Examination of Witnesses (Questions 294
- 299)
TUESDAY 27 NOVEMBER 2007
Dr Edwin Borman, Ms Josie Irwin, Ms Lesley Rimmer
and Mr Colin Angel
Q294 Chairman:
Good afternoon and thank you very much for coming along to help
us a great deal with our inquiry. We have quite a lot to get through
this afternoon but I am always told to ask you at the beginning
to please speak up and speak slowly so we get an accurate account
of what you are saying. Do you want to go straight into the questions
or do you want to say anything to start the ball rolling? Well
done; straight to questions. Which occupations in your sector
have the highest shares of migrants and why? To what extent do
you think the employment of migrants is a reflection of pressures
to minimise labour costs? Is there a difference in this context
between privately and publicly funded health care jobs?
Ms Irwin: As the Royal College of Nursing said
in our written evidence, some 90,000 internationally recruited
nurses were registered in the UK between 1997 and 2005. A substantial
proportion of those nurses work in the independent sector in care
homes. About 45% of all nursing registrants to the UK registered
between 1997 and 2005 were from overseas and the findings in one
of our own surveys called Holding On, which we have cited
in the evidence, indicates that 25% of nurses working in care
homes come from overseas. So, for the whole of the nursing workforce
in the UK, which is just over 600,000, some 90,000 are internationally
recruited nurses, which is crudely about a sixth of the nursing
workforce in the UK. The second part of the question was about
a reflection of pressures to minimise labour costs. In the independent
sector, in care homes, we see a much more direct relationship
between costs and the employment of internationally recruited
nurses. I should say that the majority of internationally recruited
nurses are employed on the lowest of the nursing scales, which
is known in the jargon as a band five, which in old terms is a
staff nurse grade. In the independent sector, because we know
there are acute pressures on nursing care homes, the pressure
is on labour costs so nurses are paid less and they tend to work
longer hours in the independent sector too. The third part of
the question was whether there is a difference in this context
between privately and public funded healthcare jobs. Across the
whole of the healthcare sector internationally recruited nurses
tend to be paid less as a consequence of the funding pressures
but there is a specific difficulty in the independent care sector
and care homes. I should say also, my final point, in general
terms, the employment of migrants is a deliberate policy choice
to employ a workforce at a lower cost.
Q295 Chairman:
So they could get people if they wanted to, but not at the same
cost? Is that what you are saying:
Ms Irwin: Yes.
Q296 Lord Sheldon:
The Royal College of Nursing suggests that immigration is a short-term
solution to domestic shortages. What is the long-term solution?
What do you consider is the role of migrant workers in meeting
labour demand over a lengthy period?
Ms Irwin: Again, as our evidence shows, the
NHS in particular could not have delivered what it has managed
to deliver in the last ten years without there being supplies
of internationally recruited nurses. They would not have been
able to work without the 90,000 that came to the Health Service
between 1997 and 2005. We have described it as a short-term solution
because, in the longer term, we know that the nursing workforce
is a global workforce. There are acute pressures on the nursing
workforce, for example, in the US right now and what we are beginning
to see is a shift in the proportions of nurses registering from
overseas and the proportion of nurses going out of the UK. Last
year there were some 10,000 nurses who joined from overseas, roughly
7,900 from countries like South Africa, from India and from the
Philippines, just over 1,000 from the European Union; that proportion
coming into the country but 8,000 going out, some of whom were
Filipino nurses, for example, who had come from the Philippines
during that ten-year period now seeking other employment opportunities
in the US. We are seeing a shift, therefore the continued recruitment
of internationally recruited nurses in the short term becomes
more of a difficult option and for the longer term what we would
like to see is more focus on workforce planning. In evidence that
we have given on workforce planning to the Commons Select Committee
on Health we have emphasized the importance of proper workforce
planning and, of course, the economic argument, if nurses were
paid a fair salary, then that clearly would have an economic impact
in attracting domestic trained nurses to join the workforce.
Q297 Lord Sheldon:
Are migrant workers as effective as workers who are in this country?
Ms Irwin: Many of the migrant nurses, in particular
from the Philippines—and I am sure colleagues will want
to say something about other professions—and India are degree-educated
compared with the UK nursing workforce where a substantial proportion
are diploma-educated, so in terms of academic qualifications they
have a high qualification. There is no difference whatsoever in
terms of the level of service that is provided by a nurse trained
overseas and a nurse trained domestically.
Q298 Lord Turner of Ecchinswell:
I just wanted to ask one follow-up. You said that over the last
ten years internationally recruited nurses or other medical professions
have been essential.
Ms Irwin: Yes.
Q299 Lord Turner of Ecchinswell:
Was there a different set of policies which might have made them
not essential? What could have happened 10 or 15 years ago and
were they doable things? Was there something inherent about this
or was it just we did not do the policies 10 or 15 years ago that
could have enabled native supply to meet demand?
Ms Irwin: Two things which would have impact
on supply: one is for the government of the day to have provided
more training places in colleges, in universities, so that there
was a greater supply of nursing staff coming through. The second
was to make nursing a more attractive profession, either in terms
of economic benefit, in terms of salary crudely, or in terms of
the working conditions and the working environment and addressing
issues to do with morale and motivation.
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