Following the decision for Britain to leave the European Union there has been steady decline in the number of nurses coming to work within the NHS from the European states. Reports say that more UK graduates are abandoning the nursing profession due to the pressures of the work involved. This has lead to severe shortages of nurses within the NHS with them having no other means but to return to their own trusted old friends India and the Philippines.
According to reports, the NHS is to recruit up to 5,500 nurses from overseas in an “earn, learn and return” scheme to plug staff shortages. This news is a boon to those several thousands of nurses who struggle to live with the meagre pay they receive in countries like India. However, this news also brings out those opportunist fraudulent recruitment agents who see this as a means to fleece those prospective nurses by playing with some of the not so clear or grey rules and regulations that govern the NHS recruitment procedures.
In an effort to find out the truth about the oversease recruitment process we spoke to several professionals and also with Febin Cyriac of Envertiz Consultancy. Please see below excerpts from the interview exclusively given to www.ukmalayalee.com.
Q: NHS is to recruit up to 5,500 nurses from overseas in an “earn, learn and return” scheme". Does this mean that these nurses recruited now will have to return back home? Is this recruitment not like the one before where one could settle? Is there any clarity on this?
A: As per the Home office guidelines migration is capped to 21,000 a year. “Earn, learn and return” scheme is something like part of a political terminology. If they do not mention then this may go against the government's migrant targets and media may construe it a wrong way. Moreover, as per the World Health Organisation recruitment guidelines developed countries are not allowed to recruit nurses from developing countries. All the NHS trusts in the country must adhere with NHS Code of Conduct on overseas recruitment. The above quote will cover up the WHO guidelines. It is up to the migrant nurses to decide whether they should stay in the country or return to their home country. Anyone can apply for Permanent Residency if they have legally worked in the UK for five years.
Q: Is it true that all official recruitment agents for a particular NHS Trust have to be registered with the Healthcare Trust Europe Framework (www.healthtrusteurope.com) or London Procurement Programme (Lot 5) (www.lpp.nhs.uk). It is said that these initiatives are designed to provide Trusts with recruitment quality assurances and best value for money?
A: As of my knowledge there is no such requirement. Any firm who is legally trading in the UK can approach NHS for a contract ,doesn't need to be in the above framework but NHS prefer to use recruitment agencies registered with the above framework and its the discretion of each trust. There are 100s of agencies currently recruiting for the UK, either they have direct contract with NHS or they will be working as a supplier for NHS contractors.
Q: There are many recruitment agents out there to recruit nurses from Kerala and abroad. Are they supposed to take any money from a prospective nurses looking to migrate to the UK?
A: Currently UK recruitment is free. The NHS Trusts rely on fair recruitment which normally goes through following completion of the following procedures online and therefore any agent will also have to submit the same for any nurse who they want to enroll or get them a job with NHS. The remuneration for these agents vary with each individual Trusts and thus there is no clarity on how much an agent is supposed to receive as costs from a prospective nurse looking to migrate to the UK. Recruitment companies who has contract to do this free recruitment wouldn't be able to charge any sort of money from candidates towards recruitment.
Q: What are the most important factors a nurse looking to migrate to the UK has to be sure before approaching a recruitment agent - be it in India, Kerala or any other part of the world?
A: Approach an agent only if you qualify for the three options given below.
First of you would need check yourself whether you are eligible to register as a nurse/midwife in the UK. You could find deatailed information on the NMC website. You must meet NMC's basic criteria to register as a nurse/midwife which is successful completion a minimum 3 year (or Equivalent) nursing programme and you must have minimum 12 months post registration experience as a qualified nurse or midwife.Also you must meet the one of the following criteria.
OPTION I: You must score 7 band in IELTS Academic version. You must score 7 band in All modules (listening, reading, writing, speaking). Candidates can also take two IELTS tests, in which case the scores in both sittings are above 6.5 and they achieve 7.0 or higher in all four fields when the results of both sittings are viewed together. Both tests must be within 6 months. Or you must score B grade in OET for all modules, candidates who take the OET, all grades in both sittings should be above grade C+ and they must achieve a grade B or higher in all four fields when the results of both sittings are viewed together. Both tests must be within six months and they must complete all sections on each test.
OPTION II : BSc / GNM Nurses who have passed in the academic years 2015-16 or later, with English medium study, and having at least one year experience in any reputed hospital. The course must have been composed of at least 50 per cent clinical interaction. At least 75 per cent of the course’s clinical interaction with patients, service users, their families and other healthcare professionals must have taken place in English. The training that you have undertaken must have provided you with an opportunity to demonstrate ability in reading, writing, speaking and listening in a range of environments. (This is the most confusing changes made by the NMC. Therefore fraudsters or scammers use this evidence to collect money from candidates.. Some companies even know this is not applicable to Indians but still they advertise this to gain candidates data. As far as my knowledge this will not be applicable for Indians as there is no hospital in India where candidate communicate with patients in English. To prove this none of the NHS hospitals in the country recruit nurses through this category. I am still waiting for a confirmation from NMC.
OPTION III: Registration and one year’s practice with a nursing or midwifery regulator in a country where English is the first and native language and a language assessment was required for registration
Q: What are the grey areas you mention which can confuse an applicant and which helps recruitment agents to take advantage of?
A: Most of the nurses who approach the agents back in Kerala doesn't read all the rules and regulations. Nurses are a hot commodity in the market and most of the advertisements are aiming to collect nurses data or collect some sort of money from nurses. The advertisements in Kerala are mostly misleading and lacks clarity leading to several nurses approaching these agents to somehow reach the land of their dreams. The agents necessarily do not provide the nurses with the clear picture and as an initial registration fee they take huge amounts.
For example, in IELTS Academic Module one has to get Band 7 in all modules and only then you will be considered as Band 7 (If you have not then you can get 7 in both the score sheets within six months). If someone has told you that you can become a nurse with 6.5 then its not right.
In the OET (Occupational English Test) you will have to obtain B Grade in all modules. You can get this on your two tests within 6 months. However, you should not have received lower than C Plus in any modules. There is so much that agents do not reveal to the propective nurses as they are only after ensuring that they get a good number of nurses ready for their overseas agents to do interviews.
Therefore, nurses working in Kerala or India has to take great care before giving money to agents as you may lose your registration fees if you fail in this test. The actual benefits lies to those who have worked in other countries where the communication was in English. Therefore, please check out before you pay money to an agent. Be aware that you can become qualified nurses only if you have passed the CBT& OSCE tests as well.
With the new rules anyone can register on the NMC website and you don't necessarily need to be a nurse. Therefore, don't think that you become registered if you just signed up on their website. NHS nurses recruitment is hot commodity and therefore please do not fall in their trap.
Q: How do the NHS Trusts pay these agents?
A: There is a fixed costs for both EU and Non-EU recruitment per nurse are similar for all agencies, with variable costs usually associated with support programmes for IELTS, depending upon the candidates’ level of attainment and discretionary payments of exam and other immigration costs (which may be reclaimable).
Payment schedules do vary slightly between agencies, for example Agency 1 may take 25 per cent placement fee (fully refundable) for each Nurse on receipt of conditional offer, the additional 75 per cent of the placement fee invoiced upon arrival and start date at the trust. And for example Agency 2 may take 50 per cent invoiced on arrival or 50 per cent invoiced on start date (or successful NMC registration for nurses required to demonstrate IELTS)
Typically NHS Trusts offer the following as a minimum to an agency. However, this may vary according to various Trusts. However, its worth checking with the Agent on how much you are paying and asking questions on how much the Trust they are going to work will pay towards their recruitment or for any other training.(Agents will not disclose this to anyone)
NHS Trust typically pay for NMC registration fee, Tailored induction/preceptorship programme, Accommodation e.g. funded for a set period 1 – 3 months, Additional English Course training, Funding some immigration, exam and health insurance costs (can be reclaimed over time from employee)
Q: Please shed some light on the NMC tests?
A: The Nursing and Midwifery council, UK test of competence is a computer based multiple choice tests that intend to assess a potential nurse’s nursing qualification, training and experience against UK Standards and confirms their competence to practice according to UK standards. NMC test of Competence has been made mandatory Since October 2014 for nurses and midwives trained outside the European Economic Area, seeking UK registration.
The test consists of two parts, one a computer-based multiple-choice test (CBT) and a practical structured clinical examination (OSCE).CBT implies Computer Based Test of competence. Applicants take this Test after the online eligibility assessment. The computer-based multiple-choice examination is conducted by Pearson VUE, at various designated test centers. The CBT tests applicants’ theoretical and practice-based knowledge.The test consists of 120 multiple choice questions, of maximum 4 hours duration, with no negative score for unanswered questions. Examination results will be emailed to candidates within 48 hours after taking the examination. You can also obtain your results within 48 business hours by logging on to your Pearson VUE account which you will have created when booking your exam. Candidates are initially allowed two attempts of the CBT at separate sittings. If they do not pass in the second attempt, they can re-apply to take the test again, but only after waiting for at least six months to do so.
The second part of the test OSCE can only be attempted after successfully passing the CBT It is only available in the UK at a designated test centre. OSCE implies objective structured clinical examination. Each part of clinical examination is known as a ‘skill station’ and candidates are to visit all the stations within a set time. The OSCE is designed to assess a candidate’s ability to competently apply ones professional nursing or midwifery skills and knowledge in a real clinical scenario in a UK hospital setting. It is set at the level expected of nurses and midwives as they enter the professional.
The test of competence requires candidates to complete an online application process through NMC website. After your eligibility assessment, an NMC Candidate ID will be communicated to you by the NMC and you will receive authorization (ATT) to take the test. Before you can book and pay for your exam with Pearson VUE. Subsequently. You will be provided a username and password to log into your Pearson VUE account to book and pay for your CBT exam. Each Authorization is valid for six months.
Q: A nurse who is qualified in another country will not work as a nurse immediately on arrival to the UK. Is this correct?
A: All Overseas Nurses will be Know as Pre-registered Nurse until the time they gain the NMC Registration. They will be working as Pre-registered nurses with the direct/indirect supervision of a registered Nurse. NHS or Other Care sector Firms Tend to use different names to this post.
As there is no approved title for an overseas trained nurse until they get the NMC registration, NHS Trusts located in various parts of the country are using different titles in their job advertisements. Unfortunately due to this inconsistency, prospective employees are advised to use the common titles such as Overseas Nurses programme, International Nurse Programme, Adaptation Nurse Programme, Band 3 nurse, Staff Nurse - International Nurse Programme, Healthcare Assistant - Registered Adaptation Nurse Programme (not an exhaustive list) as a keyword during their search with nhsjobs (www.jobs.nhs.uk). Most employers will provide you with the necessary training to complete the relevant NMC examinations, and offer a timetable of study to help you achieve your goal. Most of these jobs will be advertised as fixed term roles, but are likely to be offered as full time positions once the NMC registration is achieved. The candidates are free to apply direct to these positions from their home countries through the nhs jobs website and the individual Trusts will organise interview either through skype or telephone. Most of the hospitals has dedicated international recruitment and education teams with expertise in the field and are very helpful to assist with the recruitment enquiries. If a candidate apply direct to an NHS Trust, they don't need to use the services of any recruitment agencies as the hospital will offer support with the process.
Q: What are the most important factors a nurse has to take into consideration before migrating to the UK?
A: From my personal opinion overseas nurses recruitment is complicated and time consuming as it comprise of Nursing Registration and Immigration. A good number of trusts directly recruit nurses that doesn't mean they are well experienced in the field. An expert's advice on this would be always beneficial. Before choosing any employer candidate might consider 3 factors and find answers to the below questions.
1. Why the hospital is recruitment overseas nurses ?
2. How long they been recruiting overseas nurses ?
3. How's their OSCE training and the Passing rate ?
The main reason for a trust/care home to relay on overseas recruitment is due to staff shortage. Candidate must find out the reasons behind this. Common reasons are: high cost living area (it's not advisable for migrants. For example a hospital in Harrow is continuously recruiting overseas nurses since 2009. Due to the high cost living majority of the staff leaves the trust in an year.
Lack of infection control issues and Communicable disease, Regulators poor report (A number of hospitals CQC report is poor which leads to staffing issues), Work pressure due to population density (A prominent hospital in London is recruiting nurses from overseas and the reason behind this since it's in high cost living area and high population area majority of staff could not handle the work pressure and leave the hospital which is not an ideal place for a migrant). Some other factors to be considered are remote location, hospital development or department development, size of the Hospital etc.