Nurses exodus

The NHS answer to Britain's shortage of nurses has been, in part, to lure them from other countries. But the impact on some "donor" countries has been devastating.

7000 nurses arrived from the Philippines last year, tempted by much higher wages, but as a result the South East Asian country is now facing a dearth of trained staff.

For many this is a classic example of a richer nation exploiting the poverty of a much poorer one.

Now officials in the Philippines want next months meeting of the World Trade Organisation in Mexico to agree new rules limiting the movement of skilled workers between states.

Clive Myrie reported.

CLIVE MYRIE:
This is Manila, a study in contrasts. The 'haves' seem to have it all. The 'have nots' have very little. A select few can buy what they see, for others the road to riches leads far from home.

How long have you lived in this area?

CONRADO ROSARIO:
Twenty-eight years.

MYRIE:
And your children grew up in this area? This is their home?

ROSARIO:
Yes.

MYRIE:
Conrado Rosario is not a wealthy man. His home, in the working class suburb of Balara. His daughter Sherelyn had always dreamed of leaving the village. Her parents were understanding, becoming a nurse was her way out, her ticket to a better life.

EVELINA ROSARIO:
I was happy because I know her dreams were fulfilled. The work abroad, to have a greener pasture, and to be able to help her other brothers and sisters, as well as our family, financially.

MYRIE:
How did you feel when your daughter said she wanted to leave the Philippines, wanted to work abroad?

ROSARIO(TRANSLATION):
We Filipino are clans, we want our children, our kids, to be with us, but for common denomination, earning something for the pocket and for the future, especially in our case. We are already in the sunset (of our lives).

EVELINA ROSARIO:
We love her, we want her to stay with us, but because we cannot provide for what she wants, for her future, we have to let her go. To work in another place, to serve other people.

MYRIE:
The lure of relatively high wages overseas means this country's medical schools are churning out nurses with little interest in using their talent here.

UNNAMED GIRL:
Frankly, I would still be writing abroad because I heard that there are more opportunities there than we have here.

MYRIE:
More opportunities, more money?

UNNAMED GIRL:
Yes, I can say!

UNNAMED GIRL TWO:
I just want to work abroad.

MYRIE:
You want to work abroad? Where would you like to go?

UNNAMED GIRL TWO:
Somewhere outside the country. I want to earn money.

UNNAMED GIRL THREE:
Here, the salary is too small. Other than abroad.

MYRIE:
So the money is an important thing for you?

UNNAMED GIRL THREE:
Yes. I want to help my parents.

MYRIE:
The Philippines is haemorrhaging nurses at a rate it simply cannot sustain. Every year, thousands leave nursing colleges with the right skills and qualifications, but decide to work abroad, mainly in America and the UK.

Britain has been criticised for not attracting enough home-grown talent by paying higher wages. Nevertheless, the money is good enough for the people here.

The migration of talent is becoming so acute some here predict the collapse of the Philippines health system within five years. Their loss is the rest of the world's gain. Officially in 2001, more than 13,500 nurses left the Philippines. The true figure is thought to be double that. More than 7,000 came to Britain. Most of the rest ended up in the US, Saudi Arabia and Ireland. And it's not hard to see why. Nurses in the Philippines earn a basic monthly salary of 8,500 pesos, just over £100. In the UK, the figure is 14 times that.

It's mid-afternoon at the local memorial hospital. Last year, more than half the nurses working here, Sixty in all, resigned and moved to the UK. The hospital couldn't find experienced replacements fast enough. It's had to take on staff barely out of nursing college.

DOCTOR JAIME GALVEZ TAN:
The ones who are leaving are the high calibre nurses. The more experienced ones, those who have had years of intensive care, anaesthesia for the emergency room. They're the ones leaving us. If you get new nurses, you have to retrain them. It takes time. Therefore, there will be a gap in the delivery of quality services for nurses.

MYRIE:
But many colleges pride themselves on preparing Filipinos for a life overseas.

There is no shortage of takers for the lessons here. Today, how to understand Canadians. It all helps. Softening the jolt so many Filipinos must feel starting a new life in a new land.

The bosses here say it's all about supply and demand.

DOCTOR PATRICK AZANZA:
I don't look at it as a brain drain. I look at it as a global economic situation. Then you realise that there's not much brain drain at all. You develop new talents locally, and these people serving the other countries are also serving the country by sending whatever income they get from abroad.

DOCTOR TAN:
The national government's attitude is that this is macro economics. We need the $8 billion being sent by overseas Filipino workers to stabilise our economy. They're a big contribution. But what is unseen is already the help. The help is already under-funded in the Philippines. While we keep on ringing the bell about this situation, it is the macro economics that work.

ROSARIO:
It is my dream house.

MYRIE:
Rosario is grateful for the money his daughter sends back from the UK. Not only has her dream of working abroad come true, her parents' wishes are being realised as well.

You say it is your dream home. If your daughter was not sending money back every month, would you be able to have this dream home?

ROSARIO:
No. I would be contented with my own house.

MYRIE:
Many a dwelling has been built here with money earned abroad. On this little street, there are at least three families with relatives working overseas. For the Rosarios, the extra income is literally life-saving.

EVELINA ROSARIO:
Regularly every month. Regularly for his medicines.

ROSARIO:
Medication. I'm sick with hypertension, high blood. I was operated by angioplasty, on the prostate glands.

MRYIE:
That money helps you?

ROSARIO:
Yes. It helps support us.

MYRIE:
Leave Manila. The big cities. The traffic and noise. Take the drive to the country. That's where you'll find a health service on its knees.

Rural areas have always had a problem attracting enough nurses. Towns and cities with better job opportunities and more of a magnet for healthcare professionals. So imagine the problems caused when recruitment teams acting on behalf of UK hospitals round up whole units of nurses, luring away the entire work force of an intensive care unit, for example, from hospitals already struggling to cope.

A stroke victim arrives at the Bulacan Provincial Hospital. Finally, someone comes to help. It's the hospital's security guard. The sick woman's husband had to wheel her to the nearest ward. Relatives of other patients helping move her to a bed. It's several more minutes before a nurse appears. They're chronically understaffed here.

MERCEDETAS TIONGSOU:
We teach them how to take care of the patient also. For us, to be helped by these relatives. We allow some relatives to stay with the patient.

MYRIE:
So you offer a limited amount of training to the relatives of patients so that they can look after their loved ones?

TIONGSOU:
Yes.

MYRIE:
Just imagine being a doctor in a hospital like this.

DOCTOR HJORDIS CELIS:
There's only one nurse on duty in this ward. We have about fifty patients in this ward.

MYRIE:
With one nurse?

CELIS:
With one nurse, yes.

MYRIE:
Dr Celis has worked here for six years. It hasn't been easy.

Would you consider going to the UK?

CELIS:
Me? No. Even when I was a student, I decided I'm staying. I believe I'm needed here. There has been opportunities that I may be able to leave...

MYRIE:
You have never taken them?

CELIS:
No. I feel a calling for me to be here.

MYRIE:
The poor conditions and pay here make some realise they're needed. Others want to cut and run.

Bizarrely, many doctors are retraining to become nurses to work abroad and make more money than they can here. Dr Gener Angeles is one of some 2,000 physicians in the Philippines who are trying to change profession.

DOCTOR GENER ANGELES:
I have classmates who are dentists, physical therapists, medical technologists, pharmacists. Everybody in the health profession seems to be jumping at the boat of nursing opportunities. Everybody is into nursing...

MYRIE:
As a way to make decent money?

ANGELES:
Yes, as a way to get out and earn bigger bucks.

MYRIE:
What about people who would say you are running out on your country, you have all this talent as a doctor and you'll take it away?

ANGELES:
Much as I want to stay and be of service to our countrymen... But we have our own lives to focus on. We have a future to make good. So I think I have reached my peak as a doctor here. I know and I believe I can reach higher. So if I cannot do it as a doctor because of the economy here, then I can do it as a nurse abroad.

MYRIE:
The government understands it cannot stop citizens leaving the country, but the price being paid is obvious. Leaders here want the World Trade Organisation, which will be meeting soon in Cancun, Mexico, to regulate the flow of skilled workers between countries.

TEOFISTIO GUINGONA:
For the short term, we will miss them, but we can't avoid that. They're entitled to their own future in the meantime. In the Cancun conference, which will centre on services of the unskilled services, which can certainly be availed of anywhere. But the skilled ones should be graduated and categorised.

MYRIE:
A migrating work force leaving a country that values its services, but can't pay. It's a dilemma facing many developing nations, a problem exploited by the richer ones. The damage this leaves behind in countries like the Philippines may have to get worse before rich and poor alike do something about it.

This transcript was produced from the teletext subtitles that are generated live for Newsnight. It has been checked against the programme as broadcast, however Newsnight can accept no responsibility for any factual inaccuracies. We will be happy to correct serious errors.