide by that, so it is more a case of the private
agencies recruiting for the public sector schools, so they are
still going into the public sector but they are operating as a
medium between the teacher and the school. So private sector schools,
I think, are a big issue that perhaps we will have to find another
mechanism for.
Q217 Mr Colman: My constituency,
Putney, is known, I notice in South African magazines, as "Sandton-on-Thames",
which I spotted at the weekend. I have got some 25,000 South Africans
there and I am reassured that you have told us today that you
do not have in South Africa a shortage of teachers at the moment,
which will stop me trying to encourage them to go back. Can I
ask, from a South African perspective, what was the motivation
behind the signing of the Memorandum of Understanding with the
UK? What do you believe is the hope that will come out of this
Memorandum of Understanding relating to the migration of health
service professionals?
Mr Hindle: Thanks for that, and
certainly we recognise "Sandton-on-Thames" living here,
and I would certainly not want to discourage you from getting
those teachers, after they have done their stint here, to come
back. That is the point, really. One little part that worries
me about "Sandton-on-Thames" and one of the concerns
we do have—Sandton is a very wealthy area, as you will know—is
that there is a sense of cherry-picking that is done. So you have
had, in many ways, the elite, the cream, that have been recruited,
and probably many of those 25,000 are in that capacity. So one
of the concerns we would have is about the nature of recruitment
and how fair that was actually managed within the source country.
The Memorandum deals with the health sector, so perhaps Professor
Buchan would like to comment, but it is really to, again, try
and not stop the thing but manage the thing. We see it as the
obligation of any country to manage the supply and demand of its
professionals, under normal circumstances. What the Memorandum,
I think, tries to do is to prevent large-scale recruitment in
order to meet what should be seen as normal needs that a country
should be managing on its own. So, really, that is the purpose
of that MoU. I think, at this stage, the effect of it, again because
of the absence of perhaps research data, is unknown—to me,
certainly.
Professor Buchan: I have not seen
the MoU so I cannot comment on its content, but there are two
points. One: I know that several NHS employers, including one
London teaching hospital, have been in discussion with regional
government in South Africa about contracting nurses to come here
and work for two or three years, which would include an educational
component, and then return to South Africa and work for another
two or three years. So it would be a kind of combined contract.
That may be part of it, or, if not, at least it is parallel to
it. The other issue I could comment on is that in terms of the
timing of the MoU it has occurred at roughly the same time as
the contracts for DTCs have been out—that is the Diagnostic
and Treatment Centres in the UK. My understanding is that some
South African companies were considering bidding for those, and
if they won the contracts they would be, presumably, bringing
their medical and nursing staff to the UK for periods of time
to provide the care under which the contract had been won.
Q218 Mr Colman: Can I say that whilst
parts of Putney are similar to Sandton, parts are actually not
and have significant areas of social housing, particularly in
Roehampton, where we have Roehampton University. Also in Putney
is the Voluntary Service Organisation, the VSO, and it tells me
that it finds it quite difficult to get work permits for health
care professionals and others to actually be able to work in South
Africa. You pointed out that you do not recruit teachers in from
outside South Africa because you have an excess of teachers. You
say they are lined up on the border but they cannot get in. To
what extent is this true of other professionals that the South
African Government does not allow to come in to work, albeit,
as I think Mr Cox was saying, people want the challenge of serving
in more challenging conditions? Is this something you would like
to see encouraged? To what extent do you think South Africa is
losing out in terms of not encouraging professionals from Britain
and developed countries to come and work there to deal with some
of the shortages that they have, particularly in health care?
Mr Hindle: I am not going to try
and speak on behalf of home affairs; it is probably more complicated
and I shall stay out of it, except to say that we recently reformed
our legislation which used to be called—horrible name—the
"Aliens Act" and is now the Immigration Act, and I think
it symbolises a sense of being more receptive in this regard.
I would be very surprised if any professional were not permitted
to work in the country, although, obviously, we do have a position,
I think, similar to most that where there is a local resident
who can perform that function they should be given the first choice
of it. Let me say, however, that we do have foreign teachers teaching
in South Africa, so certainly they have come in. Again, it would
be on the basis that if a local person was not able to fill the
position it would be permitted, and I am sure a work permit would
not be refused on that basis.
Q219 Mr Colman: Would Mr Cox recognise
this is a problem in many other developing countries within the
Commonwealth, where, in fact, it is difficult for a professional,
perhaps from the United Kingdom, to be able to get a work permit
to work in a developing Commonwealth country?
Mr Cox: I would recognise it as
a problem if by denying this kind of inward migration the country
in question could be seen, in fact, to be holding back its own
development. So there are situations where skilled workers from
the United Kingdom are readily snapped up in countries where those
skills are in short supply. It used to be accountants in my own
country until quite recently. Now we tend to provide most of the
accountants that we need, although I must say that when you have
filled one position as an accountant it tends to increase the
demand exponentially, so that we always seem to be running to
catch up. Engineers was another one. You are absolutely right
that it would be a problem if by so doing the country were denying
its development potential.
1 Copies placed in the Library. Back
|
