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Editor’s Comment: The bitter pill – trading across borders

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Annie Ward
Finding candidates with the right skills is rather like hunting for a needle in a haystack; the National Health Service, our biggest employer has to resort to stripping the third world of experienced medical practitioners while with the same hand turning away doctors for training posts, so just what is going on and what does it mean for recruiters?


The recruitment game has become as much a case of chance and good fortune as one of hardwork and graft. With an apparent deficit of good candidates many that work in the industry feel that their hands are tied.

I asked Claire Savage, Editor of Training Zone, a destination site for corporate training professionals to explain the position:

“There are many surveys showing that companies are struggling to recruit the right people with the right skills. Many employers also feel that school and college leavers, while apparently qualified, don’t necessarily have the skills the organisation needs. The UK is lucky enough to have high levels of employment at the moment, but that means that companies are competing for skilled staff. In such a climate the need for organisations to train and develop their existing staff is clear.”

The latest report from the Recruitment Employment Confederation (REC) and Deloitte goes someway to enlightening us.
Marcia Roberts, Deputy Chief Executive of the REC said at the time: “The widespread skills shortage of previous months is less evident as larger numbers of migrant workers and seasonal workers enter the job market and are placed by recruiters.“
In essence, we are witnessing a labour market that is failing to produce skilled workers from amongst its own workforce.

Walk into your local hospital and what they are talking about soon becomes clear. The journey from diagnosis to treatment will involve the expertise of several nationalities, dotted by a colourful array of different accents and by the time you’re discharged you will have travelled to the four corners of the globe from the comfort of your hospital bed.

And that is all well and good but what does it mean for the countries whose medical practitioner store cupboard starts to look a little bare?

I spoke to the Department of Health, who were more than a little reticent to substantiate the claims.

A spokesperson pointed to the rosy training outlook. According to their figures, there are more doctors and nurses in training than ever before: medical school intake has increased by 69% since 1997, from 3749 to 6326.

They say the number of doctors employed in the NHS has also increased by over 27,400 between September 1997 and September 2004, while the number of nurses employed has increased by 78,660.

But where have they all come from? The spokesperson told me:

“We do not actively recruit from countries that cannot afford to lose staff, including sub-Saharan Africa. We are the only developed country to implement and review systematic policies that explicitly prevent the targeting of developing countries in the international recruitment of health care professionals.

“The shortage of health workers in many countries is about much more than international migration which is why the UK is providing support to many countries in Africa to overcome the “push” factors in terms of low morale, poor pay and lack of training opportunities.”

And indeed the Department for International Development (DFID) has provided £650 million over the last five years to support health and health systems development in Africa, including the training of nurses and doctors.

But while the NHS don’t ‘actively’ recruit from Africa the very presence of their online jobs board: http://www.jobs.nhs.uk/ means that doctors and nurses from overseas can find out about the vacancies and apply.

An article in the Financial Times, published this August points to the high international recognition for the quality of Ghana’s clinical training, making her medical graduates accessible to the international schools and job markets.

Secondly, the limited number of places available for postgraduate training, coupled with unavailability of some specialist programmes, makes it imperative for these professionals to look for such opportunities for specialization in the developed countries.

And according to the Guardian, despite the crackdown on pinching medical personnel from African countries more than 1,300 nurses arrived in Britain last year from South Africa, with another 500 coming from Nigeria.

Gaby Hisliff, chief political correspondent for the paper said: “While many overseas nurses are hired by private hospitals which are not bound by the ban, others come as ‘temporary’ NHS staff but stay for years as their contracts are repeatedly extended by hospitals desperate to fill shortages. Others are recruited through the back door by agencies trawling private hospitals for staff willing to move to the NHS.”

Kim-Marie Freeston, Managing Director of Lifeline Personnel Ltd and Lifeline Locums Ltd and the REC’s Vice-Chairman of the medical sector group told me that it’s not just recruiting doctors and nurses that is causing headaches:

“There are huge problems getting qualified administrative and clerical staff. It’s something which is not recognised much yet they are the people that underpin the NHS, the unsung heroes. Finding staff with the relevant terminology, an understanding of the NHS and a good grasp of the required computer packages is very hard.

“It has been an historic problem, partly because NHS terms and conditions, notably pay aren’t that competitive. Being a medical secretary for example may not be as lucrative as being a legal secretary. Some colleges that used to train medical secretaries have since stopped.”

And plugging the gap from overseas is a crucial aspect of Lifeline’s business.

“Half of our temporary staff are Antipodeans, from Australia, New Zealand and South Africa, this supply is crucial to our business.”

So it seems that at the heart of the problem is the lack of home-grown expertise. Employers’ group the CBI recently alarmed the business community by highlighting the fall in science and foreign language take up amongst students.

The number of 16 to 18 year olds taking A Level physics more than halved (55%) between 1984 and 2004 while chemistry declined by a third 33%. And just one in 25 students study a modern language at A Level. Mandarin, Russian and Spanish take up is worryingly low too.

Claire Savage commented: “Sciences are incredibly important in the NHS, particularly if you think of those in the frontline such as doctors, nurses and all the professions allied to medicine. Government figures show that the UK is training more doctors and nurses etc, and there are now more flexible routes into training for careers such as medicine, but still the NHS recruits from abroad.

“Expansion in the health service recently means that there is an increased need for staff, and like many large organisations, the NHS also has issues retaining home-trained skilled staff, which may choose to take their talents elsewhere, whether into the private sector, another field or another country.”

Certainly the off-shoring phenomenon is causing recruitment concerns. Fortune magazine recently reported the off-the-wall case of a US-based start-up, SeaCode who plan to literally house their computer programmers in an ocean liner just off the coast of Los Angeles.

That way they avoid American labour laws and can pay staff less. Similar to the case of the numerous call centres now operated from the developing countries albeit with more land under their feet.

The juxtaposition is somewhat crass. The NHS look for their skilled labour from the developing world while our banks and other service companies continue to offshore it in search of cheaper staff and higher profit margins.

So where does that leave things? Claire Savage believes the answer lies in training.

”Training is obviously crucial if we are to have the highly-educated, skills-driven workforce that the government says we must get to continue to compete on the world stage in this era of outsourcing. Employers need to invest in developing their own staff, they need to go beyond the idea of training as a pure cost rather than an investment and concerns that if we help staff get too skilled, they may up and leave for the competition. But that’s not easy.”

With Africa fighting an epidemic of the deadly AIDS virus, it seems immoral to be pinching their best doctors and nurses when we should really be supplying our own.

And the bitter irony of it all is that doctor training posts have all but disappeared.
The British Medical Association who have been lamenting the position say that the situation has arisen because the government’s new two-tier system that will let doctors specialise earlier has caused training posts to vanish in the process.

An unknown number of juniors are facing career limbo because of the crisis that sees too many doctors chasing too few training posts – despite a UK shortage of doctors.

Recruiters within the NHS sector it would seem are literally stuck between a rock and a hard place.

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Annie Hayes

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