When Laura Sanchez one of an overseas nurses was offered a job as a NHS nurse, it sounded like a lifetime opportunity.
At her home in the Philippines, she saw Facebook-like ads on the site today that promised “an attractive relocation package” and invited her to “Start your UK dream!”
The most extreme contracts tied nurses into their roles for up to five years and included fees as high as £14,000 for those who wanted to quit early, according to the Observer.
The union Unison has also reported concerns about care home employers “trapping overseas nurses in exploitative workplaces and charging them thousands of pounds if they try to leave”.
One of its members – a nurse from the Philippines – sought to leave her job at a care home in southern England 11 months into a three-year contract, because she felt the working environment was unsafe, due to a lack of training, support or time for rest.
However, because the care home sponsored her visa, the nurse had to first find a new employer who was willing to take over the sponsorship or find herself at risk of deportation, which she said “terrified” her.
The nurse found a new job with visa sponsorship, but then when she handed in her letter of resignation, she was told she needed repay £9,000 to cover the company’s investment in her, including for a uniform, training and accommodation.
Unison managed to have £3,000 removed, because it was for the immigration health surcharge, which the employer was eligible to claim back from the government.
The nurse said: “I was so desperate to leave, so I used savings and my last month’s wage to cover the £6,000 so I could just end this nightmare. I don’t know what I would have done if I didn’t have the savings.”
Another Unison member, a nurse from Zimbabwe, was refused a reference from the care home in Northern Ireland where she was working until she paid the company £10,850 in “exaggerated” exit fees.
Unison national nursing officer Stuart Tuckwood said: “We’re finding numerous cases of overseas nurses being badly exploited by employers.
“It’s extremely concerning for the wellbeing of the nurses and their ability to provide safe, dignified care to their patients.”
He called on the government to urgently implement enforceable safeguards to protect overseas nurses.
“Without these, the UK is failing these overseas nurses and breaking agreements with the nations from which they’re recruited,” Mr Tuckwood said.
The Royal College of Nursing said it was also aware that “some employers include punitive clauses in the contracts of employment for overseas nurses”.
“This can result in health care staff being forced to pay thousands if they decide they want to work elsewhere if their visa allows for overseas nurses,” said Patricia Marquis, RCN England director.
“We have also heard of cases in which employers try to frighten and intimidate staff with threats of deportation, should they choose to work elsewhere,” she said.
She added the college was “very concerned by the practice”, which she warned “flourishes in a climate of chronic understaffing in health and care”, and pledged to challenge it when appropriate.
A recent survey carried out by the Nursing Narratives: Racism and the Pandemic project found that 52% of migrant nurses felt that work visas had made them more vulnerable to racism and exploitation.
The overseas nurses in the study expressed “vulnerability to victimization and exploitation” through work visas that tied their right to work to particular trusts.
Bosses of an NHS trust in the Southeast had even flown to the town near her village to interview the candidates in person, desperate to fill vacancies in their booths.
With eight years of experience, it fit perfectly. Hours after her interview, she was offered a job. “I was very excited,” said the 34-year-old, whose name has been changed. “My friends in other faiths had nice jobs and they enjoyed it.”
In the beginning, things went smoothly: the job was difficult, but she saved enough money to send a small amount to her elderly parents, who had re-mortgaged their land to attend a nursing college.
Then, in April 2020, everything changed. While working 12-hour shifts in an intensive care unit at the height of the first lockdown, with no full PPE or regular tests, Sanchez caught Covid. The virus left her tired and having difficulty breathing, but mentally it was even worse.
She returned to the ward, but found herself anxious and panicked at a point signed by her doctor. “I kept crying and crying. “I was horrified by the number of deaths,” he said. “Some of the nurses who died in the NHS were my friends.”
In September 2020, a little less than a year after her arrival, Sanchez made the difficult decision to go home. But when she reported the news to her manager, she was told it was not that simple. He had a two-year contract. Leaving early would cost her £6,000.
Sanchez is one of thousands of international nurses subject to repayment clauses in the UK.
To help meet a critical national staff shortage, with up to 400 NHS workers leaving each week, the UK is hiring a historically high number of nurses from abroad.
In the 12 months to the end of September 2021, there were more than 7,000 arrivals of overseas nurses from India and 5,000 overseas nurses from the Philippines, according to data from the Nursing and Obstetrics Council – part of the more than 125,000 international nurses currently registered. There are plans to increase that number: the government has pledged to add 50,000 overseas nurses to the NHS alone by 2025, with thousands more in need of social care.
In addition to the examinations and approvals needed to work in the UK, nurses abroad are ready to go. It costs employers around £10,000 to £12,000 per pre-hiring – but it saves them up to £18,500 in agency fees for the first year alone. In some cases, trusts can be paid up to £7,000 by NHS England for each overseas nurse they hire.
However, unlike their UK counterparts, those who leave before their contract expires may find themselves paying a heavy bill, according to an Observer survey – even in cases of bullying, discrimination, ill health and family emergencies.
Repayment clauses – which usually last three years and can cover everything from flights and visas to initial residence and training – are widespread in the NHS and in the private sector, although the terms vary and are not used by all employers.
“This does not encourage nurses to come and help with our vacancies,” said Francis Fernando, a London-based community leader in the Philippines.
The University Hospital Southampton NHS Foundation Trust, cited as an example of good practice in an NHS employer recruitment toolkit, charges Filipino nurses £5,000 if they wish to leave the first year, reducing it to £ 2,500 after one year.
The trust says hiring a nurse from abroad costs about £11,000, “which may include language, theory and practice exams, flights, work visas and accommodation”, and uses two-year repayment clauses to “protect this investment”. .
Sharp BH Global, a service hired in the Philippines for the Leeds Teaching Hospitals NHS Trust, uses “conventional measures” to ensure that “nurses keep their commitment” as part of the Nurses Ready to Roll program.
“This contractually binding agreement requires them to abide by full employment contracts, otherwise they face financial penalties,” the website said.
In the private sector, fees are often higher. A care provider with more than 10 homes in the UK charges £ 7,000 to migrant workers if they try to leave their role within a year, dropping to 50% of the “costs” £ 3,500 – if they leave at any time three years ago.
In a case identified by Unison, a nurse hired by Zimbabwe in August 2020 to help respond to Covid-19 says she tried to leave after her employer refused to increase her annual salary from £15,000 to £16,000. Or after its trial period. as agreed. She had been offered a job on an NHS trust, but when she asked for a report, her employer refused and told her she would have to pay £10,850.
In the worst case, employees can be laid off for five years and face charges of up to £14,000 if they try to leave early.
In Sanchez’s case, he had signed an agreement before it started, but the amount – equal to about three months’ pay – had never been clarified. Under pressure from a union and a charity, confidence eventually plummeted – but not before he said he could not work in the UK again if he did not pay. “To me, it’s not fair,” he said. “We work hard and I was sick. “I do not think they should have asked for repayment after a year, especially when I got sick while working in the trust.”
Although the clauses are not always enforced, they act as a strong deterrent, said Susan Cueva of Kanlungan, a charity for Filipino overseas nurses. Some overseas nurses stay in the workplace despite the workplace or other problems, fearing that if they leave they will not be able to pay. He likened them to a form of slavery. “You can not leave if you do not pay, and if you leave you must pay,” he said.
“Lawyers would argue that they signed the contracts and are therefore bound by them. They will say, “They have a choice, they do not need to sign it,” he said.
However, in some cases, employees are presented with different contracts than they sign when they arrive, or the UK contracts is only shown to them when they arrive in the UK. Others may not fully understand the consequences of repayment terms because they plan to stay in the UK forever – or have already spent thousands of savings to come first. “To return would mean that they would lose all the money they spent in the end trying to find work. “So they are taking their chances,” he said.
Ads targeting international candidates on Facebook give a sunny picture of life in the UK for overseas nurses. But on YouTube, dozens of nurses are talking about the harshest reality – from the challenges of bringing family members to live with them to visa problems and the cost of living.
There is a subspecies video dedicated to repayment terms. “If you have this clause, start saving now in case you need to leave,” advises a vlogger. “It’s your logic. It’s your life. “It’s your mental health,” says another. “What if you die there before completing your three-year contract? If you are not happy with your job? ” she moves away. “I knew I had to leave.”
A YouTuber, Becca Agyemang, a mother of three from Accra, Ghana, started working as an NHS nurse in the southeast in September 2020. She had paid about 40,000 cedis (about £ 4,000) for her studies. The costs of transporting her to the United Kingdom – her conversion exams, her visa and her flights – were paid for by the trust.
After a year, she wanted to leave her role not because of bullying or emergency, but because she was fighting without a support network around her.
She received an offer from another NHS trust in London, but because she left before the end of her three-year term as part of the UK contracts for their overseas nurses, she was told she would have to pay the recruitment fee of around £ 3,500. “It was okay because I had saved a little at the time,” he said, “but it was not easy. They took it from my salary. So you just have to tidy yourself up, rent, stay. “
But her condition is not as bad as that of some of her friends. “One of my friends was in a nursing home. He paid over £ 5,000 after working for more than three years. “They even made her pay for everything,” he said.
A nurse who is part of overseas nurses from the Philippines said she quit her job in a care home after being “injured” while working there at the height of the pandemic, months after arriving in the UK. “I just did not expect it to be so difficult physically and mentally,” said the nurse, who now works for the NHS in the Southwest.
She had estimated the cost of her training and relocation at around £3,000. But the caregiver said he owed £6,700. “I really wanted to move on to a better lifestyle, even though it was very, very expensive,” he said. “We gave them all our savings to get away.”
Trade unions, charities and lawyers – as well as associations representing nurses from the Philippines and India in the United Kingdom – are calling for an urgent review of the terms of the convention, which they say is discriminatory.
British Association of Nurses of India on Overseas Nurses, UK contracts
The British Association of Nurses of India believes that the issue has been on the radar for so long, because overseas Nurses – especially those from India – are unlikely to complain. “For them, this is better than being in India. “They do not realize that they are being treated unfairly,” said a spokesman.
Francis Fernando, the leader of community nurses in London, said nurses were already paying “exorbitant fees” for their visa applications at a time when the NHS was desperate for nurses, in addition to the threat of potential repayment costs. “This does not encourage nurses to come here to help with our vacancies,” he said. “We are shooting ourselves in the foot.”
Francis Fernando, a group nurse chief in London, mentioned nurses had been already paying “exorbitant charges” linked to their visa functions at a time when the NHS was determined for nurses, on prime of the specter of potential compensation prices. “This isn’t encouraging nurses to return right here to assist with our vacancies,” he mentioned. “We’re capturing ourselves within the foot. We now have to do higher as a society.”
Associations representing care dwelling suppliers didn’t reply to requests for remark final week. However Danny Mortimer, chief govt of NHS Employers, which represents NHS trusts, mentioned they valued “the essential contribution” of abroad nurses and recognised that “to assist workers make the transfer from overseas, supporting them with a number of the related prices can be necessary”.
NHS Employers publishes steering for organisations to “develop and talk the monetary packages obtainable,” Mortimer mentioned.
He pointed to the federal government’s code of observe for the worldwide recruitment of well being and social care workers in England, which says “no particular person ought to be charged charges to achieve employment” – however doesn’t point out compensation clauses.
The Institute for Human Rights and Enterprise (IHRB), mentioned that, as with all jobs, there was a “regular fee of attrition” concerned with hiring from abroad that employers needed to consider. “Corporations have to simply accept that as a enterprise value,” Neill Wilkins, head of the IHRB migrant staff programme mentioned. “The British authorities’s personal fashionable slavery assertion says recruitment prices ought to be borne not by staff however by employers.”
It isn’t the primary time compensation phrases have been within the highlight.
In 2018, two main outsourcing companies had been threatened with authorized motion by former workers who had been met with calls for for as much as £20,000 in coaching prices after they tried to go away inside two years.
And in 2019, an employment tribunal sided with an Indian who was part of the overseas nurses who had £2,000 deducted from her wages by a care dwelling supplier, which had claimed it was compensation of a mortgage to cowl her coaching prices when she left inside two years of beginning the job.
Employment Decide Christopher Camp mentioned the concept it was a mortgage was “illusory” and that it was really an unenforceable penalty clause. The usage of the clauses on the UK contracts for Overseas nurses by care suppliers, he mentioned, was an “more and more frequent observe”.
Alex Bernardino, a part of overseas nurses from the Philippines, is at the moment locked in a authorized battle along with his outdated employer over a £7,000 payment. He had agreed to the care dwelling’s three-year time period on arrival within the UK – regardless of it being totally different from the contract he had been proven whereas within the Philippines – as a result of he thought it was the norm and deliberate to remain for “the longest of occasions”.
“Possibly I used to be naive,” mentioned Bernardino, who will not be utilizing his actual title due to the authorized case. “I used to be simply considering, ‘I’m going to be there for that lengthy anyway.’ I used to be actually excited; I simply wished to be within the UK.”
The truth of his life within the UK turned out to be totally different from what he imagined. In his first few months, he says he witnessed workers being verbally abusive to aged residents and “speaking down” to them.
After elevating issues, he claims managers did nothing and he was bullied by colleagues. “Within the Philippines I used to be an emergency room nurse,” he mentioned. “However they advised me I used to be not likely a nurse and handled me as a janitor, making me clear the flooring.”
He was supplied a job within the NHS in London, which he accepted. However the care dwelling advised him he must pay £7,000 – a payment he’s at the moment being pursued for.
If he does find yourself having to pay the sum, for which he was by no means given a breakdown, the implications can be dire. With a spouse and younger kids to help, his household will “must make sacrifices”.
“I must work extra; to do extra time to have the ability to afford every thing,” he mentioned. “But when I stayed in that care dwelling I’d be very depressing. So it will’ve been worse.”
Parosha Chandran, a barrister who helped draft the UK’s fashionable slavery legal guidelines, and professor of contemporary slavery legislation at King’s School London, referred to as to be used of the clauses to be urgently reviewed by the federal government.
She mentioned overseas nurses may very well be put underneath “big quantities of strain by these contract clauses to remain in employment” in situations akin to debt bondage.
“Like some other employee there could be myriad causes – private or skilled – that cause them to take a tricky choice to go away,” she mentioned. “However in contrast to healthcare staff not topic to these UK contracts, there’s a sum of cash, thought to be a debt, that needs to be paid again earlier than the particular person is free.
“Clearly there was an entrenchment of conditioning within the minds of migrant staff, and their employers, to suppose that is acceptable when it’s not.”