Recruiting foreign nurses is frustrating and expensive

It is “distracting, frustrating and expensive” to have to recruit large numbers of nurses from overseas.

It is distracting, frustrating and expensive to have to recruit large numbers of nurses from overseasDr Keith McNeil, who runs Addenbrooke’s Hospital in Cambridge, urged officials to “figure out” what resources were needed and improve UK recruitment.

Around 7,500 nurses from countries such as Spain, Romania and Italy registered to work in the UK last year.

Figures from the Nursing and Midwifery Council (NMC) show the recruitment of overseas staff to the UK is growing.

The number of nurses coming here from other parts of the EU has risen steadily during the past six years – now making up the vast majority of new overseas recruits – while the number of foreign nurses from beyond Europe has dropped.

The trend has been driven partly by the financial crisis in countries such as Spain and Portugal – and because of extra demand for NHS nurses in the wake of the Mid Staffordshire scandal.

The number of training places for nurses in England fell in 2011 and 2012.

Cambridge University Hospitals NHS Foundation Trust has taken on 303 foreign nurses in the past year. Half were from the Philippines – with significant numbers from Italy, Spain and Portugal.

Dr McNeil, the trust’s chief executive, told BBC News: “Nurses are the backbone of the NHS. You can’t run services effectively in an acute hospital like this without adequate numbers of trained nursing staff.

“It’s distracting, frustrating and expensive to do international recruitment. It would be nice not to have to do it and to have a more targeted approach.”

He added: “We don’t have enough home grown nurses, but we know the demographics. The health service has to figure out what resources are needed for our activity.”

“We need proper planning; I think the people at Health Education England are doing that now.  At least doing it now means avoiding having to do this in the years to come.”

Nursing experts fear that shortages could be fuelled in the coming years by retirement among the baby-boomer generation, and limits on the number of skilled workers from outside the EU who are allowed into the UK.

Last month, NHS Employers issued guidance to trusts on how to plan successful international recruitment.

Addenbrooke’s believes it costs £3,000 to recruit each nurse from elsewhere in the EU. New arrivals are given their first month’s accommodation and also £400, so long as they stay for 18 months.

They are also sent on a language course if they need to boost their conversational skills in English – as well as being given 10 weeks of support in the hospital to help their technical and clinical language.

The Cambridge hospital believes the big recruitment drive is paying off, because it is now using fewer temporary staff from agencies.

But there have been concerns that some overseas nurses leave the UK after just a short period here.

Commenting on the need for more UK training, the head of the Royal College of Nursing, Dr Peter Carter, said: “Last year there were 57,000 applicants for 20,000 nurse training posts.

“Isn’t that a matter of huge regret that you’ve got people in the four countries of the UK who want to train as nurses. They’re being turned away, while we’re going off and raiding the often impoverished workforce of other countries.”

He added: “It’s hugely regrettable and the UK is not exactly covering itself in glory in this.”

IVF- guide to effectiveness

In July 1978 Louise Brown was hailed as the world’s first “test-tube baby”, born through the fertility treatment IVF.

In July 1978 Louise Brown was hailed as the world's first "test-tube baby", born through the fertility treatment IVFBut how has IVF effectiveness improved compared with modern IVF procedures?

Louise’s birth was cloaked in secrecy. Even her father John’s first visit to see her in Oldham General Hospital was under the eye of police officers, who lined the corridor outside.

She was the first to be born through in-vitro fertilisation (IVF), a process in which an egg is removed from the woman’s ovaries and fertilised with sperm in a laboratory, before being implanted into the uterus.

It is a treatment used to enable couples with a range of fertility problems to conceive a child, and now allows same sex couples and single mothers to have children too.

Technological advancements mean – according to 2013 estimates – more than five million people worldwide have been born through IVF.

But in 1978 it was highly experimental, and Dr Mike Macnamee, chief executive at the world’s first IVF clinic – Bourn Hall in Cambridge – believes Louise “really was a miracle”.

The two men who pioneered the treatment – gynaecologist Patrick Steptoe and Nobel Prize-winning physiologist Robert Edwards – “had gone through hundreds of embryo transfers before Louise was conceived”, he adds.

The pair had joined forces a full 10 years earlier, with skills that perfectly complemented one another – Edwards having developed a way to fertilise human eggs within the laboratory and Steptoe having devised a method for obtaining the eggs from the ovaries.

When Louise’s mother Lesley was put in contact with Steptoe by her doctor, she was warned there was a “one in a million” chance of success.

So when it worked, it was such a momentous scientific advancement that the birth had to be filmed – under agreement with the government – to give documented evidence that Louise was indeed her mother’s.

This is a far cry from modern procedures, which – owing much to the work of Bourn Hall in the 1980s – follow a refined and well established clinical process.

“Once Steptoe and Edwards worked out how to fertilise the egg, they very soon wanted to restrict the number of embryos they transferred into women – so they didn’t have too many multiple births,” Dr Macnamee explains.

“Development of the freezing technique in the mid-80s meant they could implant one or two embryos into the would-be mother and then freeze other embryos for future use, saving her the uncomfortable procedure of having the eggs removed again.”

Progress can also be seen in the modern use of ultrasound imaging to harvest the eggs under a mild sedation, rather than the form of keyhole surgery known as laparoscopy that was previously employed.

Techniques developed in the late 1980s also made a big difference in treating male infertility by injecting single sperm directly into the egg.

These, and other, small incremental steps mean the success rate for each round of IVF has grown from 10% to 40% since the early 80s, when Dr Macnamee’s first role included the hands-on task of mixing the eggs and sperm in a petri dish.

The chances of successfully conceiving through IVF decline with age, but the process is now more effective per cycle than natural reproduction. It does not, however, have approval from all quarters.

Dr Macnamee thinks the chances of women conceiving through IVF will only increase in future – and says he hopes to see a 60% success rate in IVF cycles before he retires.

One prominent area of research is aimed at exploring the way in which embryos interact with the lining of the womb when they are implanted.

Many believe it is when the two fail to engage with each other that the IVF cycle can prove unsuccessful.

Progress is slow – as there is no model to undertake tests in the lab – but Dr Macnamee believes this line of research could be key. “If we understand that better, it’d be the next big breakthrough,” he says.

NHS negligence bill tops £1 billion

The NHS in England paid out over £1.1 billion in 2014/15 to lawyers and to patients who suffered harm.

The NHS in England paid out over £1.1 billion in 2014/15 to lawyers and to patients who suffered harmThis coming year it will be £1.4 billion, said the NHS Litigation Authority. The body said it would work with other parts of the NHS to reduce costs and improve safety and learning.

Chief executive officer Helen Vernon said: ”Negligence claims place increasing pressure on the health service, frontline staff, our members and ultimately patients.

“It is one area of the NHS where no one would argue against a reduction.”

The NHS in England has seen an increase in costs associated with clinical negligence claims in recent years, although the figure last year was slightly higher at £1.192 billion.

The authority said in its annual report that several factors were involved, including an increase in the number of patients being treated on the NHS.

It also said there was an increase in the number of reported incidents, although this could be due in part to a positive reporting culture.

The Medical Defence Union, which provides medical indemnity to doctors, said the money paid out by the NHS to compensate patients could have funded over eight million MRI scans.

Dr Michael Devlin, head of professional standards and liaison, said: “The cost of care is the main reason for the staggering negligence bill.”

“The money paid is no reflection on clinical standards, which remain high, but it reflects the unsustainable cost of private sector health and social care packages.”

“We have to stop money haemorrhaging out of the NHS in compensation awards. Today’s figures only accentuate the need for a complete rethink of personal injury law.”

Last month, the government said it intended to put strict limits on the “excessive fees” some lawyers claim in medical negligence cases against the NHS in England.

Officials have called for a defined limit on legal costs in cases where the claims are below £100,000, saying that some lawyers submit bills that charge more than patients receive in compensation.

Solicitors have warned the move could deny patients access to justice.