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REVISED AUGUST 2004
A guide for nurses from overseas working in the UK
UNISON THE UNION FOR NURSES, MIDWIVES AND HEALTHCARE STAFF
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CONTENTS Foreword
4
Introduction
5
Background
5
The need for international recruitment
6
Unlawful, misleading and exploitative contracts
21
Financial penalties
21
Withholding documentation
22
Regulation of Independent sector
22
Advice for branches and regions
22
Table – number of overseas registrations
7
Ethical recruitment from overseas
7
Organising and recruiting internationally
22
Treatment of overseas nurses
8
How are overseas nurses recruited?
22
UNISON’s campaigning
9
Recruitment of overseas nurses
9
Establishing links with community groups
23
Establishing networks of overseas nurses
23
Membership and recognition
23 23
Use of agencies
9
Work permits
10
Working extra hours
11
Student visas
11
Establishing close links with Trusts and NHS workforce confederations
Refugee and asylum status
12
Rescue missions
24
Registering as a nurse in the UK
13
Supervised practice/adaptation
14
Post termination remedies: Unfair dismissal & constructive dismissal
24
Grading
15
Role of Government departments and regulatory bodies
26
English Language Tests
16
International bodies
27
European Union accession countries
16
Useful contacts
29
Map of the new European Union
17
Checklist for internationally recruited nurses
30
Pre-deployment orientation and induction
17
Checklist for UNISON representatives
33
Airfares and registration fees
19
Joining UNISON (Application form)
37
Contract of employment
20
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UNISON OVERSEAS NURSES’ RESOURCE GUIDE
FOREWORD Welcome to the latest guide from UNISON on overseas nurses working in the UK. We have produced this guide as an update to our previous publication ‘A UNISON guide for nurses from overseas working in the UK’. With nurses continuing to arrive from overseas to the UK we know how vital international recruitment has become for the NHS. Our original overseas nurses guide was widely welcomed and recognised as a valuable tool to help support branches and internationally recruited nurses, many of whom were exposed at that time to unethical practice. Much has been achieved by UNISON and the Department of Health (DoH) in tackling the early problems. This coupled with changes in the legislation and the Nursing and Midwifery Council (NMC) has led us to undertake this review and update our resource tool. We hope that overseas nurses will use this as a resource to improve their working lives and employers will use it, as it reflects best practice and reinforces some of our joint work to date. Finally this guide is a unique tool for branches who are approached by overseas nurses in difficulty. We would like to express our thanks to Robert Baughan, Celestine Laporte, the NMC and Work Permits UK for their assistance in producing this guide and to all overseas nurses for truly making a positive impact on the NHS – we value, respect and thank you for your contribution to patient care. If you have any comments or need to talk to somebody about your current or future employment we would like to hear from you. Best wishes Gail Adams Head of Nursing – UNISON
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Ann Moses Chair of UNISON Nursing Sector
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1. INTRODUCTION 1.1 This guide sets out the main issues around the recruitment of overseas nurses within the UK. It aims to provide a useful overview of the considerations surrounding international recruitment, both for the overseas nurses and for branch representatives. We aim to identify ways in which we can encourage more nurses to come to the UK and show how we can make their employment here more enjoyable. 1.2 UNISON supports the international recruitment of nurses, though the issue raises a number of important moral and ethical dilemmas. UNISON believes that recruitment drives should concentrate on pre-registered nurses as recruiting large numbers of fully trained nurses from developing countries will be costly for those countries when they are left with a depleted workforce. International candidates should be offered education and training at pre-registration level in British universities with opportunities for employment at the point of qualifying.
2. BACKGROUND 2.1 Nurses registering each year in the UK has increased four-fold. In 1999 UNISON produced ‘A UNISON guide for nurses from overseas working in the UK’ and international registrations stood at just under 4,000. The figure has risen dramatically since then with registrations for 2002/3 standing at just under 13,000. Around 75,000 overseas nurses approached the NMC for an application pack last year. Therefore, it has become even more important to set out UNISON’s aims towards nurses recruited from overseas and to offer advice and support to the thousands of nurses entering the UK for the first time every year. 2.2 This guide is an update to the original document and provides overseas nurses with essential information on procedures and information. It informs UNISON branches of their role in welcoming and assisting international nurses during their period work in the UK. 2.3 UNISON welcomes the enormous contribution that nurses recruited from overseas have made to the NHS and aims to ensure that all nurses are treated fairly and equally regardless of where they were born or trained. However UNISON believes the UK’s nursing recruitment and retention crisis can only be alleviated in the long-term by introducing measures to: i) retain nurses who have already qualified ii) encourage more nurses back into the profession iii) encourage more people into nurse training, especially those from second-generation British-born black and Asian ethnic minorities, who are currently under-represented in the NHS.
“UNISON has been at the forefront of campaigns to help promote and protect the rights of overseas nurses coming to the UK. We are extremely proud of our achievements, but we still have a long way to go before we are happy that all internationally recruited nurses are being treated equally and fairly.” Gail Adams, UNISON Head of Nursing
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3. THE NEED FOR INTERNATIONAL RECRUITMENT 3.1 International nurse recruitment is not a new phenomenon, with Irish nurses coming to work in the UK before World War II and post-WWII large numbers of Afro-Caribbean and Mauritian nurses. However, as the NHS becomes increasingly dependent on their services the problem of retaining them becomes more pertinent and with record numbers of nurses emigrating from the UK, a large number of well-trained, qualified nurses from countries such as the Philippines, who, for professional and economic reasons wished to work in the UK, were encouraged to enter the country. 3.2 Over half these internationally recruited nurses now see the UK as a longterm option and in a recent UNISON survey among 600 Filipino nurses 90% said they would recommend the NHS to a friend. 3.3 Around 30,000 nurses and midwives have arrived in the UK from overseas in the last two years, making up almost 50% of the newly registered nurses coming from overseas. Without them, the NHS would have a huge struggle to work efficiently. 3.4 UNISON believes that helping internationally recruited nurses will enable the NHS to run more effectively and provide an improved service for all patients. 3.5 As more overseas nurses choose to stay on in the UK for longer periods, different concerns are arising, such as those around citizenship and bringing other family members, including partners and young children left at home, into the UK. 3.6 The table on the opposite page shows the huge growth in international recruitment since 1999. The Philippines continues to be the main target for overseas nurse recruitment, though the number of nurse registrations from those originally trained in India has almost doubled in the last twelve months from 994 to 1833.
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Number of registrations from overseas and country of origin (Figures and table taken from the NMC) Country
1998/99
1999/2000
2000/01
2001/02
2002/03
Philippines
52
1052
3396
7235
5594
India
30
96
289
994
1833
South Africa
599
1460
1086
2114
1480
Australia
1335
1209
1046
1342
940
Nigeria
179
208
347
432
524
Zimbabwe
52
221
382
473
493
New Zealand
527
461
393
443
292
Ghana
40
74
140
195
255
Pakistan
3
13
44
207
172
Kenya
19
29
50
155
152
Zambia
15
40
88
183
135
USA
139
168
147
122
89
Mauritius
6
15
41
62
60
West Indies
221
425
261
248
57
Malawi
1
15
45
75
57
Canada
196
130
89
79
53
Botswana
4
-
87
100
42
Malaysia
6
52
34
33
27
Singapore
13
47
48
43
25
Jordan
3
3
33
49
18
TOTAL ALL OVERSEAS
3440
5715
8046
14,584
12,298
4. ETHICAL RECRUITMENT FROM OVERSEAS 4.1 UNISON welcomes the contribution that nurses from overseas have made to our health service. International recruitment provides benefits and opportunities for all parties. It enables the overseas nurses to learn different nursing practices and about a different culture. Likewise it provides the NHS and its employees with the opportunity to learn new skills or methods from the overseas nurses and provides the necessary numbers to sustain an effective workforce. 7
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“The freedom of association is a fundamental right for all migrant workers. When you’re in an unpleasant situation you often have to depend on others to provide you with information and this is where UNISON comes in. Migrant workers should feel able to ‘blow the whistle’ on bad practice and mistreatment.” Sofi Taylor, Co-ordinator for Overseas Nurses Network, Scotland
4.2 UNISON maintains that international recruitment should not be seen as a cheap or short-term solution to the UK’s nursing problem. Recruiting overseas can be very expensive. Costs are incurred either by contracting agencies to undertake the recruitment or by sending delegations of managers overseas. Greater emphasis must be placed upon long-term solutions such as encouraging nurses to return to practice programmes and others into the profession. Where necessary, trusts and other employers should either provide or fund return to practice courses, for those nurses who need in order that they may successfully re-enter the NMC register. Health Care Assistants should be encouraged and funded to undertake nurse training through secondments. 4.3 The UK is not alone in experiencing recruitment problems. The United States, Canada, Australia and New Zealand are all experiencing similar difficulties in recruiting and retaining nurses. The worldwide shortage means that the UK is competing for an increasingly diminishing pool of nurses in an economic climate where many countries are offering lucrative financial and residential packages. 4.4 These issues coupled with the expansion of the European Union have highlighted the need for an international debate to identify possible solutions, without which the economic competition will only increase.
5. TREATMENT OF OVERSEAS NURSES 5.1 Since publishing its first guide on the recruitment of overseas nurses, UNISON has worked with the Department of Health and a number of other government departments to improve the working conditions of internationally recruited nurses. Although significant progress has been made within the NHS, with figures such as 90% of 600 Filipino nurses surveyed saying they would recommend working in the NHS to a friend, there remain a number of issues that UNISON continues to campaign on. 5.2 In recent years the independent and private sectors have increasingly been targeting overseas nurses to meet their staffing shortages in private hospitals, nursing and residential homes. Although there are many examples of good practice in the private sector, there are still significant areas of concern remaining. 5.3 In order to prevent the indiscriminate recruitment of nurses from countries that can least afford it, the Department of Health, in conjunction with UNISON, has published guidelines on working with developing countries (See Code of Practice for NHS Employers, Department of Health, 2001). UNISON continues to work with the British Government and our sister unions overseas to minimise the negative effects of this practice, not least by trying to ensure that agencies recruiting for the private sector adhere to the guidelines published by the Department of Health. 5.4 This states, “NHS employers should not target developing countries for recruitment of healthcare personnel unless the government of that country formally agrees a ‘Memorandum of Understanding’ via the Department of Health. In these circumstances individuals may be appointed to a structured programme aimed at enhancing clinical practice in order for them to return home after an agreed period.”
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5.5 An agency originally on the list was removed after it was found to have been breaking the guidelines. 5.6 Trusts are also discouraged from recruiting from developed countries where the country has indicated that they do not want the UK recruiting their healthcare professionals, and where that country has taken similar steps to avoid recruiting from the UK. 5.7 Although these guidelines are very welcome they only cover the NHS. Agencies continue to recruit for the private sector from developing countries, even where there is no ‘Memorandum of Understanding’, such as South Africa, Ghana, Kenya, Zimbabwe and India. The Independent Healthcare Association recommends that independent sector employers be “aware of the sensitivities of targeting countries which cannot support large-scale targeted nurse recruitment”. However, these recommendations are not binding on the independent sector and employers continue to recruit inappropriately from these countries.
6. UNISON’S CAMPAIGNING 6.1 During the last four years UNISON has campaigned vigorously for the rights of internationally recruited nurses. Through its work with the Department of Health and other government departments, UNISON has succeeded in improving the working conditions, education and training of internationally recruited nurses. Issues of concern such as grading and the length of supervised practice still remain and it is only by continuing to campaign on the issues that we can ensure that all nurses, whether recruited in the UK or from overseas, are rewarded fairly to help provide a strong health service.
7. RECRUITMENT OF OVERSEAS NURSES Use of Agencies 7.1 When recruiting internationally, employers, both inside and outside the NHS, often use agencies. Two companies are usually involved – one based in the UK and one in the country from where the nurses will be recruited. 7.2 Whilst many of the agencies provide a valuable service, with in-depth knowledge and local resources, some have been seen to operate in a way that has caused concern. An agency is often the first contact an overseas nurse has with the UK and there is an enormous level of trust that is placed in the agencies. 7.3 It is often the agency that, on behalf of the employer, is responsible for obtaining work permits and for providing nurses with the terms of their contract of employment. 7.4 The Department of Health has issued guidance on agencies in its “Code of Practice for NHS Employers involved in the International Recruitment of Healthcare Professionals”. This states that NHS employers should work with 9
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agencies that comply with the Department of Health Code of Practice and demonstrate an understanding of the role of professional bodies and trade unions. They should not work with agencies who charge recruitment fees to the candidates to be considered for work in the UK, or who are in partnership with agencies in other countries that charge individuals a fee solely for the purpose of a placement in the UK. These recommendations are included in the Independent Healthcare Association’s (IHA) guidance. However, neither the DoH nor the IHA’s code is legally binding on employers from the independent and private sectors. 7.5 UNISON continues to hear of cases where charges have been levied on nurses by recruitment agencies. Individual countries have also taken action. In October 2001 the Philippine Overseas Employment Administration (POEA) issued a memorandum ordering the abolition of placement fees being charged by recruiters in the Philippines. 7.6 The NHS London Region piloted a project whereby it recruited directly from the Philippines, thus eliminating the need for an agency. Increasingly NHS recruitment is being co-ordinated through NHS Workforce Development Confederations. 7.7 UNISON seeks to ensure that all employers operate in a way consistent with the Department of Health’s and the IHA’s Code. 7.8 Employers should: ■ work only with commercial agencies that operate in accordance with the codes. ■ not work with agencies that charge fees to the nurses concerned. ■ satisfy themselves that the UK commercial recruitment agencies they use are not in any partnership agreement with agencies in other countries that allow fees to be charged to the nurses concerned. ■ maintain contact with unions and talk to overseas nurses to make sure no charge is levied.
Work Permits 7.9 International recruitment of nurses throws up a number of considerations, not least the issues surrounding immigration procedures and work permits. Not all overseas nationals require work permits to work in the UK – information about who needs one can be found on the website of Work Permits UK (WPUK), www.workingintheuk.gov.uk (the body responsible for processing work permits.) 7.10 It is the employer or an authorised agent acting on behalf of an employer and not the employee who can apply for a work permit. In order to issue a work permit WPUK has to be satisfied that: ■ there is an established UK employer. Recruitment agencies are not considered to be established employers and therefore cannot apply for work permits ■ there is a genuine vacancy; one that is also open to UK residents and which satisfies the skills criteria of the work permits arrangements. ■ the employee meets the job criteria ■ the pay and other conditions of employment should be at least equal to those normally given to a ‘resident worker’ doing similar work 10
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■ the applicant and employer must be able to comply with all relevant legislation/registration requirements of the employment 7.11 If the application has been successful the employer should send the nurse their work permit and retain a copy. The permit will detail specific terms and conditions of employment and the specific period of approval, post and location of the employment. This means that if an employee is made to work under conditions different to those stated on the work permit e.g. salary or hours, there may be grounds for prosecution of the employer (please see page 10 information under Work Permit UK section 7.9). If the employer subsequently wants to continue the nurse’s employment beyond the date specified they must apply for an extension to the employee’s work permit. 7.12 After four years of continuous work permit employment, the permit holder can apply to remain indefinitely in the UK. 7.13 Nurses employed under work permits are often in a vulnerable position. It is important to remember that: i) the employee cannot claim any state benefits ii) the employee’s right to remain in the country is linked to their employment. 7.14 Although it is the employer who has applied for the work permit, a nurse is free to apply for alternative employment. The new employer is then required to apply for a new work permit. It is important that a nurse does not terminate his/her employment until a new formal offer of employment has been reached and a new work permit obtained, otherwise the nurse may be in breach of Home Office regulations. Where an employer imposes a financial penalty for the ending of a contract the nurse must consult their trade union as these clauses may be illegal.
Working Extra Hours 7.15 For many overseas nurses working in the UK, the wages that they earn are used to support their families back home. Therefore, many of these nurses wish to work additional hours to supplement their incomes, but there is often confusion about the extra work a nurse can do under the terms of the work permits. 7.16 To clarify; an employee can undertake supplementary employment to that specified in the work permit, but only up to a maximum of 20 additional hours per week – the work may not be obtained through a recruitment agency and it must be of a similar grade and type to that specified in the permit.
Student Visas 7.17 UNISON would advise any nurse against undertaking an adaptation programme on a student visa. If an employer recommends that a nurse apply for this type of visa it could be grounds for concern about the employer. 7.18 On a student visa a nurse will have little recourse to employment law or tribunals. In addition a student visa only allows a person to work a maximum of 20 hours per week. UNISON has come across a number of members who have been employed on student visas and have been expected to work more than 50 hours per week, which has put the member in breach of their permit and at risk of deportation. 11
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7.19 Some employers who have recruited from overseas on student visas have expected the individual to work in excess of the maximum 20 hours. This is despite it being in breach of their work permit, nurses are aften too afraid to speak out. This is why UNISON are lobbying the Government to plug this loophole. Overseas nurses wishing to come to the UK for an adaptation place should only be issued with a work permit.
Refugee and asylum status 7.20 Asylum seekers are people who have applied for protection in the UK under the provisions of the UN Convention on the Status of Refugees, the European Convention of Human Rights, or other international human rights agreements. They are classified as asylum seekers until their asylum application is decided. If they are successful they are recognised as refugees and will be granted either indefinite leave to remain (if accepted as UN Convention refugees) or exceptional leave to remain for four years if protected by one of the other provisions of international law. 7.21 Currently asylum seekers are not usually allowed to work during the first six months immediately following their application, unless of course their application is decided in their favour and they are granted refugee status. A refugee is free to work and does not need special permission from the Home Office. A number of asylum seekers are nurses and doctors. We need to develop methods of assessing and encouraging their career development in the NHS. This should involve the Department of Health and the Refugee Council working closely together to ensure that a valuable source of healthcare workers is not overlooked. 7.22 An asylum seeker can apply to the immigration authorities for permission to work if a decision has not been made after six months. If the authorities see no prospect in taking a decision in the near future they will normally grant permission. Permission for an asylum seeker to work is granted in the form of a stamp, placed on their Home Office asylum seeker identity document that is known as an SAL. 7.23 UNISON has made representations regarding nursing students who, although being granted asylum, have been removed from their course for failure to comply with the Criminal Records Bureau (CRB) checks. Such checks are normal practice and are carried out on UK as well as overseas nurses. They are carried out to protect the interests of patients. However, in the case of refugees as it is the country from which they were fleeing persecution that would provide the CRB with the information it seeks, it is difficult for a refugee to comply with these checks. UNISON believes it is unfair that they should be removed from their course on this basis. 7.24 As a result of UNISON’s lobbying, the Department of Health has agreed to recommend that where it is not possible to obtain a police check from the country of origin and because there will be no information on UK police records, it is reasonable to waive the requirements for a CRB check. 7.25 UNISON believes that as the Home Office carries out similar criminal checks when considering applications for asylum, there is no need for the universities to replicate this process. 7.26 In order to be eligible for registration, a refugee or asylum seeker must provide the Nursing and Midwifery Council with copies of their nursing 12
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diploma(s) and registration documents. Without these they will be unable to apply. If a UNISON nurse has immigration problems they can obtain initial legal advice from the union.
8. REGISTERING AS A NURSE IN THE UK 8.1 In order to practice as a registered nurse in the United Kingdom an overseas nurse must first register with the Nursing and Midwifery Council (NMC). The NMC assesses whether a nurse’s training and experience equips them to carry out the duties of a registered nurse within the UK. An applicant will need to provide details of their pre-registration education and training (both theoretical and clinical) and post-registration education and practice. It is the individual and not the employer who must apply to the NMC. The NMC charges for this process, the current application fee for overseas nurses is £140. UNISON recomends good employers should pay this initial registration fee as part of the adaptation. 8.2 Registration procedure for: i) Nurses and Midwives who obtained their qualifications inside the European Union: Under European Union Directive 77/452/EC, a first level nurse trained within the European Union can expect to have their application for registration accepted without any additional training or period of supervised practice. Please note this does not apply to second level nurses. A second level nurse qualification from outside the United Kingdom is not always accepted as a pathway to registered nurse status. ii) Nurses and Midwives who obtained their qualifications outside the European Union: The NMC states that in order to be considered for registration as a general nurse a person must comply with the following minimum requirements: a) They need to have undertaken a programme of education and training of not less than three years in length. This programme should contain a balance of theoretical and practical training of not less than one-third theoretical training and not less than one-half clinical/practical training. a) The programme must have included theoretical and clinical/practical training and experience in: general and specialist medicine; general and specialist surgery; childcare and paediatrics; maternity care; mental health and psychiatry; care of older people and community nursing. a) In addition a nurse will be expected to have completed at least six months continuous, post-registration training before being eligible for registration. 8.3 When the NMC receives a completed application pack it will make a decision on whether the applicant meets its requirements. If the applicant is not accepted for registration immediately, they may be asked either to undertake a period of additional training in the United Kingdom, or to undertake a period of supervised practice in the United Kingdom in order to develop specified skills. The NMC will set a time period for this, which will normally be 3 to 6 months. The NMC charge for assesing each application, currently this is £140.00. 13
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8.4 When a nurse is accepted for registration, they will be asked to sign a form agreeing to abide by the NMC’s Code of Professional Conduct and will need to pay a registration fee. This is currently £129.00 for three years for overseas nurses. UNISON recommends that employers should cover the cost of registration for the first year. 8.5 Filipino midwives at present are not automatically accepted to register and the NMC has recently been looking at issues that have arisen following the expansion of the European Union (see section 12, page 16 on European Union Accession countries).
9. SUPERVISED PRACTICE/ADAPTATION 9.1 It is vitally important that applicants do not start a period of supervised practice until their application for registration has been processed and a decision made, as the NMC is not prepared to accept the backdating of supervised placements and will not accept references from placements that have been completed in this way. 9.2 The type and length of supervised practice will depend on each applicant’s education, training and post-registration experience. Some applicants, for example, may be given a decision that their placement can only be carried out in an acute NHS Trust setting. 9.3 The placement is neither a course nor an exam. It is meant as a period of support and supervision by a named mentor for a minimum period stipulated by the NMC. 9.4 UNISON is aware that some nurses, particularly those employed in the private sector, have not received adequate support during the period of supervision. They also may be expected to undertake domestic duties such as cleaning, catering or laundry alongside providing nursing care to the residents or patients. Some nurses have not been allowed to gain registration for more than 18 months and in the case of one employer the NMC has removed its approval for supervision. Nevertheless, UNISON continues to support/represent nurses where the employer continues to recruit, falsely promising supervision for registration. 9.5 UNISON has campaigned for national standards for supervised programmes and it fully supports the decision by the NMC to take a more active role in monitoring the pre-registration process. The NMC has recently concluded a consultation on overseas nurses and standards. 9.6 In order for a nursing home to be deemed suitable for the supervision of overseas nurses the NMC requires evidence that the home has been successfully audited by a college of nursing and midwifery affiliated to a Higher Education Institution (HEI). This is to ensure that minimum standards are met in relation to the supervised practice and that the potential registrant will be supported through the process. 9.7 If a nursing home cannot become affiliated to a university or college then it cannot offer supervised placements. In order for a home to take overseas nurses on supervised placements it should provide details of the supervision programme and a list of supervisors/mentors, their PIN numbers, qualifications and place of work details. 14
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9.8 The length of a supervised placement/adaptation must be carried out at the same nursing home. It is not acceptable for a nurse to carry out different segments of the placement at different places. 9.9 Furthermore, once a nursing home has been accepted as a suitable provider of supervised placements it means that placements can be carried out at that home only. Companies that own several nursing homes and that wish to use them all for placements should have each of the homes audited. 9.10 Each nursing home must strictly adhere to the number of adaptation students that the HEI states that they can take. Any increase in nurses placed over and above this number could mean that the NMC would not accept the placement of these nurses as valid. 9.11 The NMC will not accept nurses onto the register who have completed a supervised placement at a nursing home that has not been audited and approved. It is therefore essential that applicants check that the home where they would be working is acceptable to the NMC and has been audited by an HEI prior to the start of their placement. Failure to do this can result in frustration and lengthy delays to an application. 9.12 If a nurse has carried out a supervised placement at a nursing home that has not been audited, their time served there will not count towards their placement time and they will need to begin that placement again once the home becomes audited if required to do so. Nurses should therefore check that the home they are working in is fully accredited – a list is available on the NMC website at www.nmc-uk.org/nmc/main/Overseas/Placements.doc
“We in UNISON want to ensure that overseas nurses get a better deal than those that arrived from the Caribbean as part of the Windrush generation of nurses. We should treat overseas nurses with the professional respect they deserve. 4 in 10 London nurses are now from overseas and as such they deserve a louder voice in nursing.� Michael Walker, UNISON Regional Officer
9.13 The NHS has produced its own guidance on the Provision of Adaptation for Nurses in the Independent and National Health Service Sectors. This reinforces the recommendations of the NMC. It also recommends the establishing of learning contracts. This is an agreement between the adaptation nurses, mentor and clinical manager. The aim of the agreement is to establish clear measurable learning outcomes that can be easily assessed. It also recommends that the period of supervision should normally range from three to six months. 9.14 UNISON also has concerns that nurses working within the private sector have limited opportunities to develop professionally and we believe that the independent sector should be made to form stronger links with universities in order to help nurses wishing to take specialist courses which would be available easily to them within the NHS.
10. GRADING 10.1 UNISON believes a D grade is the level that fairly reflects the work that the nurses undertake and shows recognition of the skills and expertise that many nurses arrive with. Nurses undertaking supervised practice should be paid at the same rate as any newly qualified nurse and to do otherwise could, we believe, discriminate against them purely on the basis of where they have come from. 10.2 The Department of Health recommends that a supervised practice nurse should be paid at B grade or above, before they rise to D grade or above on registration. The pay for a nurse working in the private sector during their period of supervised practice ranges from the minimum wage to that of an A or B grade nurse. 15
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10.3 Whilst acknowledging that our view is not shared by the NMC or the DoH, UNISON believes the period of supervised practice or adaptation is the equivalent of the period of preceptorship that is advocated for registered nurses by the NMC, when a more experienced nurse provides advice and support to the newly registered nurse. 10.4 In addition, by allowing overseas nurses to be paid less than qualified UK nurses, it may contribute towards their exploitation as there is an economic reason for employers to delay the adaptation process. We have seen examples of the overseas nurses adaptation programme being in place for 18 months before an employer signs the NMC declaration form for the nurse’s registration and pin number. 10.5 Many overseas nurses arrive in the UK with a wealth of knowledge and expertise. By grading nurses at less then grade D, UNISON believes it undervalues the incredible contribution that they are making to the NHS and patient care.
11. ENGLISH LANGUAGE TESTS 11.1 The NMC stipulates that all nurses who have trained outside the UK and are not from the European Union must demonstrate competency in the English Language. They must achieve a score of not less than 5.5 in the individual bands and not less than 6.5 overall in the International English Language Testing System administered by the British Council. 11.2 It is therefore the responsibility of the employer to assess whether a nurse from an EU country has a sufficient level of English to be able to perform their job effectively. UNISON therefore would encourage employers to provide orientation programmes that can ensure that nurses have sufficient language skills to work effectively in a medical environment.
12. EUROPEAN UNION ACCESSION COUNTRIES 12.1 On 1st May 2004 10 new countries joined the European Union. They were: Cyprus, Hungary, Malta, Poland, Czech Republic, Estonia, Latvia, Lithuania, Slovakia and Slovenia. 12.2 This has raised a number of issues for the NMC regarding the standards of nurse and midwifery training. There are concerns about the levels of nurse training in three of these countries: Czech Republic, Latvia and Poland. 12.3 The NMC has been liaising with the accession countries to ensure that nurses trained in all of the 10 countries comply with UK standards. The NMC needs to be able to confirm that all programmes started on or after 1 May 2004 meet the Nursing and Midwifery Directives. Nurses that began their training prior to this date must produce evidence of practice. 12.4 The NMC is not allowed to stipulate an English language test for nurses coming to work in the UK from other EU countries in order for them to be registered, as this would be seen to be blocking the free movement of labour. This has to be left to the employer. It is therefore employers who should 16
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ensure that Accession State nationals, in accordance with existing guidance, as with all EU nationals, have sufficient knowledge of English to be able to work efficiently. As is the case with all newly appointed nurses, induction or orientation programmes should be available to help support the nurses’ development. This is especially important in relation to overseas nurses who are trying to adapt to a new country, culture and different nursing practices. 12.5 UNISON believes that as the EU continues to expand, ways to help welcome overseas nurses in the UK must be found, including making the transition as smooth as possible and helping the professional development of the nurses. 12.6 Nurses from new EU accession countries, although not required to do adaptation should still have access to some form of orientation to help familiarise them with different policy and procedure, such as record keeping or the administration of medicines.
13. PRE-DEPLOYMENT ORIENTATION AND INDUCTION 13.1 According to the Department of Health’s Code of Practice for the NHS and its Guidance on International Nursing Recruitment, overseas nurses should be fully assisted during their transition to the UK. They must be made aware of how to find help and assistance in every aspect of their employment and domestic arrangements. 13.2 A good induction programme should maintain contact with new employees to ensure a smooth introduction into the organisation over a period of time, rather than just one or two days at the outset. It should involve colleagues and other members of staff who know the organisation well. Ideally there should be a pre-deployment orientation (one that informs and deucates 17
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them of their rights) before the nurse even leaves their home country so that they know: ■ what will be expected of them as a nurse, including what they will need to do to obtain their registration ■ what their rights are (including trade union rights) ■ cultural differences both inside and outside their workplace ■ variations in weather and climate. 13.3 Adjusting to a new culture can be difficult for even the most well lookedafter nurses and it is essential for employers and UNISON branches to ensure the nurses from overseas are not left feeling isolated or without any means of redress against their employer if the situation demands it. 13.4 In many cases this does not happen. Increasingly NHS Workforce Development Confederations, rather than recruiting directly from another country, are recruiting overseas nurses who are already resident in the UK and possibly working in the private sector. In such cases they will have had no input into any pre-deployment orientation. 13.5 It is therefore important there should be an initial welcome, greeting newcomers at the airport if recruited directly from overseas, or some other location if from within the UK. New starters should also receive information on the following: ● the role of the nurse ● the role of the NHS and other bodies such as the NMC ● differences in nursing practice between the UK and their country of origin ● education and training needs including Post Registration Education and Practice (PREP) ● cultural differences and information ● climatic variations ● cost of living advice, assistance and guidance on accommodation. (It is UNISON’s view that trusts should provide maximum assistance in providing suitable, affordable accommodation) ● pay - their contract and letter should already have informed them how much and how often they will be paid. However, they will need additional information explaining how it will be paid, any enhancements (e.g. unsocial hours) they are entitled to, and any deductions ● opening a bank account ● obtaining a National Insurance number ● telephoning home ● registering with a general practitioner and dentist ● providing information relating to joining a trade union. Ensuring that recruits are made aware of what services trade unions can provide ● information on equal opportunities policies ● local cultural, religious and social centres. 13.6 UNISON representatives should ensure that, where possible, employers inform potential recruits about all aspects of the terms and conditions of their contract and provide details of where they will work before the nurse decides 18
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to leave their home country (see section on pre-deployment and induction). Once they arrive in this country branch representatives should ensure the employer provides a full induction process. 13.7 In addition to the induction programme an education package should be available to assist overseas nurses in their nursing transition. Programmes should include information on the following: ● NMC and conduct ● standards ● ethics ● cultural diversity ● health and safety ● administration of medicines ● difference in medical equipment e.g. IVAC pump and syringe drivers ● common medical terms ● consent ● governance ● structure of NHS ● appraisals and personal development systems ● education mechanisms ● National Institute for Cclinical Excellence (NICE) / Commission for Healthcare Audit and Inspection (CHAI) ● complaints handling ● EU-based practice ● career progression.
14. AIRFARES AND REGISTRATION FEES 14.1 The Department of Health’s ‘Guidance on International Recruitment’ states that NHS employers should pay for recruits’ airfares and that there should be NO agency registration costs for recruits. 14.2 The Government of the Philippines states that the employer must pay for the airfare of nurses recruited into the UK. 14.3 UNISON also feels that there should be NO cost to individuals for supervision or training. However, private sector contracts often do contain charges by the employer for training and airfares. Many nurses employed in the private sector will also have paid a large sum of money to the recruitment agency. 14.4 UNISON’s legal advice is that the payment of such fees may amount to unlawful penalties. If there is an agreement to repay these “golden handcuff” payments on termination of employment by the employee there may be an argument that these payments are acting as a restraint to deter employees from seeking employment elsewhere. 14.5 The cost of three years’ registration with the NMC is currently £129 from 1st August 2004. UNISON recommends that employers should cover the cost of registration for the first year. 19
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15. CONTRACT OF EMPLOYMENT 15.1 The acceptance of a job offer, whether verbally or in writing, means a legal contract has been established. If a position of employment is offered and then withdrawn, an applicant may have grounds to claim for a breach of contract even if no written agreements have been exchanged. 15.2 It is important for employers when recruiting from overseas to ensure that the applicant has a clear idea of the terms and conditions of their contract, where they will be working and what they will be doing. 15.3 An employer is required to provide a written statement of the main points of employment to a new employee within two months of the beginning of employment. However, a good employer should provide this to an overseas nurse before they leave their country of origin and when the job is initially offered. Any written contract should reflect the conditions agreed upon in initial verbal agreements. 15.4 Contracts, whether written or verbal, should indicate: ● details of employer and employee ● location of work place ● job title and description of duties ● hours of work including overtime requirements ● date when the nurse or employee started work and the period of continuous employment ● scale and rate of pay, how it will be calculated and how often it will be paid ● holiday entitlement and holiday pay ● sick leave and pay ● where employment is temporary, the date on which employment ends ● details of any collective agreement negotiated by a union on behalf of staff. ● pension arrangements ● notice period ● disciplinary and grievance procedures (where there are 20 or more employees). 15.5 A contractual agreement may be contained in more than one document. These could include: ● written statement ● any letter sent by the employer before the nurse started work ● anything signed since starting work ● instructions, announcements on the noticeboard ● the Office Manual ● clauses in a collective agreement reached between a union and employer. 15.6 In addition a contract may include provisions that are either spoken or implied. An example of an implied provision would be the employers’ responsibility to provide a safe working environment or that the employee must accept reasonable instructions from the employer to make the contract workable. 20
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15.7 If a nurse is unhappy with the conditions of the contract it is important to raise concerns as soon as possible, either with the employer or UNISON, because working under new conditions without complaint can be seen as giving implied consent to the changes. 15.8 It is also important to note that a contract, even if an employee signs it, cannot take away that person’s basic legal rights. Also once agreed, a contract cannot be altered without the employee being consulted and agreeing to the changes, the same restrictions apply to the issuing of a new contact, which upon arrival differ significantly from the contract promised.
Unlawful, misleading and exploitative contracts 15.9 The vast majority of internationally recruited nurses who come to work in the UK are extremely positive about their employment and the country. However UNISON has experience of employers who act irresponsibly, and in some case illegally, by taking advantage of the vulnerability of nurses who come to work in a new country. 15.10 There are examples of nurses arriving in the UK to find that their written contract differs significantly from the terms and conditions promised to them in their home countries. Their new contract may contain additional clauses relating to the charges for their training or accommodation or the nurse may discover that they will be working in a nursing home for the elderly when they possess skills and expertise in acute care and thought they would be working in a hospital. There have also been other examples of employment contracts containing gagging clauses phrased to prevent or deter employees from taking part in trade union activities. 15.11 Faced with unethical threats of deportation or the retention of their passports by their employer, nurses can find themselves in frightening situations. 15.12 No employer has the legal right to retain a passport – they are the property of the issuing government and the employee must keep hold of them throughout their employment. 15.13 Nurses should ensure that they fully understand the provisions of their contracts and that the contract terms are reasonable and legal. There should be a genuine commitment from the employer to provide long-term employment once the registration has been accepted. The Department of Health recommends a minimum two-year contract.
Financial penalties 15.14 Department of Health and Independent Healthcare Association (IHA) guidelines state that trusts should cover all costs including airfares and agency fees and there should be no cost to the individual for supervision of training. However, some private sector employers have inserted into the contract of employment, clauses reclaiming money for training, airfares or registration fees. These fees can be thousands of pounds and the debts can be a huge constraint on nurses, particularly if their salaries are already low. Other nurses have received contracts that state that these sums must be paid upon the termination of employment, which deters nurses from leaving what can be exploitative situations. 21
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Withholding documentation 15.15 There have been examples of employers in the private sector withholding passports, birth certificates, NMC pin numbers or educational documents, who will only release them upon payment of a fee. This action is illegal and employees may consider reporting their employers to the police in such cases. A nurse is free to apply for alternative employment and the new employer is then required to apply for another work permit.
16. REGULATION OF INDEPENDENT SECTOR 16.1 The independent sector is not bound by the Department of Health’s Code of Practice. The Independent Health Care Association has produced its own code, Supervised Practice for Internationally Qualified Nurses, IHA, 2001, detailing recommendations when employing nurses from overseas. These include: ■ independent sector employers will not use recruitment agencies that levy charges to applicants ■ the supervised practice (or adaptation) nurse should be overseen by a named and experienced registered nurse
“We are not Asian Angels; we are nurses with a professional job to do, committed to our patients and to our union.”
■ employers should make no monetary charges to the employees for any adaptation placement. 16.2 UNISON welcomes these and other recommendations contained within the Independent Health Care Association’s Code and would like the guidelines to become statutory in order to ensure good practice among all employers.
17. ADVICE FOR BRANCHES AND REGIONS Janice Carandang, rescued nurse
Organising and recruiting internationally 17.1 UNISON has led the way in the recruitment and representation of nurses recruited from overseas. This has been of benefit to the nurses themselves in terms of the representation and services UNISON can provide and in providing the nurses with the tools and confidence to help organise themselves. It has also assisted UNISON in terms of recruitment and cementing its position as a leading union for nurses. 17.2 The way in which overseas nurses are recruited will vary from one part of the country to another. However, there are certain steps that a branch or region can follow to ensure that overseas nurses do not encounter too many difficulties when coming to the UK.
How are overseas nurses recruited? 17.3 The way in which overseas nurses are recruited will play a key role in determining how a campaign is organised locally. In London, for example, the recruitment of overseas nurses was organised by the NHS on a regional basis and the UNISON Greater London Region eliminated the use of agencies by recruiting directly from the Philippines. This enabled UNISON to have a direct input into the pre-deployment orientation and induction process and the drawing up of the supervised practice/adaptation programme. UNISON was able to ensure that it had access to the nurses to explain the benefits of union 22
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membership. However changing methods of recruiting from overseas calls for different approaches. The abolition of Regional Health Authorities has changed the way the NHS recruits overseas nurses and increasing numbers of nurses are being recruited into the private and independent sectors.
Establishing links with community groups 17.4 One of the leading sources of overseas nurses has been the Philippines. UNISON has been very active in working with Filipino community groups and has been particularly helped by the work of Father Claro Conde, a Filipino priest who has been actively involved in assisting nurses from the Phillipines working in the UK and Allen Reilly, UNISON branch secretary of the Filipino Community of Croydon and Coulsdon. 17.5 At a national level UNISON has developed links with the Filipino Embassy. Such links have enabled UNISON to develop a stronger understanding of Filipino culture and values and has increased our profile within the Filipino community. This has led to Filipino nurses asking to join UNISON, whereas otherwise they may have been unaware of what the union is able to do for them. Recent figures indicate that India is now a leading target for international recruitment. This will pose new challenges for UNISON both in terms of establishing new links and contacts and understanding a different set of cultural values.
Establishing networks of overseas nurses 17.6 Internationally recruited nurses are likely to feel isolated when they arrive in the country or they may be working in small groups. UNISON has a role to play developing networks of nurses, by either establishing its own network as has been the case in Scotland or through work with other local community groups. 17.7 Networks provide opportunities: ■ for overseas nurses to talk to and communicate with each other ■ for UNISON to find out what their concerns are ■ to empower nurses by providing them with further training in, for example, interview skills ■ for UNISON to recruit more members.
Membership and recognition 17.8 In some situations a nurse may not belong to UNISON or any other trade union because they have not had the opportunity to do so. They may have been instructed that they will be in breach of their employment contract if they become involved in trade union activities. 17.9 They are likely to be vulnerable and may be unaware of the UK’s culture of employment/industrial relations and their right to join a trade union. In such circumstances it is unlikely that UNISON has a recognition agreement with the employer.
Establishing close links with Trusts and NHS Workforce Confederations 17.10 Regional and Branch UNISON officials should have close links with Trusts and their Personnel Departments. This will help in terms of the representation of nurses already employed by the trust and also if other nurses approach UNISON for assistance in finding new employment. 23
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17.11 NHS Recruitment within England is co-ordinated through Workforce Development Confederations (WDCs). These are local NHS membership organisations consisting of NHS Trusts, Primary Care Trusts, Health Authorities, Care and Ambulance Trusts. Regions may find it beneficial to establish close links with WDCs as they will be able to: a) provide information on activities on international recruitment in your region b) assist in finding alternative employment for internationally recruited nurses
Rescue missions 17.12 UNISON has experience of a number of cases in the private sector where the treatment of internationally recruited nurses has become threatening or abusive. The nurses may have been threatened with deportation, made to work excessively long hours or were subjected to racial discrimination. 17.13 If it is clear that there is no effective way of representing members within the confines of the nurses’ existing contract or the situation is too extreme to leave the nurses exposed, UNISON will attempt to intervene to find alternative employment within the NHS and arrange for the nurses to leave their place of work and accommodation safely. UNISON Regional Officers need to be satisfied that the employer’s conduct is unacceptable and that the contracts of employment are irregular or breach labour laws. It is important that UNISON does not openly encourage nurses to break their contracts. Such activities are only used as a last resort, when local discussion and/or procedures cannot address the situation; the UNISON regional office must be informed. 17.14 The rescue missions often start from meetings arranged secretly with nurses outside of their place of employment. Copies of their employment contracts and evidence such as “separate” duty rotas are brought along. Alternative employment for the nurses can be found either through Workforce Development Confederations or the individual trusts. The trust through the UNISON regional office can arrange interview dates and the trust carries out the interview procedures and applies for the work permits. 17.15 The region or branch may also organise transportation to assist the nurses to move home. Often the nurses’ accommodation is tied to their employment. The move can be very traumatic or frightening and any assistance in helping with transport, such as hiring a mini bus, can speed up the process of moving and is a demonstrable and tangible way of helping reduce fear and anxiety. 17.16 Sometimes nurses may have already run away and will be in touch with their respective embassy. Local community associations may also help by providing “safe housing” until UNISON can assist with settlement with a new employer.
Post Termination Remedies 17.17 UNISON strongly advises members not to resign their jobs without first consulting a UNISON representative as they may be in breach of Home Office regulations. However there are some circumstances in which the member is forced to resign or dismissed before help can be sorted: 24
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■ Unfair Dismissal: Most employees have the right to complain of unfair dismissal, though there are a number of exceptions which are listed on the Department of Trade and Industry’s website at www.dti.gov.uk. However there are a number of circumstances in which anyone can complain of unfair dismissal regardless of age or length of service. These include dismissal for trade union membership, for taking time off for dependants or for taking certain specified types of action on health and safety grounds among a number of others. ■ Constructive Dismissal: If a member is determined to leave their employment immediately, UNISON can advise them of their freedom to resign followed by the possibility of a claim of constructive dismissal. An employee who resigns because of conduct by his or her employer may be shown to have been ‘constructively dismissed’. For a tribunal to rule in this way the employer’s action has to be such that it can be regarded as a significant breach of the employment contract e.g. the employee was demoted to a lower rank or a poorer paid position. 17.18 We would not advise members to resign from their jobs without seeking advice. if the member intends to leave immediately regardless, they may lose nothing by considering the possibility of a claim based on constructive dismissal. However unfair dismissal cases are complex. An Industrial Tribunal would normally expect to see evidence that an applicant had tried all possible avenues to resolve the issue and was left with no alternative but to resign. It is important that all such cases are treated individually and advice sought from the relevant regional officer at a minimum. Sometimes, the employer will have breached an express term in the contract (e.g. not paid the due rate for overtime) but sometimes there will be no express breach. In these cases, we should look to see whether the employer has breached the implied term that the parties maintain mutual trust and confidence. In the latter case, it is worth remembering that the claim is not that the employer has acted unreasonably (for there is no legal duty to be reasonable) but that it has so undermined the duty to maintain trust and confidence, that the employee had no option but to resign. 17.19 One of the difficulties with constructive dismissal is that the employee must resign in response to the breach. If the employer breaches an express or implied term and the employee dislikes it but nonetheless continues to work, they are taken to have affirmed the contract. In these cases, the employer would argue that the matters about which members are complaining are matters that they have tolerated for some time so that the important requirement in establishing constructive dismissal – that the employee resigned in response to the breach – is not satisfied. But where the members are working in an oppressive environment and abusive treatment is continuous or regular, we cannot advise them to remain in employment and wait for the next major breach before resigning. We could still claim constructive dismissal by arguing that the most recent actions of the employer came at the end of a string of similar actions and were simply the “last straw”. It would be advisable to draft a letter of resignation citing examples of abusive behaviour or misconduct by the employer, mentioning the most recent. In most situations there are plenty of examples such as intimidating behaviour, threatening deportation, withholding of passports, delayed registration, long working hours and so on. Branches and regions should always seek legal advice wherever possible as each case should be assessed individually. 25
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ROLE OF GOVERNMENT DEPARTMENTS AND REGULATORY BODIES Department of Health (www.dh.gov.uk) UNISON has worked closely with the Department of Health to improve the working conditions of overseas nurses employed in the NHS. As a result the Department has produced the following publications aimed at standardising both the terms and conditions under which the nurses are employed and the procedures in recruiting them: i) Guidance on international nursing recruitment, 1999 ii) Code of Practice for NHS Employers, 2001 iii) Guidance for the Provision of Adaptation for Nurses, 2003. All these publications are available on the Department of Health website. UNISON is also in discussions over how the Department of Health can assist in the allocation of rescued nurses to NHS Trusts.
Work Permits UK (Home Office) (www.workingintheuk.gov.uk) UNISON has had discussions with Work Permits (UK) concerning the allocation of work permits and the sanctions that may be taken against employers who are flouting employment law. These discussions have already resulted in the removal of work permits from unscrupulous employers. However the Home Office can only act if they have grounds to believe the employer or employee is in breach of the conditions of Work Permit or UK Employment law. If an employer is found to be operating illegally, WPUK may take action against them, which may result in the employees leave to remain being revoked. Any employee in this situation should seek UNISON or legal advice immediately. UNISON believes that if an employer is reported to Work Permits UK, our members’ interests should be protected. The employee’s right to stay in the country depends on their employment, but UNISON feels they should not be penalised if they are working for an unscrupulous employer.
Nursing and Midwifery Council (www.nmc-uk.org) It is important that suspect employers are reported to the Nursing and Midwifery Council (the professional regulatory body for nursing and midwifery).The NMC may remove their approval for the employer to provide supervised practice, or where the nursing homeowner is a nurse they can be reported for professional misconduct. If the owner is a doctor they should be reported to the General Medical Council. If an employer’s personal conduct is found to be inconsistent with the Code of Conduct of the NMC, it should be considered whether to report them.
Higher Education Institutions As a means of commissioning, preparing and monitoring placements, education audits are conducted in each clinical area where students are 26
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placed. The auditors are Registered Nurse Teachers who are linked to Higher Education Institutions. Concerns about the standard and content of supervised practice placements should be raised with Higher Education Institutions.
Care Standards Commission and Local Authorities Local Authorities are responsible for the licensing of nursing homes, residential care homes and independent hospitals, while the Care Standards Commission is responsible for their regulation and standards of care.
Department of Trade and Industry (www.dti.gov.uk) Concerns about recruitment agencies can be raised with the Employment Agency Standards Inspectorate, part of the DTI.
Workforce Development Confederations Workforce Development Confederations (WDCs) are local NHS membership organisations consisting of NHS Trusts, Primary Care Trusts, Health Authorities, Care and Ambulance Trusts. They enable Strategic Health Authorities to deliver their franchise plans through: ■ planning and development of the healthcare workforce ■ working with Postgraduate Deaneries to commission education and training ■ managing the Department of Health Budget in training WDCs play a key role in increasing NHS staff numbers and changing the way staff are trained and developed. They are also responsible for developing and disseminating improved ways of tackling problems of recruitment and retention and enhancing the working lives of staff.
INTERNATIONAL BODIES UNISON has the largest international department of any UK trade union. It is active worldwide, assisting our international sister trade unions through a range of activities, including programmes of capacity building, twinning and establishing links with health sector trade unions across Central and Eastern Europe. UNISON is affiliated to several international trade union organisations the most important of which is Public Services International (see overleaf). UNISON works closely with overseas trade unions, including the Philippines Nurse Association and has formal partnership agreements with the Finland’s Union of Health and Social Care Services (Tehy) and Spain’s Comisiones Obreras (CCOO). These innovative agreements ensure that any nurse member from Tehy or the CCOO has an automatic membership of UNISON. This results in continuity of trade union membership and direct access to support should they need it. As the biggest union in the United Kingdom, UNISON is in a powerful position to assist our international trade secretariats and its affiliates. In addition 27
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UNISON has a strong voice in terms of shaping the global health and nursing agenda. UNISON has contacts within the World Health Organisation and through PSI holds a powerful position on the European Public Services Union. In 1990 the United Nations General Assembly approved the Convention on the Protection of the rights of all Migrant Workers and Members of their Families. This suggests that migrant workers should be given a basic understanding of the language, culture, legal, social and political structures of the states to which they are going and in a language they understand. They should also be informed in advance of the wages and general working conditions. Neither the UK nor any EU state has signed up to the convention. UNISON believes it is time the UK set an example and signed up to the convention.
Public Services International (PSI) (www.world-psi.org) This is an international trade union federation for public sector unions and is an officially recognised Non-Government Organisation - NGO - for the public sector within the International Labour Organisation. It is made up from more than 600 public service trade unions in more than 140 countries, together representing more than 20 million public sector workers. PSI has recently published a comprehensive report based on its research entitled ‘Women and International Migration in the Health Sector’. Copies of the report are available from the PSI website.
“Without overseas nurses, the NHS would struggle to work efficiently, which is why it is vital that we continue to support and promote their rights, and make the UK an attractive place for nurses to work.” Karen Jennings, UNISON Head of Health
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Overseas Nurses Network (www.unison-scotland.org.uk/nhs/overseas/index.html) Launched at the end of 2002, the Overseas Nurses Network operates in Scotland and provides an opportunity for nurses and care workers from overseas to meet others in the same situation. It also serves as an information point, a conduit for consultation, provides access to training as well as providing a means of networking on a professional and social level.
International Council of Nurses (ICN) (www.icn.ch) The International Council of Nurses is a federation of national nurses’ associations representing nurses in more than 120 countries. Operated by nurses, the ICN works to ensure quality nursing care for all, sound health policies globally, the advancement of nursing knowledge, and the presence worldwide of a respected nursing profession and a competent and satisfied nursing workforce.
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USEFUL CONTACTS UNISON Head Office UNISON, 1 Mabledon Place London WC1H 9AJ Contact: Gail Adams, Head of Nursing Tel: 0845 355 0845 Fax: 020 7551 1101 Text tel: 0800 096 7968 www.unison.org.uk
Scotland UNISON House 14 West Campbell Street Glasgow G2 6RX Tel: 0870 777 7006 Fax: 0141 331 1203 Text tel: 0141 248 3981
Eastern Region UNISON, Church Lane House Chelmsford, Essex CM1 1NH Tel: 0870 889 0373 Fax: 01245 492 863 Text tel: 01245 499 135
South East UNISON, Glen House, High Street Banstead, Surrey SM7 2LH Tel: 0870 770 1112 Fax: 01737 733 328 Text tel: 0870 777 9877 Email: southeast@unison.co.uk
East Midlands UNISON Regional Centre Vivian Avenue, Nottingham NG5 1AF Tel: 0115 847 5400 Fax: 0115 847 5422
South West UNISON House, The Crescent Taunton, Somerset TA1 4DU Tel: 01823 288 031 fax: 01823 336 013
Greater London UNISON, Congress House Great Russell Street London WC1 3LS Contact: Michael Walker Tel: 020 7535 2100 Fax: 020 7535 2105
Cymru/Wales UNISON, Transport House, Third Floor 1 Cathedral Street, Cardiff CF11 9SB Tel: 02920 398 333 Fax: 02920 220 398 Email: cymruwales@unison.co.uk
Northern UNISON, 140-150 Pilgrim Street Newcastle upon Tyne NE1 6TH Tel: 0191 245 0800 Fax: 0191 245 0899 Northern Ireland UNISON, Unit 4, Fortwilliam Business Park Dargan Road, Belfast BT3 9JZ Tel: 02890 770 813 Fax: 02890 779 772 North West UNISON, Arena Point, 1 Hunts Bank Manchester M3 1UN Tel: 0161 211 1000 Fax: 0161 661 6710
SCOTTISH OVERSEAS NURSES NETWORK Glasgow Resource Centre 2, Fitzroy Place, Glasgow G3 7RH Contact: Sofi Taylor Tel: 0141 243 2119 www.unisonscotland.org.uk/nhs/overseas
NHS CAREERS This is a specialised service providing information on careers in the National Health Service (NHS) in England. Tel: 0845 60 60 655 www.nhscareers.nhs.uk/
FILIPINO COMMUNITY OF COULSDON & CROYDON 113 Chipstead Valley Road Coulsdon, Surrey CR5 3B Contact: Allen Reilly Email: Reilly113@aol.com
West Midlands UNISON, 24 Livery Street Birmingham B3 2PA Tel: 0121 685 4200 Fax: 0121 685 4400 Text tel: 0121 685 4410 Email: westmids@unison.co.uk www.westmids.unison.org.uk Yorkshire & Humberside UNISON, Commerce House Wade Lane, Leeds LS2 8NJ Tel: 0113 244 9111 Fax: 0113 244 8852 Text tel: 0113 234 6911
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CHECKLIST FOR INTERNATIONALLY RECRUITED NURSES This checklist is for overseas nurses applying to work or already working in the UK 1. If you are interested in coming to work in the UK: i)
You should contact the Nursing and Midwifery Council to ask for an Overseas Nurse pack.
ii) Complete and return the pack to the NMC. iii) You can look for employment in the UK, but you should not commence work until you have received an approval letter from the NMC iiii) If a recruitment agency or an agent acting on behalf of an employer approaches you should ask the following questions: a) Who pays for my adaptation programme? b) Who pays for my airfare? c) Who pays for my accommodation in the UK? You shouldn’t have to part with any money. If asked to do so by an employer or agent you should note that it might mean they are acting unethically or illegally. 2. Have you been asked to pay for anything other than the specified amount of money for the registration fee?
■ Yes
■ No
3. Has your contract of employment or terms & conditions been changed from what you were led to believe they would be before starting?
■ Yes
■ No
4. Have you been asked to apply for a student visa to undertake your adaptation programme?
■ Yes
■ No
If you answered yes to one or more of the above questions you must seek advice immediately from a UNISON representative as there is a high risk that aspects of your contract may be illegal or you may be treated unethically by your employer.
WORK PERMITS 5. Is the employer stated in the work permit different from your actual employer?
■ Yes
■ No
6. Does the job description in the work permit differ from what you are expected to do?
■ Yes 30
■ No
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7. Is the location of your job different to the one stated on the work permit?
■ Yes
■ No
8. Does the spelling of your name, date of birth or terms and conditions on the work permit differ from those shown on your passport and/or visa?
■ Yes
■ No
If you answered yes to one or more of questions 4-7 you should seek UNISON or legal advice immediately as you may be refused entry when you arrive in the UK or if you are already working in the UK your work permit could be invalid.
CONTRACT OF EMPLOYMENT You should ensure that you obtain a written contract from your employer, which should contain the following information: ■ your name and the name of your employer ■ date when you started work and the period of continuous employment. ■ your rate of pay, how it will be calculated and how often it will be paid. ■ hours of work. ■ holiday entitlement and holiday pay. ■ job title. You should be made aware of your entitlement to: ■ sickness leave, pay and pensions ■ notice provisions and disciplinary procedures (where there are 20 or more employees). The contract should not contain any unlawful items, gagging clauses or financial penalties that may be imposed on you should you break your contract. Airfares and registration fees UNISON suggests that you should only deal with employers who pay for your airfare and for your initial NMC registration fee. Grading Ensure that you are being paid at an appropriate grade. UNISON recommends a minimum of grade D; the Department of Health recommends a minimum B grade. Registration and adaptation Make sure you are familiar with the requirements to be fulfilled in order to achieve registered status as a nurse. If you are required to undergo a period of supervised practice or adaptation, check that the placement matches the requirements stipulated in the NMC’s letter to you and will lead to you achieving registration. Ensure that you have a mentor who fully understands their role. (eg. What support you will need and what responsibilities they will have.) 31
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UNISON OVERSEAS NURSES’ RESOURCE GUIDE
Pre-deployment orientation and induction You should be given pre-deployment orientation and then given an adequate level of induction. The deployment orientation and induction between them should contain information on: ■ your role as a nurse ■ the role of the NHS and other bodies such as the NMC ■ differences in nursing practice between the UK and your country of origin. ■ education and training needs including PREP (Post Registration Education and Practice) ■ cultural differences and information ■ climatic variations ■ cost of living ■ advice, assistance and guidance on accommodation ■ details about pay ■ opening a bank account ■ obtaining a National Insurance number ■ telephoning home ■ registering with a general practitioner and dentist ■ joining a trade union ■ equal opportunities policies ■ local cultural, religious and social centres. Accommodation Comfortable and affordable accommodation is vital for your well-being. Your employer should give maximum assistance in providing or obtaining adequate, reasonably priced and secure accommodation. If you want to work in the UK you should investigate the subject thoroughly and access information from the overseas nurses web page on the NMC site or look at the NHS careers site (see Useful Contacts section). You should consider joining a union when you arrive so that you are fully briefed and aware of your rights within your workplace. An application form to join UNISON can be found at the end of this guide.
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CHECKLIST FOR UNISON REPRESENTATIVES WHEN DEALING WITH INTERNATIONALLY RECRUITED NURSES Work Permits It is the employer that applies for the work-permit, not the employee. However it is important to prompt employees to check that their work permit is accurate and reflects their employment situation accurately. It should also be checked that: ■ the employer stated in the work permit is the actual employer ■ the job described in the work permit reflects what the nurse is doing ■ the location described in the work permit describes where the nurse is working. ■ the spelling of names, date of birth and terms and conditions are correct on the work permits as any differences between the work permit and the passport and/or visa may result in the person being refused entry when they arrive in the UK. If the work permit is not accurate, it could be invalid and place the nurse in breach of landing conditions. Contract of employment Check that the nurse has a written contract containing: ■ names of employer and employee ■ date when the nurse or employee started work and the period of continuous employment. ■ rates of pay, how it will be calculated and how often it will be paid. ■ hours of work. ■ holiday entitlement and holiday pay. ■ job title. The employee should be aware of their entitlement to: ■ sickness leave and pay ■ pensions ■ notice provisions and disciplinary procedures (where there are 20 or more employees). The contract should not contain any misleading or unlawful items, gagging clauses or financial penalties. Airfares and registration fees Ensure that the employer pays for a recruit’s airfare and for a nurse’s initial NMC registration fee. Grading Check that the nurse is paid at the appropriate grade. UNISON recommends a minimum of grade D; the Department of Health recommends a minimum B grade.
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UNISON OVERSEAS NURSES’ RESOURCE GUIDE
Registration and adaptation Ensure that the nurse understands their registered status, the difference between a registered and non-registered nurse and their requirements to achieve registration. If a nurse is required to undergo a period of supervised practice or adaptation, check that the placement matches the requirements stipulated in the NMC’s letter to the nurse and that it will lead to the nurse achieving registration. Check that the nurse has a mentor and that the mentor fully understands their role, so that they may support the overseas nurses fully during their adaptation programme. Pre-deployment orientation and induction Check to see if a nurse has undergone any form of pre-deployment orientation. Then check that the nurse is given adequate induction. The deployment orientation and induction between them should contain information on: ■ the role of the nurse ■ the role of the NHS and other bodies such as the NMC ■ differences in nursing practice between the UK and their country of origin ■ education and training needs including PREP (Post Registration Education and Practice) ■ cultural differences and information ■ climatic variations ■ cost of living ■ advice, assistance and guidance on accommodation ■ details about pay ■ opening a bank account ■ obtaining a National Insurance number ■ telephoning home ■ registering with a general practitioner and dentist ■ joining a trade union ■ equal opportunities policies ■ local cultural, religious and social centres. Accommodation Comfortable and affordable accommodation is vital for the well-being of the nurse. Ensure that the employer provides maximum assistance in providing and obtaining adequate, reasonably priced and secure accommodation. Extreme circumstances If a nurse is working in the private sector and the circumstances are particularly worrying or their working conditions seem extreme, you should consider helping them move to the NHS. Senior nurses and Human Resource departments within the NHS who have been made to be aware of such extreme cases have in a number of instances 34
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waived the need for a reference from the UK employer, allowing the nurses just to undergo an interview. (see section on Rescue Missions, page 24, 17.2 to 17.16) In these cases you should collate as much evidence and get full details of their case. In some instances nurses may be afraid to be seen entering union premises, so a meeting should be arranged on neutral territory. You should notify your branch secretary and your regional officer as their may be other cases in the region, or even in the same work place which will build a stronger case against the employer. Advice can also be sought from Gail Adams, head of nursing at National Office by emailing: gail.adams@unison.co.uk Legal action should be considered in extreme cases.
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Regional offices Eastern
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