The UK is not producing enough nurses to meet demand, so it’s importing trained foreigners… with mixed results.
Maria Gonzales – who prefers to use a pseudonym – a nurse at Kingston hospital, in south London, thought her elderly patient wanted to buy something when she said: "I want to spend a penny."
Maria, who speaks excellent American English, is not the only one who has never heard such expressions as "I am feeling a bit peaky."
The shortage of nurses in Britain is serious.
Hospitals are now recruiting from as far as South East Asia.
There are 42,000 foreign nurses currently in the UK – more than double the number three years ago.
Half of the nursing staff come from overseas in some NHS acute-care trusts in south east England, according to Royal College of Nursing (RCN) study, ‘Here to Stay?’
The report found that some NHS employers are now reliant on foreign nurses.
Patricia Godfrey, 84, who suffers from hernia and arthritis, often goes to the local medical centre in Highgate, north London.
She said: "My doctor is Indian and the nurse is also foreign. They seem okay, but I get a bit scared and nervous if they don’t reassure me what is wrong with me. Their English is good but they have strong accent. Sometime I need to ask them to repeat what they said."
Bob Hardy-King, chief officer at the Southward Community Health Council says: "Foreign nurses usually have a good command of English but if you are in hospital, you are already a bit nervous. I think foreign accents can be an extra strain for patients."
Anne Mitchell a spokesperson at Unison, which represents medical workers, acknowledges that there are communication problems between foreign nurses and patients, but they haven’t heard complaints from patients directly.
She said: "The real difficulty is that the NHS would not function without foreign nurses. At the moment, without them, the NHS would come to a grinding halt. We need to look at the NHS system carefully and do something."
British public services have always relied on imported skilled labour.
The NHS has a long record of hiring nurses from Ireland and the West Indies.
Working holidays have brought New Zealanders and Australians, but demand has recently soared – nurses are now mainly coming from the Philippines, India and South Africa.
The systematic recruitment of foreign nurses started three years ago when the government set a target for 2004 of recruiting 20,000 nurses.
Unison’s Mitchell said that the country cannot retain home-grown nurses, there was little hope that these targets could be met without hiring from abroad.
Depending on their experience, foreign nurses get a three to six-month induction course to help them bridge the culture gap.
Before they register, they work as trainee nurses in NHS or private hospitals, or nursing homes.
Compulsory language tests, administered by the British Council, have been introduced.
The Nursing and Midwifery Council (NMC) says it was responding to complaints from hospital managers, nurses and patients that staff were being employed without an adequate grasp of English.
A spokesperson for the Royal College of Nursing (RCN) said: "Some hospital managers complained about the foreign nurses’ English. The nurses were technically proficient in speaking English but had difficulty in writing or could not understand local accents or colloquialisms."
Some witnesses reported doctors and nurses having difficulties in understanding each other.
"Foreign nurses might find it difficult to understand colloquialisms, but it is the same for English nurses when they start work outside their own area," continued the RCN spokesperson.
Free English courses have been introduced to help them handle dialect, colloquialisms and idiom.
Gonzales says she is trying to watch television as much as possible to learn the British accent and culture.
In the south of England, foreign nurses are being shown episodes of EastEnders and in the north, many hospitals are showing Coronation Street.
Some staff were apprehensive about overseas nurses risking lives due to the lack of proper communication.
Christina Williams, an English nurse who works at a medical centre in Croydon said: "I think recently recruited foreign nurses will make a tremendous different to this country’s health care system."
She believes that staff and management will come to recognise their positive contribution.
Last year, orthopaedic surgeon David Nunn sparked controversy when he warned that patients’ lives in NHS hospitals were being put at risk because of the poor English of some overseas nurses.
David Brooks, a spokesperson at the NMC, said he was talking complete "rubbish" and Dr Nunn was later dismissed.
In fact, the majority of hospital workers support foreign nurses.
Brooks continues: "Filipino nurses have positive attitudes and their quality of service is much better than British nurses. they are friendly and happy to work long hours. They are from the so-called third world, but the standard of nursing is high over there and they are doing a good job here."
However, there is another aspect to recruiting from overseas.
A spokesperson for the Liberal Democrats said: “The NHS is turning a blind eye to the problems of agency nurses coming from developing countries. The damage this brain drain does to the health care systems of third world countries is unacceptable."
Hilary Ward, a spokesperson at Nurse Finders UK, a nursing recruitment company said: "We try not to recruit from third world countries. We mainly recruit nurses from Australia, New Zealand and Canada, as adaptation courses are needed for those from developing countries. I know hiring nurses from poor countries can be ethically wrong but you’ve got to understand that they have the right to move and find a job abroad."
Due to chronic unemployment and desperate poverty, thousands of nurses in developing countries are waiting for jobs in the UK.
The RCN predicts that the UK will never be able to train enough nurses to meet the needs of an ageing population.
As long as there is this demand, nurses will want to move from the third world.
Most Filipino nurses are sending their salaries back home to families in the Philippines.
"Lots of my nurse friends in the Philippines are jealous of me," says Gonzales. "I am lucky to get here. I can send money back home and my brothers and sisters will have better education."