An Observer investigation published in March 2022 uncovered the widespread practice of charging overseas nurses who are working for NHS trusts and private care homes thousands of pounds if they wish to change job or return home early. In some cases, nurses who are tied to their roles for up to five years can face charges in excess of £10,000 even if forced to leave their jobs because of bullying or family emergencies.
In Britain at present, one in three nurses are over 50 years old and will retire over the next decade. The number of district nurses has fallen from 7,055 to 4,031 in the ten years to 2019. There are also 40,000 nursing vacancies across the NHS and only once since 2017 has Britain trained over 25,000 nurses domestically. One in five currently practising nurses are overseas trainees, and that figure rises to half for new recruits: 23,000 in 2021, mainly now from the Philippines and India. It costs around £12,000 to recruit an overseas nurse. In Britain it takes three years to train one, and costs upwards of £50,000.
To ensure that overseas trainees stay tied to the NHS jobs for which they have been recruited, their contracts include clauses that require the repayment of some or even all of the recruitment costs. A contract seen by The Observer and used by University Hospital Southampton NHS Foundation Trust includes a £5,000 repayment clause for candidates from the Philippines that halves after a year. Fees requiring repayment can include exam costs, flights, visa and accommodation. FRFI supporters have spoken with Lebanese Palestinians who have been on conversion training in Liverpool John Moores University who confirm that their contracts include similar clauses.
Many of the nurses tied by these contracts have served on the frontline at the height of the pandemic, now pushed into debt or locked into long-term payment agreements after leaving their roles. The Filipino UK Nurses Association in May 2020 stated ‘As of this writing, we have the highest number of staff mortalities in both the NHS and social care due to Covid-19. It’s a staggering 22% of all deaths’. Parosha Chandran, a UN expert on human trafficking, likened the clauses to ‘debt bondage’ and said that ‘this gives rise to very serious concerns about exploitation’. Patricia Marquis, director for England at the Royal College of Nursing, said she was ‘very concerned’ by a practice occurring ‘in a climate of chronic understaffing’.
Both Philippines and India have below the number of nurses they need, and a WHO report says in the Philippines, ‘only 50-60% of nursing graduates become professional nurses… [practicing] as nurses in the country.’ The country faces a shortfall of 250,000 nurses by 2030. The NHS’s bonded labour system is one aspect of the continuous looting of skilled labour much-needed by underdeveloped countries, an essential feature of imperialism.
Ellie McNamara
