Portuguese nurses Pedro and Ines Goncalves (no relation) were hired by Queen Elizabeth hospital in King’s Lynn, after failing to find work at home. Photograph: Fabio de Paola
As Ines Goncalves begins her 12-hour shift at Queen Elizabeth hospital in King's Lynn, she looks back over the year she has worked at the Norfolk hospital's stroke unit. "It's quite different from Portugal, the culture and the people. But I'm enjoying it," says the 23-year-old nurse from Lisbon.
After graduating last year she was unemployed for five months before signing up with a recruitment agency who found her work in the UK. And she is not the only Portuguese nurse on her ward."At the moment there are six or seven," she says.
Unable to attract enough applications from domestic nurses, Queen Elizabeth hospital NHS trust launched a major recruitment services drive in Portugal in 2010. It followed one in Spain a year earlier. While many of the Spanish nurses who arrived struggled to settle and have returned home, the 65 Portuguese nurses have fared better, helped by the area's already strong Portuguese community, where many migrants work in agricultural and food processing industries.
Jacqui Bate, director of human resources at the trust, says: "We decided to recruit from abroad because we were getting insufficient response to our job adverts from potential candidates in this country."
Queen Elizabeth hospital is not alone in recruiting heavily from the Iberian peninsula. Faced with a shortage of nurses across acute departments such as cardiac, stroke and accident and emergency, many hospitals have looked to southern Europe to fill vacancies. Northampton general hospital brought in 40 nurses from Portugal, Spain and Italy earlier this year. In Cambridgeshire, Hinchingbrooke healthcare NHS trust last year sent six senior nurses and HR managers on a recruitment drive to Madrid and hired 25 Spanish nurses.
Iberian recruitment
Society Guardian has learned that the number of nurses from Portugal and Spain registering to work in the UK has increased 15-fold in the last four years. Between 1 December 2010 and 30 November 2011, 536 nurses from Portugal and 431 from Spain joined the Nursing and Midwifery Council (NMC) register. That compares with only 32 and 31 respectively between 1 December 2006 and 30 November 2007.
While they number only a fraction of the 600,000 nurses registered with the NMC, these Iberian nurses represent the latest wave of immigrants to prop up the NHS.Britain's reliance on healthcare professionals from overseas began in the 1950s and hospitals have recruited foreign nurses and doctors ever since, initially from Australia, New Zealand, India, Pakistan, South Africa and the West Indies.
In recent years, overseas recruitment has shifted towards Europe, underpinned by the principle of "mutual recognition" of medical qualifications between EU member states that allows nurses from EU countries to register for work in the UK without having to undergo other competency checks.
Most employers insist that applicants have a good level of English. But the new reliance on nurses for whom English is a second language has raised concerns about their ability to talk to patients.
In October, the House of Lords recommended that regulatory bodies should be allowed to test the language skills of EU-trained nurses and midwives.
"Nurses and midwives who trained outside the UK enrich the diversity of healthcare services delivered across the UK. However, being able to effectively communicate with patients and colleagues is fundamental to delivering care that is safe," says Professor Dickon Weir-Hughes, chief executive and registrar of the Nursing and Midwifery Council .
In Norfolk, Queen Elizabeth hospital has set up language classes to help foreign nurses learn local colloquialisms , such as "blar" (to cry) and "hull up" (to vomit).
"Many of the terms for body parts, illnesses and bodily functions don't feature in the average English language class but are absolutely necessary for nurses to understand," explains Bate.
The sudden availability of vast numbers of young graduate nurses from Spain and Portugal has been driven by massive public sector cuts amid the eurozone debt crisis. In Catalonia, for example, the healthcare budget was this year cut by 10% in a bid to save 1bn euros, and hospitals have already begun to close.
Alina Souza, technical adviser for the Spanish General Nursing Council, says graduates are having to wait two years before they can get a hospital placement and the employment crisis has been made worse by the private sector recruiting cheap nurses from Ecuador and Colombia.
Many Spanish nurses are attracted to working in the UK, says Souza, because they "have proper contracts, not just work for a day or two days," and the training opportunities are better. "They can come to the UK and, say, in half a year get a midwifery certificate, and then come back to Spain as a specialist. It's very hard to get into a specialist programme here."
It is a similar story in Portgual where many nurses have to hold down two or three jobs to make a living, says Goncalves. "Contracts are very short and there is not a lot of career progression. I would earn maybe 900 euros a month, maximum, in a public hospital. Here it's about £1,600."
Professor Jim Buchan, who specialises in healthcare HR at Queen Margaret University in Edinburgh, believes there will no let-up in inward migration services as the EU austerity measures continue to bite.
"The factors pushing nurses in Spain and Portugal to the UK are likely to continue at least for another couple of years. They are looking to make the move and there's nothing to stop them," he says.
While hundreds of nurses are being brought over in recruitment campaigns, Buchan says large numbers will be applying for jobs directly from home – or booking a cheap flight and chancing their luck.
But with austerity measures starting to hit British hospitals, many more could find themselves working in private care homes rather than hospitals. A recent internal NHS workforce analysis, showed a net fall of 3,647 nurses between May 2010 and July 2011 as hospitals begin to make cuts.
Barchester, which runs more than 200 nursing homes, has recruited dozens of nurses in Portugal this year. "There has been a notable increase in the interest we've had from Spanish and Portuguese nurses," says Hayley Senior, a Barchester spokeswoman. "They are keen to work for us, especially as job opportunities are dwindling in their respective countries."
Earlier this year, Peter Carter, Royal College of Nursing chief executive, , added his voice to increasing concerns about new nurses lacking the basic care skills required to provide the standard of care that patients expect.
Ricardo Magalhães, who runs Reach Health Recruitment, supplies Portuguese nurses for a major care home company in the UK. He claims they are better equipped to provide the basic nursing care than British nurses. "In Portugal it's a standard part of their graduation that they have to have learned the basic things, like feeding, bathing and lifting," he says.
Pedro Goncalves, who works alongside Ines, but is no relation to his colleague at King's Lynn's stroke unit, is determined to make a success of his new life. "I came [through a recruitment drive last December] without knowing anyone, which was difficult," says the 25-year-old nurse. "But I didn't even try to find a job in Portugal because there are so few."
