Plan to recruit Nepal nurses for NHS puts them ‘at risk of exploitation’ | Health policy

Plans to recruit nurses from Nepal to help plug shortages in the NHS will expose workers to an “unacceptable risk” of exploitation and should be halted until safeguards are in place, labor experts have been warned.

The UK has been accused of pressing ahead with a hiring spree despite concerns about abusive practices by Nepali recruitment agencies, which are notorious for charging illegal fees that leave workers saddled with debt.

The government-to-government deal, signed last month despite Nepal’s status on the World Health Organization’s recruitment “red list”, will begin with an initial pilot involving about 100 recruits but could see thousands of nurses and other healthcare workers move to the UK from Nepal over the next few years.

The Department of Health has hailed the scheme as an “ethical” initiative that will allow for “managed” recruitment to plug UK shortages. A memorandum of understanding says workers should not be charged fees and that recruitment will be overseen by a Nepali government-run “implementation unit”. But critics accuse ministers of turning a blind eye to abusive recruitment practices in Nepal. They say safeguards are needed to protect workers from exploitation.

In May, a study by the Nepal-based research institute Social Science Baha found that about 40% of Nepalis who are interested in foreign employment seek the help of illegal agents. That same month, the Bureau of Investigative Journalism revealed that fruit-pickers from Nepal were routinely charged up to £5,000 in illegal fees for jobs working on UK farms as part of the government’s seasonal worker scheme. Many take out informal loans that they struggle to pay back.

Evidence gathered by the Observer suggests that agencies operating in Kathmandu have begun offering job-finding services to candidates seeking NHS roles – despite the pledge that no workers will be charged.

Facebook ads targeting Nepali workers, which were live on the platform last week, offered consultancy services, including application support and access to a “sponsor database” for candidates seeking jobs in the UK. A second ad offered “online coaching” for nurses and claimed to offer “the best route to the UK”.

Other ads suggest that recruitment agencies have been targeting nurses in Nepal for months, despite its red list status, which requires that active recruitment should not take place because of the potential effect on the country’s fragile health system. Nepal has 21 nurses per 10,000 people, compared with the UK’s 84 per 10,000.

Andy Hall, an independent migrant rights specialist based in Nepal, said “systemic corruption” meant that “in reality in Nepal there are illegal agents involved in every step of migration”. Many of those charging fees have links with UK-based companies, he said. Hall and other critics, including the UK Nepal Friendship Society, are calling for third-party oversight and the involvement of human rights experts to ensure recruitment does not result in worker exploitation. “For the Department of Health to just say, ‘Everything’s fine,’ is not acceptable,” he said.

In a rare intervention this weekend, the World Health Organization expressed support for practical safeguards, saying they were an “excellent suggestion”.

Jim Campbell, director of health workforce at the WHO, said: “We would very much encourage the UK and Nepal to take on board some of these comments and take all mitigating measures to ensure that there are protections for workers rights, protections from fees and protections from poor working conditions.”

He said having third party oversight or input from human rights organizations would “help the government understand the lived experiences of workers to ensure good practice is being followed”. “It would be a safeguard for the workers in this case,” he said. “You’ve got to ensure that behavior is not allowed to start and that if it is, it is identified immediately and eliminated from the bilateral agreement.”

Siobhán Mullally, the UN’s special rapporteur on trafficking in persons, said the charging of recruitment fees could place “a significant burden on workers, leading to conditions akin to debt bondage”. “This is a concern in many sectors and it needs to be looked at in the healthcare sector,” she said. “The problem is often that we have words on paper but the guarantees are not implemented in practice.”

The Department of Health said it would be inappropriate for bilateral discussions to be overseen by a third party and that it would be engaging appropriate stakeholders during the implementation of the pilot scheme. No UK recruitment agencies would be involved in the initial phase, it said, adding that the process on the Nepal end was “an issue for the government of Nepal”.

Nurses often take out loans to pay agents which they struggle to repay.
Nurses often take out loans to pay agents which they struggle to repay. Photograph: MartinPrescott/Getty Images

The agreement is part of an international recruitment drive to address a shortage of 50,000 nurses and midwives in the UK. It is the first recruitment deal signed with a country on the WHO’s red list.

Pat Cullen, the Royal College of Nursing’s chief executive, said it was an example of the UK’s “over-reliance” on overseas workers and called on the government to “do more to invest in the domestic workforce”, including “paying nursing staff fairly to boost recruitment and retention”.

She added that the “government’s determination” to hire from Nepal despite its red list status was “highly worrying”. “Recruitment should be managed sustainably and steps taken to benefit both countries. The fact that we are taking nurses from countries with poor health infrastructure and chronic shortages is unforgivable.”

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