Investigating the working conditions of Filipino and Indian-born nurses in the UK

Abstract

Situated within the framework of the ILO’s Decent Work Across Borders Project, this study is primarily intended to investigate the recruitment experiences and the working conditions of migrant workers in the health sector. In particular, this study explores the experiences of Filipino-born and Indian-born nurses in the United Kingdom (UK). The objective is to understand the intersections between the institutional framework, which has evolved across time in response to changes in the political and economic priorities, and the work experience of the Internationally Recruited Nurses (IRNs). The review of policy documentation and literature in the field is combined with interviews with 13 key informants who were identified among trade unions, professional unions, employers association, immigrant associations and governmental bodies. An on-line survey was also developed to hear from IRNs working in the UK; a total of 433 valid questionnaires were collected from March to June 2013. Information and data collected during the fieldwork indicate a positive relation between satisfaction about recruitment experiences, motivations and working conditions of nurses. Respondents hired directly by the NHS tend to report more positive assessments than other respondents and especially compared with the ones recruited by private agencies to work in care and nursing homes. The recruitment process is only one factor influencing IRNs’ working conditions, however. Changes in the situation of IRNs must be interpreted within the wider leverage of working conditions of healthcare workforce stemming from the economic crisis and consequential cuts in NHS funding starting in 2008 as recent surveys in the UK and in Europe demonstrate. Concerns about losing the job are common among nurses in the UK. IRNs interviewed in our survey also reported concerns; only 1 in 10 of them considers that job security has increased over the years. Many also feel operating in increasing unsafe working conditions. Most of the respondents arrived in the UK before 2006 as the result of NHS expansion and have therefore been witnessing cuts in NHS funding and structural reforms of the whole public health sector started after that period. Overall, empirical evidence suggest that the easiest way for employers to deal with funding cuts in the public health sector has been reducing the personnel and intensifying work shifts and workloads. IRNs seem to be in a vulnerable position to such pressure. Changes in immigration rules, cuts in NHS funding and the progressive privatization of the health care system in the UK combine and shape employers’ utilization of migrant health workers in ways that may increase risks of unequal treatment in the workplace. A substantial proportion of IRNs who participated in our survey reported lacking professional and career prospects, their professional identity not adequately recognized and valued by the manager and lacking cooperation and solidarity from colleagues in the team. These feelings correlate with what IRNs reported about equality issues in the workplace – i.e. unequal treatment and discrimination in the workplace driven by ethnic considerations. The consequences of such a situation are not limited to the working conditions of the IRNs but also extend to the quality of care as demonstrated by the correlation between disappointment reported by respondents about their working conditions and the quality of care they are able to provide to patients. Results of the fieldwork indicate a significant relation between the worsening of working conditions, experiences of ethnic discrimination and unequal treatment in the workplace. Empirical evidence also suggest that differences between IRNs in terms of working conditions significantly cut across issues of access to opportunities, equality and diversity management in the workplace. Finally, differences in working conditions reflect different IRNs’ orientations towards the UK labour market. Namely, disappointment about working conditions combined with a general feeling of uncertainty about the future in the UK turned out to be an important factor in influencing the decision of many IRNs interviewed of leaving the UK.