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The sting in the tail

August 27, 2004 -- Today the Guardian (U.K.) ran an analysis piece by its social affairs editor John Carvel about the ongoing debate over the issue of the U.K.'s "poaching" of nurses from developing world nations. Carvel's piece recounts some of the history of the issue there, as well as the current state of debate, but he closes by suggesting that the story's final "sting in the tail" may be that though Britain has been the most powerful player in "the poaching game" to date, the U.S. is poised to assume that role--not only as to "overseas" nurses, but "British" ones as well.

The main theme of Carvel's piece is that while it's good the British government has now accepted that it should not rebuild its National Health Service by "stripping developing countries of their scarce supply of qualified nurses," it has still not found a "robust solution to the problems of medical migration." Carvel notes that about 40,000 overseas nurses have registered to work in the U.K. in the last four years, mainly from the Philippines, South Africa, Australia and India. While some nations, such as the Philippines, "appear not to mind," the "drain is a real problem for the countries of sub-Saharan Africa." (It is, as Celia Dugger's July 12, 2004 piece in the New York Times makes clear.)

Carvel goes on to relate some of the complex debate over the last few years as to just how far the government should go in limiting the "poaching." It has restricted the NHS' ability to participate directly in the practice (apparently it can do so now only pursuant to intergovernmental agreements). But private employers have remained free to do it, providing a back door way for the practice to continue, as overseas nurses start at private institutions, then move to the NHS. British nursing unions, on the other hand, have evidently been dubious about limits on the mobility of individual nurses. In the last week, the government has reportedly proposed forbidding employment agencies from supplying the NHS if they also "poach" for the private sector.

But the Royal College of Nursing reportedly doubts anything short of applying the current NHS restrictions to the private sector will have much impact on the practice, and evidently such restrictions are unlikely. Carvel proposes compensation (in the form of technology, skills and financial assistance) to affected nations as the remaining viable solution. Carvel supports that solution even though he recognizes that it might in some cases entail transfers from one developed nation to another, and even if it might provide an influential precedent as to the migration of other "skilled workers," such as "builders" and "plumbers." Without taking anything from these other important jobs, we imagine any such compensation arrangement would involve some showing that the drain of workers in question was causing grievous harm to a nation's wellbeing, as the nursing shortage is in a number of nations.

Carvel concludes by noting that Britain has been "the most powerful player in the poaching game, but that role is set to pass to the U.S. The NHS may be about to lose staff--both British and overseas--to the lure of the dollar." The final irony, of course, is not just that a nation that has been agonizing over its own "poaching" might find itself on the other side of the equation, but that if the solution Carvel and others have proposed were to be applied across the board, it could result in the transfer of compensation from the United States to nations like Britain, to say nothing of sub-Saharan Africa.

There have been a few articles about the "poaching" issue in the U.S., but compared to Britain, the issue is barely on the governmental or media radar screen. The issue may never gain comparable prominence here, given differences in views about the role of government and other factors. It may also be that for the foreseeable future the main destination of dissatisfied U.S. nurses will remain retirement or other jobs in the U.S., where they will at least remain subject to potential enticements back to the field, such as safe staffing ratios. But those in the U.S. should consider where "nurse migration" could really end, and whose tail could get stung last.

See John Carvel's article "Nil by mouth" in the August 27, 2004 issue of the Guardian.


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