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How to engage more foreign nurses in health politics: history, language and solidarity

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I have been to a fair few healthcare demonstrations over the last few years – supporting the causes that have aggrieved nurses, doctors and other healthcare professionals.

Often, the whole thing is friendly, and sometimes you have time to chat to other people as the march goes along. However what is always striking to me is the difference between the crowd of participants and the clinical environment in which I have worked: on the rallies and demonstrations I don’t meet many nurses from abroad. I just don’t. I have no obvious statistics at hand to back this up – studies on political participation (although there are some available) – and so what I say is wholly anecdotal. But the possible lack of engagement with foreign nurses concerns me somewhat. And as someone concerned by health care politics in general, things need to change.

Could my rather flimsy story be contradicted? Many marchers/protestors at recent events have union affiliation. The RCN, the biggest health union boasts about 432,000 members. However, how many of these are active, foreign nurses is quite hard to work out (although I have asked the RCN this and am awaiting their reply). The nursing union offers student nurses and retired nurses membership, as well as nurses already on the NMC register. UNISON has around half a million healthcare members but this includes professionals other than nurses. If we look at some statistics concerning overall trade union membership, the overall of proportion of members (for any trade union) aged over 50 has increased. “Those employees with ten or more years of service make up about 52.5% of all union members but only 30.5% of all employees,” says a study by the Department of Business, Energy and Industrial Strategy. So we can hazard that there are quite a few union members close to retirement, or already retired. To extrapolate, it is unlikely that many older foreign nurses would come from the UK looking for work when close to retirement. The profile of migrants to the UK within relatively recent times, is one of younger people looking for work. Thus by making some deductive leaps, (ones needing further substantiation), it is likely that many of those foreign nurses that come to the UK are not and remain outside unions.

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But it is possible that we are looking at this from the wrong angle: just because a professional is not attached to a trade union it does not mean that they are not politically engaged. Besides – being a member of a trade union does not necessarily imply that you are active within it. However, when it comes to building a mass movement of healthcare staff to effect change the support of many foreign nurses would be useful, considering the changing demographics of the NHS. The figures behind the oncoming shortage of nurses caused by Brexit, poor working conditions and nurses retiring do not need restating here. If we want a better NHS then foreign nurses need to be part of that process. I enjoy the knockabout conversations on Twitter and other social media – healthcare politics is active and vibrant there – stimulated by tough work in desperate and dire conditions. But not only is social media an echo chamber of political activity, it is predominantly on such mediums, particularly Twitter, that the voices seem white and middle class.

So let us return to where we began – how to engage more foreign nurses with healthcare politics. I know from experience that settling in a foreign country makes you feel unable to upset the Status Quo. But beyond my own rather privileged experiences of migration – the implicit racism and xenophobia that has crept into mainstream political discourse can be quite frightening. It is important then to share an inclusive narrative of the NHS’ history. In an article last Summer, Sasha Scambler highlighted migrants’ legacy on the NHS.

 The unexpected success of the NHS and the rise in demand in the first years after its launch led to recruitment campaigns in 1949 which saw thousands more migrant nurses arriving in Britain predominantly from the Caribbean  […] by 1957 12% of NHS doctors were mainly overseas trained, with the majority being Jewish or central European refugees from WW2.

The success story of the NHS is one that could not exist without migration. The stories of many of these people need to be told, and receive public attention. Healthcare is an emotional business, and requires emotive story-telling that relates to present circumstances.

However, story-telling is not enough. Even if the present pressures on foreign nurses were eased – nursing will always be a hard job that requires a great deal of energy – both mental and physical. The working language of the NHS is English. But campaign groups need to be aware that for staff whose English is not native, continually operating in a non-native language is tiring. There is absolutely no reason that activists and campaigners cannot produce healthcare politics news in simple English (politics has jargon enough). Content could event be produced in other languages that reflect the diversity of staff. Politics is not just work, but also free-time and our life outside work. The content that is produced needs to be something picked up and read easily – on a smartphone on the train home or on a break at work. The accessibility of Nursing Notes content, for instance, is very good.

To change how our health service is run will involve nurses and healthcare assistants, who exist as the single biggest group of  NHS employees. For too long healthcare politics has though well-meaning, not appreciated fully who its workforces consist of. Even if it fails in this specific task, by making healthcare politics more accessible and emotionally relevant, campaign groups can bring more people from all walks of life over to their side. A good healthcare service is open to everyone, and defending it requires solidarity with all its workers regardless of where they’re from.

Opinion

‘Student nurses graduate with £54k of debt, shouldn’t we pay them a wage instead?’

The Government claims students are “supernumerary” and “not contracted to provide nursing care”.

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student nurses walking

Student nurses are the unseen workforce and vital to patient care.

While I am pleased for the thousands of students who will soon be starting their journey to become a registered nurse, it comes with a stark reminder.

In November 2015, ministers announced the NHS Student Bursary and tuition fee payment would be cut in a plan to increase the number of available student places.

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Suffice to say, this hasn’t worked.

Instead, we have seen a consistent decline in the number of student nurses qualifying. Official figures from the Universities and Colleges Admissions Service (UCAS) show an overall decline in applications of 8% since 2015.

There is no debate that nurses need to be degree-level educated – but are student loans the best way to fill an ever-widing gap in our workforce?

The unseen workforce.

Student nurses are the unseen workforce and are sometimes vital to the delivery of safe, compassionate, person-centered care.

Completing over two-thousand hours of hand-on, direct clinical practice over three years – is it fair to ask them to accumulate up to £54,582 (plus 6.3% annual interest) of debt?

With a starting salary of £24,214, this is a debt the majority of nurses will never pay off.

The Government claims that because student nurses are “supernumerary” and “not contracted to provide nursing care” they need to be treated like all other higher education students.

While is it true that the Nursing and Midwifery Council (NMC) mandates that student nurses are considered ‘supernumerary’ – how realistic is this expectation? We hear stories of student nurses, trainee nursing associates and healthcare support workers being used to fill nurse staffing gaps on an almost daily basis.

A self-perpetuating cycle.

With an estimated 40,000 unfilled nursing vacancies in the NHS alone, health and social care services in England are stuck in a self-perpetuating cycle.

Chronic under-investment in services has led to an increased demand on staff and subsequently affected recruitment and retention rates. Universities then fail to recruit enough nurses to meet the current demand and so the cycle continues.

The Royal College of Nursing has called on the Government to invest at least £1b per year into nursing education and come up with a long-term plan after its plan to increase numbers has failed to work.

Matching the proposed apprentice wage while student nurses are on placement would go some way towards alleviating the financial burden the government has placed on student nurses.

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Opinion

A fresh start?

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RCN Congress

I’m excited and I’m nervous. I qualified as a nurse just 15 months ago. I left a career in IT of “quite a few years” – I decided I needed a fresh start.

Now I’m sat on a train heading to my first ever RCN Congress. I’m a voting delegate and will be honoured to carry that responsibility for my branch.

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I’m also excited to finally be meeting people that I’ve solely (or mostly) only ever connected with online.

Finally, I’m looking forward to the various debates and resolutions. Listening to the speakers will further inform my views and I might even share a thought or two myself – fortunately speaking in public does not generally worry me (I’ll be the one with the ukulele).

A brief glance back to this time last year when certain “irregularities” were noticed by some members around the pay deal and communications regarding it.

The train of events that followed uncovered a number of poor practices regarding transparency and accountability and our current council were elected to address these.

I also mentioned I am nervous.

Recently, it has become clear that further “irregularities” have occurred – and questions will be asked.

Tomorrow morning is the Royal College of Nursing’s Annual General Meeting – an opportunity for members to ask questions. An opportunity for the council to demonstrate its commitment to openness, transparency, and accountability. An opportunity for a fresh start.

I genuinely hope the answers to the questions I raise are clear and dispel the concerns many of us have.

And if they don’t? Well, that’s why I’m nervous.

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