Back to the future?

As the world, including the UK, faces a deficit of medical, midwifery and nursing personnel, competition for these vital human resources increases and with it the challenge to find solutions. This situation is not new. The year the NHS was founded also marks the passing of the 1948 Nationality Act, designed to encourage colonial residents to come to Britain to help with post-war reconstruction.

Since then many health workers from across the Commonwealth have come to call the UK their home and have contributed immeasurably to the health and well-being of this country. So as we pick-up the pieces after the Windrush scandal let’s not make the same mistakes as we look for solutions to workforce shortages.

It was with great pride that all my family waved me off at the airport. It was a big event. I was the first sibling and the second in the family to leave Jamaica and venture overseas to study.

It was with great pride that all my family waved me off at the airport. It was a big event. I was the first sibling and the second in the family to leave Jamaica and venture overseas to study. Some went to Canada, USA, Spain or Mexico, others like me headed for the UK, our shared intention was to study (learn) and return. It was meant to be no more than four or five years.

I wanted to study general nursing, pediatrics and midwifery. It was both an exciting and tearful exodus and, as I gazed out the window at the beautiful Caribbean Sea, my heart was heavy. I arrived in London on a cloudy, wintery December day. My coat brought from Canada, by my friend, did its best but the wind at Paddington Station seeped into my bones.

I enjoyed the study and the camaraderie but I longed for home. After three years punctuated by homesickness, I found resilience and qualified as a nurse. I then pursued midwifery education, fell thoroughly in love with it and made it my career. The journey took me on a path that included community midwifery, midwifery management and midwifery education to a Director at the Royal College of Midwives and latterly President of the International Confederation of Midwives.

Solutions to this dilemma?

So given my own journey, when I read that The Department of Health and Social Care had embarked on a scheme to encourage the exchange of nurses between the UK – my home, and Jamaica – my country of heritage I was intrigued to say the least.

Many health professionals decisions are actually based on ‘push factors’ and migrate out of the profession or out of their country due to limited career opportunities, poor working environments, poor pay, lack of resources, commodities and continuing professional development opportunities.

This new ‘earn, learn and return’ (ELR) partnership with Jamaica, facilitated by Health Education England, will see Jamaican nurses work in the NHS for 3 years to gain specialist skills and experience to take back to the Jamaican health system. NHS staff will also have the opportunity to travel to Jamaica to share their expertise with the Jamaican health service and help them to improve their care.

At face value the scheme is a valuable one, however, it is scant on detail and there are more questions than answers.

I believe that the majority of the diaspora, like myself, had every intention of returning to the health system of their country of origin. However, life intervenes and at times conspires to thwart best intentions. In the third year of training I married secretly. I did not return as planned. I was not ‘pushed’ rather ‘pulled’ by personal circumstances.

Whilst the western countries are often accused of poaching health professionals with the ‘pull factors’: prospect of better pay, working conditions, education and career progression. Many health professionals decisions are actually based on ‘push factors’ and migrate out of the profession or out of their country due to limited career opportunities, poor working environments, poor pay, lack of resources, commodities and continuing professional development opportunities.

Criticism of the ELR scheme

The ELR scheme is welcomed by some but not by others. The Minister of Health for Jamaica, requested UK assistance in tackling the shortage of critical-care nurses on the island, and the Minister of State for Health UK, made clear his delight to be “partnering with Jamaica in this scheme”. Among the dissenting voices in Jamaica is the Nurses Association of Jamaica (NAJ), which “the latest British recruitment drive as “horrible” news for Jamaica’s health sector.

Opportunities to learn specializations are attractive but recognition of the existing technical expertise appears to be overlooked.

Opportunities to learn specializations are attractive but recognition of the existing technical expertise appears to be overlooked. James Moss-Solomon, chairman of the University Hospital of the West Indies in Kingston, highlighted the technical expertise of nurses; “We do very good training of specialist nurses here, at a fraction of the cost of what it costs in the United States or Canada or the U.K. So it’s an economic issue. There’s a great saving [for foreign countries] in just poaching instead of training.” Where is the reciprocity?

Yet both governments have seemingly pursued bilateral agreements, and cooperation with advanced training, consistent with the WHO Global Code. So why are there dissenting voices? A question that arises is what engagement, if any, was there with the respective professional organizations? Would the leadership of the NAJ have responded so negatively if they had been included?

Forward to the future

As we recognize the reality that the global way we live is only going to increase we must also acknowledge the associated mobility and migration of health workers, either by intent or outcome. Considering my three decades old experience I think there are some lessons to be drawn from the reflections of those who came before.

The NHS needs to do more to recognize the impact recruiting health workers from overseas has on those countries if we are to hold true to these values.

The NHS and its values of equity and fairness can rightly be seen as a good healthcare model of choice for countries around the world. But as we engage internationally, the NHS needs to do more to recognize the impact recruiting health workers from overseas has on those countries if we are to hold true to these values.

I believe it is also crucial that low-middle income countries identify and address the push factors if they are to retain their skilled health workforce. To build a future where health professionals enjoy security in their living and working environments. Domestic action is crucial yet we’re all in this together and together must find solutions for the future.

“Back to the Future?” featured as a keynote presentation at the Tropical Health and Education Trust’s 2018 Annual Conference in London on 27th September, for more information on THET please visit www.thet.org or for conference highlights please visit: https://www.medics.academy/