Overseas Nurses Guide

A guide for nurses fromoverseas working in the UK

UNISON THE UNION FOR NURSES, MIDWIVES AND HEALTHCARE STAFF

REVISED AUGUST 2004

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CONTENTS

Foreword 4

Introduction 5

Background 5

The need for international recruitment 6

Table – number of overseas registrations 7

Ethical recruitment from overseas 7

Treatment of overseas nurses 8

UNISON’s campaigning 9

Recruitment of overseas nurses 9

Use of agencies 9

Work permits 10

Working extra hours 11

Student visas 11

Refugee and asylum status 12

Registering as a nurse in the UK 13

Supervised practice/adaptation 14

Grading 15

English Language Tests 16

European Union accession countries 16

Map of the new European Union 17

Pre-deployment orientation and induction 17

Airfares and registration fees 19

Contract of employment 20

Unlawful, misleading and exploitative contracts 21

Financial penalties 21

Withholding documentation 22

Regulation of Independent sector 22

Advice for branches and regions 22

Organising and recruiting internationally 22

How are overseas nurses recruited? 22

Establishing links with community groups 23

Establishing networks of overseas nurses 23

Membership and recognition 23

Establishing close links with Trusts and NHS workforce confederations 23

Rescue missions 24

Post termination remedies: Unfair dismissal & constructive dismissal 24

Role of Government departments andregulatory bodies 26

International bodies 27

Useful contacts 29

Checklist for internationally recruited nurses 30

Checklist for UNISON representatives 33

Joining UNISON (Application form) 37

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FOREWORDWelcome to the latest guide from UNISON on overseas nurses working in theUK. We have produced this guide as an update to our previous publication ‘AUNISON guide for nurses from overseas working in the UK’. With nursescontinuing to arrive from overseas to the UK we know how vital internationalrecruitment has become for the NHS.

Our original overseas nurses guide was widely welcomed and recognised as avaluable tool to help support branches and internationally recruited nurses,many of whom were exposed at that time to unethical practice. Much hasbeen achieved by UNISON and the Department of Health (DoH) in tackling theearly problems. This coupled with changes in the legislation and the Nursingand Midwifery Council (NMC) has led us to undertake this review and updateour resource tool.

We hope that overseas nurses will use this as a resource to improve theirworking lives and employers will use it, as it reflects best practice andreinforces some of our joint work to date.

Finally this guide is a unique tool for branches who are approached byoverseas nurses in difficulty. We would like to express our thanks to RobertBaughan, Celestine Laporte, the NMC and Work Permits UK for their assistancein producing this guide and to all overseas nurses for truly making a positiveimpact on the NHS – we value, respect and thank you for your contribution topatient care.

If you have any comments or need to talk to somebody about your current orfuture employment we would like to hear from you.

Best wishes

Gail Adams Ann MosesHead of Nursing – UNISON Chair of UNISON Nursing Sector

UNISON OVERSEAS NURSES’ RESOURCE GUIDE

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1. INTRODUCTION1.1 This guide sets out the main issues around the recruitment of overseasnurses within the UK. It aims to provide a useful overview of theconsiderations surrounding international recruitment, both for the overseasnurses and for branch representatives. We aim to identify ways in which wecan encourage more nurses to come to the UK and show how we can maketheir employment here more enjoyable.

1.2 UNISON supports the international recruitment of nurses, though the issueraises a number of important moral and ethical dilemmas.

UNISON believes that recruitment drives should concentrate on pre-registerednurses as recruiting large numbers of fully trained nurses from developingcountries will be costly for those countries when they are left with a depletedworkforce. International candidates should be offered education and training atpre-registration level in British universities with opportunities for employmentat the point of qualifying.

2. BACKGROUND2.1 Nurses registering each year in the UK has increased four-fold. In 1999UNISON produced ‘A UNISON guide for nurses from overseas working in theUK’ and international registrations stood at just under 4,000. The figure hasrisen dramatically since then with registrations for 2002/3 standing at justunder 13,000. Around 75,000 overseas nurses approached the NMC for anapplication pack last year. Therefore, it has become even more important toset out UNISON’s aims towards nurses recruited from overseas and to offeradvice and support to the thousands of nurses entering the UK for the firsttime every year.

2.2 This guide is an update to the original document and provides overseasnurses with essential information on procedures and information. It informsUNISON branches of their role in welcoming and assisting international nursesduring their period work in the UK.

2.3 UNISON welcomes the enormous contribution that nurses recruited fromoverseas have made to the NHS and aims to ensure that all nurses are treatedfairly and equally regardless of where they were born or trained. HoweverUNISON believes the UK’s nursing recruitment and retention crisis can only bealleviated in the long-term by introducing measures to:

i) retain nurses who have already qualifiedii) encourage more nurses back into the professioniii) encourage more people into nurse training, especially those from

second-generation British-born black and Asian ethnic minorities, who are currently under-represented in the NHS.

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“UNISON has been at theforefront of campaigns tohelp promote and protectthe rights of overseasnurses coming to the UK.We are extremely proud ofour achievements, but westill have a long way to gobefore we are happy thatall internationally recruitednurses are being treatedequally and fairly.”

Gail Adams, UNISONHead of Nursing

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3. THE NEED FOR INTERNATIONALRECRUITMENT3.1 International nurse recruitment is not a new phenomenon, with Irishnurses coming to work in the UK before World War II and post-WWII largenumbers of Afro-Caribbean and Mauritian nurses. However, as the NHSbecomes increasingly dependent on their services the problem of retainingthem becomes more pertinent and with record numbers of nurses emigratingfrom the UK, a large number of well-trained, qualified nurses from countriessuch as the Philippines, who, for professional and economic reasons wished towork in the UK, were encouraged to enter the country.

3.2 Over half these internationally recruited nurses now see the UK as a long-term option and in a recent UNISON survey among 600 Filipino nurses 90%said they would recommend the NHS to a friend.

3.3 Around 30,000 nurses and midwives have arrived in the UK fromoverseas in the last two years, making up almost 50% of the newly registerednurses coming from overseas. Without them, the NHS would have a hugestruggle to work efficiently.

3.4 UNISON believes that helping internationally recruited nurses will enablethe NHS to run more effectively and provide an improved service for allpatients.

3.5 As more overseas nurses choose to stay on in the UK for longer periods,different concerns are arising, such as those around citizenship and bringingother family members, including partners and young children left at home, intothe UK.

3.6 The table on the opposite page shows the huge growth in internationalrecruitment since 1999. The Philippines continues to be the main target foroverseas nurse recruitment, though the number of nurse registrations fromthose originally trained in India has almost doubled in the last twelve monthsfrom 994 to 1833.


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Number of registrations from overseas and country of origin(Figures and table taken from the NMC)

Country 1998/99 1999/2000 2000/01 2001/02 2002/03

Philippines 52 1052 3396 7235 5594

India 30 96 289 994 1833

South Africa 599 1460 1086 2114 1480

Australia 1335 1209 1046 1342 940

Nigeria 179 208 347 432 524

Zimbabwe 52 221 382 473 493

New Zealand 527 461 393 443 292

Ghana 40 74 140 195 255

Pakistan 3 13 44 207 172

Kenya 19 29 50 155 152

Zambia 15 40 88 183 135

USA 139 168 147 122 89

Mauritius 6 15 41 62 60

West Indies 221 425 261 248 57

Malawi 1 15 45 75 57

Canada 196 130 89 79 53

Botswana 4 - 87 100 42

Malaysia 6 52 34 33 27

Singapore 13 47 48 43 25

Jordan 3 3 33 49 18

TOTAL ALL 3440 5715 8046 14,584 12,298OVERSEAS

4. ETHICAL RECRUITMENT FROMOVERSEAS4.1 UNISON welcomes the contribution that nurses from overseas have madeto our health service. International recruitment provides benefits andopportunities for all parties. It enables the overseas nurses to learn differentnursing practices and about a different culture. Likewise it provides the NHSand its employees with the opportunity to learn new skills or methods from theoverseas nurses and provides the necessary numbers to sustain an effectiveworkforce.

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4.2 UNISON maintains that international recruitment should not be seen as acheap or short-term solution to the UK’s nursing problem. Recruiting overseascan be very expensive. Costs are incurred either by contracting agencies toundertake the recruitment or by sending delegations of managers overseas.Greater emphasis must be placed upon long-term solutions such asencouraging nurses to return to practice programmes and others into theprofession. Where necessary, trusts and other employers should either provideor fund return to practice courses, for those nurses who need in order thatthey may successfully re-enter the NMC register. Health Care Assistantsshould be encouraged and funded to undertake nurse training throughsecondments.

4.3 The UK is not alone in experiencing recruitment problems. The UnitedStates, Canada, Australia and New Zealand are all experiencing similardifficulties in recruiting and retaining nurses. The worldwide shortage meansthat the UK is competing for an increasingly diminishing pool of nurses in aneconomic climate where many countries are offering lucrative financial andresidential packages.

4.4 These issues coupled with the expansion of the European Union havehighlighted the need for an international debate to identify possible solutions,without which the economic competition will only increase.

5. TREATMENT OF OVERSEAS NURSES5.1 Since publishing its first guide on the recruitment of overseas nurses,UNISON has worked with the Department of Health and a number of othergovernment departments to improve the working conditions of internationallyrecruited nurses. Although significant progress has been made within the NHS,with figures such as 90% of 600 Filipino nurses surveyed saying they wouldrecommend working in the NHS to a friend, there remain a number of issuesthat UNISON continues to campaign on.

5.2 In recent years the independent and private sectors have increasinglybeen targeting overseas nurses to meet their staffing shortages in privatehospitals, nursing and residential homes. Although there are many examplesof good practice in the private sector, there are still significant areas ofconcern remaining.

5.3 In order to prevent the indiscriminate recruitment of nurses fromcountries that can least afford it, the Department of Health, in conjunction withUNISON, has published guidelines on working with developing countries (SeeCode of Practice for NHS Employers, Department of Health, 2001). UNISONcontinues to work with the British Government and our sister unions overseasto minimise the negative effects of this practice, not least by trying to ensurethat agencies recruiting for the private sector adhere to the guidelinespublished by the Department of Health.

5.4 This states, “NHS employers should not target developing countries forrecruitment of healthcare personnel unless the government of that countryformally agrees a ‘Memorandum of Understanding’ via the Department ofHealth. In these circumstances individuals may be appointed to a structuredprogramme aimed at enhancing clinical practice in order for them to returnhome after an agreed period.”


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“The freedom ofassociation is afundamental right for allmigrant workers. Whenyou’re in an unpleasantsituation you often have todepend on others toprovide you withinformation and this iswhere UNISON comes in.Migrant workers shouldfeel able to ‘blow thewhistle’ on bad practiceand mistreatment.”

Sofi Taylor, Co-ordinatorfor Overseas NursesNetwork, Scotland

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5.5 An agency originally on the list was removed after it was found to havebeen breaking the guidelines.

5.6 Trusts are also discouraged from recruiting from developed countrieswhere the country has indicated that they do not want the UK recruiting theirhealthcare professionals, and where that country has taken similar steps toavoid recruiting from the UK.

5.7 Although these guidelines are very welcome they only cover the NHS.Agencies continue to recruit for the private sector from developing countries,even where there is no ‘Memorandum of Understanding’, such as South Africa,Ghana, Kenya, Zimbabwe and India. The Independent Healthcare Associationrecommends that independent sector employers be “aware of the sensitivitiesof targeting countries which cannot support large-scale targeted nurserecruitment”. However, these recommendations are not binding on theindependent sector and employers continue to recruit inappropriately fromthese countries.

6. UNISON’S CAMPAIGNING6.1 During the last four years UNISON has campaigned vigorously for therights of internationally recruited nurses. Through its work with theDepartment of Health and other government departments, UNISON hassucceeded in improving the working conditions, education and training ofinternationally recruited nurses. Issues of concern such as grading and thelength of supervised practice still remain and it is only by continuing tocampaign on the issues that we can ensure that all nurses, whether recruitedin the UK or from overseas, are rewarded fairly to help provide a strong healthservice.

7. RECRUITMENT OF OVERSEASNURSESUse of Agencies

7.1 When recruiting internationally, employers, both inside and outside theNHS, often use agencies. Two companies are usually involved – one based inthe UK and one in the country from where the nurses will be recruited.

7.2 Whilst many of the agencies provide a valuable service, with in-depthknowledge and local resources, some have been seen to operate in a way thathas caused concern. An agency is often the first contact an overseas nursehas with the UK and there is an enormous level of trust that is placed in theagencies.

7.3 It is often the agency that, on behalf of the employer, is responsible forobtaining work permits and for providing nurses with the terms of theircontract of employment.

7.4 The Department of Health has issued guidance on agencies in its “Codeof Practice for NHS Employers involved in the International Recruitment ofHealthcare Professionals”. This states that NHS employers should work with

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agencies that comply with the Department of Health Code of Practice anddemonstrate an understanding of the role of professional bodies and tradeunions. They should not work with agencies who charge recruitment fees tothe candidates to be considered for work in the UK, or who are in partnershipwith agencies in other countries that charge individuals a fee solely for thepurpose of a placement in the UK. These recommendations are included in theIndependent Healthcare Association’s (IHA) guidance. However, neither the DoHnor the IHA’s code is legally binding on employers from the independent andprivate sectors.

7.5 UNISON continues to hear of cases where charges have been levied onnurses by recruitment agencies. Individual countries have also taken action. InOctober 2001 the Philippine Overseas Employment Administration (POEA)issued a memorandum ordering the abolition of placement fees being chargedby recruiters in the Philippines.

7.6 The NHS London Region piloted a project whereby it recruited directlyfrom the Philippines, thus eliminating the need for an agency. Increasingly NHSrecruitment is being co-ordinated through NHS Workforce DevelopmentConfederations.

7.7 UNISON seeks to ensure that all employers operate in a way consistentwith the Department of Health’s and the IHA’s Code.

7.8 Employers should:

■ work only with commercial agencies that operate in accordance withthe codes.

■ not work with agencies that charge fees to the nurses concerned.

■ satisfy themselves that the UK commercial recruitment agencies theyuse are not in any partnership agreement with agencies in othercountries that allow fees to be charged to the nurses concerned.

■ maintain contact with unions and talk to overseas nurses to makesure no charge is levied.

Work Permits7.9 International recruitment of nurses throws up a number of considerations,not least the issues surrounding immigration procedures and work permits. Notall overseas nationals require work permits to work in the UK – informationabout who needs one can be found on the website of Work Permits UK (WPUK),www.workingintheuk.gov.uk (the body responsible for processing work permits.)

7.10 It is the employer or an authorised agent acting on behalf of anemployer and not the employee who can apply for a work permit. In order toissue a work permit WPUK has to be satisfied that:

■ there is an established UK employer. Recruitment agencies are notconsidered to be established employers and therefore cannot apply forwork permits

■ there is a genuine vacancy; one that is also open to UK residents andwhich satisfies the skills criteria of the work permits arrangements.

■ the employee meets the job criteria

■ the pay and other conditions of employment should be at least equalto those normally given to a ‘resident worker’ doing similar work


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■ the applicant and employer must be able to comply with all relevantlegislation/registration requirements of the employment

7.11 If the application has been successful the employer should send thenurse their work permit and retain a copy. The permit will detail specific termsand conditions of employment and the specific period of approval, post andlocation of the employment. This means that if an employee is made to workunder conditions different to those stated on the work permit e.g. salary orhours, there may be grounds for prosecution of the employer (please see page10 information under Work Permit UK section 7.9). If the employersubsequently wants to continue the nurse’s employment beyond the datespecified they must apply for an extension to the employee’s work permit.

7.12 After four years of continuous work permit employment, the permitholder can apply to remain indefinitely in the UK.

7.13 Nurses employed under work permits are often in a vulnerable position.It is important to remember that:

i) the employee cannot claim any state benefits

ii) the employee’s right to remain in the country is linked to their employment.

7.14 Although it is the employer who has applied for the work permit, a nurseis free to apply for alternative employment. The new employer is then requiredto apply for a new work permit. It is important that a nurse does not terminatehis/her employment until a new formal offer of employment has been reachedand a new work permit obtained, otherwise the nurse may be in breach ofHome Office regulations. Where an employer imposes a financial penalty forthe ending of a contract the nurse must consult their trade union as theseclauses may be illegal.

Working Extra Hours7.15 For many overseas nurses working in the UK, the wages that they earnare used to support their families back home. Therefore, many of these nurseswish to work additional hours to supplement their incomes, but there is oftenconfusion about the extra work a nurse can do under the terms of the workpermits.

7.16 To clarify; an employee can undertake supplementary employment tothat specified in the work permit, but only up to a maximum of 20 additionalhours per week – the work may not be obtained through a recruitment agencyand it must be of a similar grade and type to that specified in the permit.

Student Visas7.17 UNISON would advise any nurse against undertaking an adaptationprogramme on a student visa. If an employer recommends that a nurse applyfor this type of visa it could be grounds for concern about the employer.

7.18 On a student visa a nurse will have little recourse to employment law ortribunals. In addition a student visa only allows a person to work a maximumof 20 hours per week. UNISON has come across a number of members whohave been employed on student visas and have been expected to work morethan 50 hours per week, which has put the member in breach of their permitand at risk of deportation.

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7.19 Some employers who have recruited from overseas on student visashave expected the individual to work in excess of the maximum 20 hours. Thisis despite it being in breach of their work permit, nurses are aften too afraid tospeak out. This is why UNISON are lobbying the Government to plug thisloophole. Overseas nurses wishing to come to the UK for an adaptation placeshould only be issued with a work permit.

Refugee and asylum status7.20 Asylum seekers are people who have applied for protection in the UKunder the provisions of the UN Convention on the Status of Refugees, theEuropean Convention of Human Rights, or other international human rightsagreements. They are classified as asylum seekers until their asylumapplication is decided. If they are successful they are recognised as refugeesand will be granted either indefinite leave to remain (if accepted as UNConvention refugees) or exceptional leave to remain for four years if protectedby one of the other provisions of international law.

7.21 Currently asylum seekers are not usually allowed to work during the firstsix months immediately following their application, unless of course theirapplication is decided in their favour and they are granted refugee status. Arefugee is free to work and does not need special permission from the HomeOffice. A number of asylum seekers are nurses and doctors. We need todevelop methods of assessing and encouraging their career development inthe NHS. This should involve the Department of Health and the RefugeeCouncil working closely together to ensure that a valuable source ofhealthcare workers is not overlooked.

7.22 An asylum seeker can apply to the immigration authorities forpermission to work if a decision has not been made after six months. If theauthorities see no prospect in taking a decision in the near future they willnormally grant permission. Permission for an asylum seeker to work is grantedin the form of a stamp, placed on their Home Office asylum seeker identitydocument that is known as an SAL.

7.23 UNISON has made representations regarding nursing students who,although being granted asylum, have been removed from their course forfailure to comply with the Criminal Records Bureau (CRB) checks. Such checksare normal practice and are carried out on UK as well as overseas nurses.They are carried out to protect the interests of patients. However, in the caseof refugees as it is the country from which they were fleeing persecution thatwould provide the CRB with the information it seeks, it is difficult for a refugeeto comply with these checks. UNISON believes it is unfair that they should beremoved from their course on this basis.

7.24 As a result of UNISON’s lobbying, the Department of Health has agreedto recommend that where it is not possible to obtain a police check from thecountry of origin and because there will be no information on UK policerecords, it is reasonable to waive the requirements for a CRB check.

7.25 UNISON believes that as the Home Office carries out similar criminalchecks when considering applications for asylum, there is no need for theuniversities to replicate this process.

7.26 In order to be eligible for registration, a refugee or asylum seeker mustprovide the Nursing and Midwifery Council with copies of their nursing


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diploma(s) and registration documents. Without these they will be unable toapply. If a UNISON nurse has immigration problems they can obtain initial legaladvice from the union.

8. REGISTERING AS A NURSE IN THE UK8.1 In order to practice as a registered nurse in the United Kingdom anoverseas nurse must first register with the Nursing and Midwifery Council(NMC). The NMC assesses whether a nurse’s training and experience equipsthem to carry out the duties of a registered nurse within the UK. An applicantwill need to provide details of their pre-registration education and training(both theoretical and clinical) and post-registration education and practice. It isthe individual and not the employer who must apply to the NMC. The NMCcharges for this process, the current application fee for overseas nurses is£140. UNISON recomends good employers should pay this initial registrationfee as part of the adaptation.

8.2 Registration procedure for:

i) Nurses and Midwives who obtained their qualifications inside theEuropean Union:

Under European Union Directive 77/452/EC, a first level nurse trainedwithin the European Union can expect to have their application forregistration accepted without any additional training or period ofsupervised practice. Please note this does not apply to second levelnurses. A second level nurse qualification from outside the UnitedKingdom is not always accepted as a pathway to registered nurse status.

ii) Nurses and Midwives who obtained their qualifications outsidethe European Union:

The NMC states that in order to be considered for registration as a generalnurse a person must comply with the following minimum requirements:

a) They need to have undertaken a programme of education and trainingof not less than three years in length. This programme should containa balance of theoretical and practical training of not less than one-thirdtheoretical training and not less than one-half clinical/practical training.

a) The programme must have included theoretical and clinical/practicaltraining and experience in: general and specialist medicine; general andspecialist surgery; childcare and paediatrics; maternity care; mentalhealth and psychiatry; care of older people and community nursing.

a) In addition a nurse will be expected to have completed at least sixmonths continuous, post-registration training before being eligible forregistration.

8.3 When the NMC receives a completed application pack it will make adecision on whether the applicant meets its requirements. If the applicant isnot accepted for registration immediately, they may be asked either toundertake a period of additional training in the United Kingdom, or toundertake a period of supervised practice in the United Kingdom in order todevelop specified skills. The NMC will set a time period for this, which willnormally be 3 to 6 months. The NMC charge for assesing each application,currently this is £140.00.

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8.4 When a nurse is accepted for registration, they will be asked to sign aform agreeing to abide by the NMC’s Code of Professional Conduct and willneed to pay a registration fee. This is currently £129.00 for three years foroverseas nurses. UNISON recommends that employers should cover the costof registration for the first year.

8.5 Filipino midwives at present are not automatically accepted to registerand the NMC has recently been looking at issues that have arisen followingthe expansion of the European Union (see section 12, page 16 on EuropeanUnion Accession countries).

9. SUPERVISED PRACTICE/ADAPTATION9.1 It is vitally important that applicants do not start a period of supervisedpractice until their application for registration has been processed and adecision made, as the NMC is not prepared to accept the backdating ofsupervised placements and will not accept references from placements thathave been completed in this way.

9.2 The type and length of supervised practice will depend on eachapplicant’s education, training and post-registration experience. Someapplicants, for example, may be given a decision that their placement can onlybe carried out in an acute NHS Trust setting.

9.3 The placement is neither a course nor an exam. It is meant as a period ofsupport and supervision by a named mentor for a minimum period stipulatedby the NMC.

9.4 UNISON is aware that some nurses, particularly those employed in theprivate sector, have not received adequate support during the period ofsupervision. They also may be expected to undertake domestic duties such ascleaning, catering or laundry alongside providing nursing care to the residentsor patients. Some nurses have not been allowed to gain registration for morethan 18 months and in the case of one employer the NMC has removed itsapproval for supervision. Nevertheless, UNISON continues to support/representnurses where the employer continues to recruit, falsely promising supervisionfor registration.

9.5 UNISON has campaigned for national standards for supervisedprogrammes and it fully supports the decision by the NMC to take a moreactive role in monitoring the pre-registration process. The NMC has recentlyconcluded a consultation on overseas nurses and standards.

9.6 In order for a nursing home to be deemed suitable for the supervision ofoverseas nurses the NMC requires evidence that the home has beensuccessfully audited by a college of nursing and midwifery affiliated to aHigher Education Institution (HEI). This is to ensure that minimum standardsare met in relation to the supervised practice and that the potential registrantwill be supported through the process.

9.7 If a nursing home cannot become affiliated to a university or college thenit cannot offer supervised placements. In order for a home to take overseasnurses on supervised placements it should provide details of the supervisionprogramme and a list of supervisors/mentors, their PIN numbers, qualificationsand place of work details.


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9.8 The length of a supervised placement/adaptation must be carried out atthe same nursing home. It is not acceptable for a nurse to carry out differentsegments of the placement at different places.

9.9 Furthermore, once a nursing home has been accepted as a suitableprovider of supervised placements it means that placements can be carriedout at that home only. Companies that own several nursing homes and thatwish to use them all for placements should have each of the homes audited.

9.10 Each nursing home must strictly adhere to the number of adaptationstudents that the HEI states that they can take. Any increase in nurses placedover and above this number could mean that the NMC would not accept theplacement of these nurses as valid.

9.11 The NMC will not accept nurses onto the register who have completed asupervised placement at a nursing home that has not been audited andapproved. It is therefore essential that applicants check that the home wherethey would be working is acceptable to the NMC and has been audited by anHEI prior to the start of their placement. Failure to do this can result infrustration and lengthy delays to an application.

9.12 If a nurse has carried out a supervised placement at a nursing homethat has not been audited, their time served there will not count towards theirplacement time and they will need to begin that placement again once thehome becomes audited if required to do so. Nurses should therefore checkthat the home they are working in is fully accredited – a list is available on theNMC website at www.nmc-uk.org/nmc/main/Overseas/Placements.doc

9.13 The NHS has produced its own guidance on the Provision of Adaptation forNurses in the Independent and National Health Service Sectors. This reinforcesthe recommendations of the NMC. It also recommends the establishing oflearning contracts. This is an agreement between the adaptation nurses, mentorand clinical manager. The aim of the agreement is to establish clear measurablelearning outcomes that can be easily assessed. It also recommends that theperiod of supervision should normally range from three to six months.

9.14 UNISON also has concerns that nurses working within the private sectorhave limited opportunities to develop professionally and we believe that theindependent sector should be made to form stronger links with universities inorder to help nurses wishing to take specialist courses which would beavailable easily to them within the NHS.

10. GRADING10.1 UNISON believes a D grade is the level that fairly reflects the work that thenurses undertake and shows recognition of the skills and expertise that manynurses arrive with. Nurses undertaking supervised practice should be paid at thesame rate as any newly qualified nurse and to do otherwise could, we believe,discriminate against them purely on the basis of where they have come from.

10.2 The Department of Health recommends that a supervised practice nurseshould be paid at B grade or above, before they rise to D grade or above onregistration. The pay for a nurse working in the private sector during theirperiod of supervised practice ranges from the minimum wage to that of an Aor B grade nurse.

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“We in UNISON want toensure that overseasnurses get a better dealthan those that arrivedfrom the Caribbean as partof the Windrush generationof nurses. We should treatoverseas nurses with theprofessional respect theydeserve. 4 in 10 Londonnurses are now fromoverseas and as such theydeserve a louder voice innursing.”

Michael Walker, UNISONRegional Officer

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10.3 Whilst acknowledging that our view is not shared by the NMC or theDoH, UNISON believes the period of supervised practice or adaptation is theequivalent of the period of preceptorship that is advocated for registerednurses by the NMC, when a more experienced nurse provides advice andsupport to the newly registered nurse.

10.4 In addition, by allowing overseas nurses to be paid less than qualified UKnurses, it may contribute towards their exploitation as there is an economicreason for employers to delay the adaptation process. We have seen examplesof the overseas nurses adaptation programme being in place for 18 monthsbefore an employer signs the NMC declaration form for the nurse’s registrationand pin number.

10.5 Many overseas nurses arrive in the UK with a wealth of knowledge andexpertise. By grading nurses at less then grade D, UNISON believes itundervalues the incredible contribution that they are making to the NHS andpatient care.

11. ENGLISH LANGUAGE TESTS11.1 The NMC stipulates that all nurses who have trained outside the UK andare not from the European Union must demonstrate competency in the EnglishLanguage. They must achieve a score of not less than 5.5 in the individualbands and not less than 6.5 overall in the International English LanguageTesting System administered by the British Council.

11.2 It is therefore the responsibility of the employer to assess whether anurse from an EU country has a sufficient level of English to be able toperform their job effectively. UNISON therefore would encourage employers toprovide orientation programmes that can ensure that nurses have sufficientlanguage skills to work effectively in a medical environment.

12. EUROPEAN UNION ACCESSIONCOUNTRIES12.1 On 1st May 2004 10 new countries joined the European Union. Theywere: Cyprus, Hungary, Malta, Poland, Czech Republic, Estonia, Latvia,Lithuania, Slovakia and Slovenia.

12.2 This has raised a number of issues for the NMC regarding the standardsof nurse and midwifery training. There are concerns about the levels of nursetraining in three of these countries: Czech Republic, Latvia and Poland.

12.3 The NMC has been liaising with the accession countries to ensure thatnurses trained in all of the 10 countries comply with UK standards. The NMCneeds to be able to confirm that all programmes started on or after 1 May2004 meet the Nursing and Midwifery Directives. Nurses that began theirtraining prior to this date must produce evidence of practice.

12.4 The NMC is not allowed to stipulate an English language test for nursescoming to work in the UK from other EU countries in order for them to beregistered, as this would be seen to be blocking the free movement of labour.This has to be left to the employer. It is therefore employers who should


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ensure that Accession State nationals, in accordance with existing guidance,as with all EU nationals, have sufficient knowledge of English to be able towork efficiently. As is the case with all newly appointed nurses, induction ororientation programmes should be available to help support the nurses’development. This is especially important in relation to overseas nurses whoare trying to adapt to a new country, culture and different nursing practices.

12.5 UNISON believes that as the EU continues to expand, ways to helpwelcome overseas nurses in the UK must be found, including making thetransition as smooth as possible and helping the professional development ofthe nurses.

12.6 Nurses from new EU accession countries, although not required to doadaptation should still have access to some form of orientation to helpfamiliarise them with different policy and procedure, such as record keepingor the administration of medicines.

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13. PRE-DEPLOYMENT ORIENTATIONAND INDUCTION13.1 According to the Department of Health’s Code of Practice for the NHSand its Guidance on International Nursing Recruitment, overseas nurses shouldbe fully assisted during their transition to the UK. They must be made aware ofhow to find help and assistance in every aspect of their employment anddomestic arrangements.

13.2 A good induction programme should maintain contact with newemployees to ensure a smooth introduction into the organisation over a periodof time, rather than just one or two days at the outset. It should involvecolleagues and other members of staff who know the organisation well. Ideallythere should be a pre-deployment orientation (one that informs and deucates

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them of their rights) before the nurse even leaves their home country so thatthey know:

■ what will be expected of them as a nurse, including what they willneed to do to obtain their registration

■ what their rights are (including trade union rights)

■ cultural differences both inside and outside their workplace

■ variations in weather and climate.

13.3 Adjusting to a new culture can be difficult for even the most well looked-after nurses and it is essential for employers and UNISON branches to ensurethe nurses from overseas are not left feeling isolated or without any means ofredress against their employer if the situation demands it.

13.4 In many cases this does not happen. Increasingly NHS WorkforceDevelopment Confederations, rather than recruiting directly from anothercountry, are recruiting overseas nurses who are already resident in the UK andpossibly working in the private sector. In such cases they will have had noinput into any pre-deployment orientation.

13.5 It is therefore important there should be an initial welcome, greetingnewcomers at the airport if recruited directly from overseas, or some otherlocation if from within the UK. New starters should also receive information onthe following:

● the role of the nurse

● the role of the NHS and other bodies such as the NMC

● differences in nursing practice between the UK and their country of origin

● education and training needs including Post Registration Education andPractice (PREP)

● cultural differences and information

● climatic variations

● cost of living advice, assistance and guidance on accommodation. (It isUNISON’s view that trusts should provide maximum assistance in providingsuitable, affordable accommodation)

● pay - their contract and letter should already have informed them howmuch and how often they will be paid. However, they will need additionalinformation explaining how it will be paid, any enhancements (e.g. unsocialhours) they are entitled to, and any deductions

● opening a bank account

● obtaining a National Insurance number

● telephoning home

● registering with a general practitioner and dentist

● providing information relating to joining a trade union. Ensuring that recruitsare made aware of what services trade unions can provide

● information on equal opportunities policies

● local cultural, religious and social centres.

13.6 UNISON representatives should ensure that, where possible, employersinform potential recruits about all aspects of the terms and conditions of theircontract and provide details of where they will work before the nurse decides


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to leave their home country (see section on pre-deployment and induction).Once they arrive in this country branch representatives should ensure theemployer provides a full induction process.

13.7 In addition to the induction programme an education package should beavailable to assist overseas nurses in their nursing transition. Programmesshould include information on the following:

● NMC and conduct

● standards

● ethics

● cultural diversity

● health and safety

● administration of medicines

● difference in medical equipment e.g. IVAC pump and syringe drivers

● common medical terms

● consent

● governance

● structure of NHS

● appraisals and personal development systems

● education mechanisms

● National Institute for Cclinical Excellence (NICE) / Commission forHealthcare Audit and Inspection (CHAI)

● complaints handling

● EU-based practice

● career progression.

14. AIRFARES AND REGISTRATION FEES14.1 The Department of Health’s ‘Guidance on International Recruitment’states that NHS employers should pay for recruits’ airfares and that thereshould be NO agency registration costs for recruits.

14.2 The Government of the Philippines states that the employer must pay forthe airfare of nurses recruited into the UK.

14.3 UNISON also feels that there should be NO cost to individuals for supervisionor training. However, private sector contracts often do contain charges by theemployer for training and airfares. Many nurses employed in the private sector willalso have paid a large sum of money to the recruitment agency.

14.4 UNISON’s legal advice is that the payment of such fees may amount tounlawful penalties. If there is an agreement to repay these “golden handcuff”payments on termination of employment by the employee there may be anargument that these payments are acting as a restraint to deter employeesfrom seeking employment elsewhere.

14.5 The cost of three years’ registration with the NMC is currently £129 from1st August 2004. UNISON recommends that employers should cover the costof registration for the first year.

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15. CONTRACT OF EMPLOYMENT15.1 The acceptance of a job offer, whether verbally or in writing, means alegal contract has been established. If a position of employment is offered andthen withdrawn, an applicant may have grounds to claim for a breach ofcontract even if no written agreements have been exchanged.

15.2 It is important for employers when recruiting from overseas to ensurethat the applicant has a clear idea of the terms and conditions of theircontract, where they will be working and what they will be doing.

15.3 An employer is required to provide a written statement of the mainpoints of employment to a new employee within two months of the beginningof employment. However, a good employer should provide this to an overseasnurse before they leave their country of origin and when the job is initiallyoffered. Any written contract should reflect the conditions agreed upon ininitial verbal agreements.

15.4 Contracts, whether written or verbal, should indicate:

● details of employer and employee

● location of work place

● job title and description of duties

● hours of work including overtime requirements

● date when the nurse or employee started work and the period ofcontinuous employment

● scale and rate of pay, how it will be calculated and how often it will be paid

● holiday entitlement and holiday pay

● sick leave and pay

● where employment is temporary, the date on which employment ends

● details of any collective agreement negotiated by a union on behalf of staff.

● pension arrangements

● notice period

● disciplinary and grievance procedures (where there are 20 or moreemployees).

15.5 A contractual agreement may be contained in more than one document.These could include:

● written statement

● any letter sent by the employer before the nurse started work

● anything signed since starting work

● instructions, announcements on the noticeboard

● the Office Manual

● clauses in a collective agreement reached between a union and employer.

15.6 In addition a contract may include provisions that are either spoken orimplied. An example of an implied provision would be the employers’responsibility to provide a safe working environment or that the employeemust accept reasonable instructions from the employer to make the contractworkable.


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15.7 If a nurse is unhappy with the conditions of the contract it is importantto raise concerns as soon as possible, either with the employer or UNISON,because working under new conditions without complaint can be seen asgiving implied consent to the changes.

15.8 It is also important to note that a contract, even if an employee signs it,cannot take away that person’s basic legal rights. Also once agreed, a contractcannot be altered without the employee being consulted and agreeing to thechanges, the same restrictions apply to the issuing of a new contact, whichupon arrival differ significantly from the contract promised.

Unlawful, misleading and exploitative contracts15.9 The vast majority of internationally recruited nurses who come to workin the UK are extremely positive about their employment and the country.However UNISON has experience of employers who act irresponsibly, and insome case illegally, by taking advantage of the vulnerability of nurses whocome to work in a new country.

15.10 There are examples of nurses arriving in the UK to find that theirwritten contract differs significantly from the terms and conditions promised tothem in their home countries. Their new contract may contain additionalclauses relating to the charges for their training or accommodation or thenurse may discover that they will be working in a nursing home for the elderlywhen they possess skills and expertise in acute care and thought they wouldbe working in a hospital. There have also been other examples of employmentcontracts containing gagging clauses phrased to prevent or deter employeesfrom taking part in trade union activities.

15.11 Faced with unethical threats of deportation or the retention of theirpassports by their employer, nurses can find themselves in frighteningsituations.

15.12 No employer has the legal right to retain a passport – they are theproperty of the issuing government and the employee must keep hold of themthroughout their employment.

15.13 Nurses should ensure that they fully understand the provisions of theircontracts and that the contract terms are reasonable and legal. There shouldbe a genuine commitment from the employer to provide long-termemployment once the registration has been accepted. The Department ofHealth recommends a minimum two-year contract.

Financial penalties15.14 Department of Health and Independent Healthcare Association (IHA)guidelines state that trusts should cover all costs including airfares andagency fees and there should be no cost to the individual for supervision oftraining. However, some private sector employers have inserted into thecontract of employment, clauses reclaiming money for training, airfares orregistration fees. These fees can be thousands of pounds and the debts canbe a huge constraint on nurses, particularly if their salaries are already low.Other nurses have received contracts that state that these sums must be paidupon the termination of employment, which deters nurses from leaving whatcan be exploitative situations.

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Withholding documentation15.15 There have been examples of employers in the private sectorwithholding passports, birth certificates, NMC pin numbers or educationaldocuments, who will only release them upon payment of a fee. This action isillegal and employees may consider reporting their employers to the police insuch cases. A nurse is free to apply for alternative employment and the newemployer is then required to apply for another work permit.

16. REGULATION OF INDEPENDENTSECTOR16.1 The independent sector is not bound by the Department of Health’s Code ofPractice. The Independent Health Care Association has produced its own code,Supervised Practice for Internationally Qualified Nurses, IHA, 2001, detailingrecommendations when employing nurses from overseas. These include:

■ independent sector employers will not use recruitment agencies thatlevy charges to applicants

■ the supervised practice (or adaptation) nurse should be overseen by anamed and experienced registered nurse

■ employers should make no monetary charges to the employees forany adaptation placement.

16.2 UNISON welcomes these and other recommendations contained withinthe Independent Health Care Association’s Code and would like the guidelinesto become statutory in order to ensure good practice among all employers.

17. ADVICE FOR BRANCHES AND REGIONSOrganising and recruiting internationally17.1 UNISON has led the way in the recruitment and representation of nursesrecruited from overseas. This has been of benefit to the nurses themselves interms of the representation and services UNISON can provide and in providingthe nurses with the tools and confidence to help organise themselves. It hasalso assisted UNISON in terms of recruitment and cementing its position as aleading union for nurses.

17.2 The way in which overseas nurses are recruited will vary from one partof the country to another. However, there are certain steps that a branch orregion can follow to ensure that overseas nurses do not encounter too manydifficulties when coming to the UK.

How are overseas nurses recruited?17.3 The way in which overseas nurses are recruited will play a key role indetermining how a campaign is organised locally. In London, for example, therecruitment of overseas nurses was organised by the NHS on a regional basisand the UNISON Greater London Region eliminated the use of agencies byrecruiting directly from the Philippines. This enabled UNISON to have a directinput into the pre-deployment orientation and induction process and thedrawing up of the supervised practice/adaptation programme. UNISON wasable to ensure that it had access to the nurses to explain the benefits of union


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“We are not Asian Angels;we are nurses with aprofessional job to do,committed to our patientsand to our union.”

Janice Carandang,rescued nurse

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membership. However changing methods of recruiting from overseas calls fordifferent approaches. The abolition of Regional Health Authorities has changedthe way the NHS recruits overseas nurses and increasing numbers of nursesare being recruited into the private and independent sectors.

Establishing links with community groups17.4 One of the leading sources of overseas nurses has been the Philippines.UNISON has been very active in working with Filipino community groups andhas been particularly helped by the work of Father Claro Conde, a Filipinopriest who has been actively involved in assisting nurses from the Phillipinesworking in the UK and Allen Reilly, UNISON branch secretary of the FilipinoCommunity of Croydon and Coulsdon.

17.5 At a national level UNISON has developed links with the Filipino Embassy.Such links have enabled UNISON to develop a stronger understanding of Filipinoculture and values and has increased our profile within the Filipino community.This has led to Filipino nurses asking to join UNISON, whereas otherwise theymay have been unaware of what the union is able to do for them. Recent figuresindicate that India is now a leading target for international recruitment. This willpose new challenges for UNISON both in terms of establishing new links andcontacts and understanding a different set of cultural values.

Establishing networks of overseas nurses17.6 Internationally recruited nurses are likely to feel isolated when theyarrive in the country or they may be working in small groups. UNISON has arole to play developing networks of nurses, by either establishing its ownnetwork as has been the case in Scotland or through work with other localcommunity groups.

17.7 Networks provide opportunities:

■ for overseas nurses to talk to and communicate with each other

■ for UNISON to find out what their concerns are

■ to empower nurses by providing them with further training in, forexample, interview skills

■ for UNISON to recruit more members.

Membership and recognition17.8 In some situations a nurse may not belong to UNISON or any other tradeunion because they have not had the opportunity to do so. They may havebeen instructed that they will be in breach of their employment contract if theybecome involved in trade union activities.

17.9 They are likely to be vulnerable and may be unaware of the UK’s cultureof employment/industrial relations and their right to join a trade union. In suchcircumstances it is unlikely that UNISON has a recognition agreement with theemployer.

Establishing close links with Trusts and NHS WorkforceConfederations17.10 Regional and Branch UNISON officials should have close links withTrusts and their Personnel Departments. This will help in terms of therepresentation of nurses already employed by the trust and also if othernurses approach UNISON for assistance in finding new employment.

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17.11 NHS Recruitment within England is co-ordinated through WorkforceDevelopment Confederations (WDCs). These are local NHS membershiporganisations consisting of NHS Trusts, Primary Care Trusts, Health Authorities,Care and Ambulance Trusts. Regions may find it beneficial to establish closelinks with WDCs as they will be able to:

a) provide information on activities on international recruitment in your region

b) assist in finding alternative employment for internationally recruited nurses

Rescue missions17.12 UNISON has experience of a number of cases in the private sectorwhere the treatment of internationally recruited nurses has becomethreatening or abusive. The nurses may have been threatened withdeportation, made to work excessively long hours or were subjected to racialdiscrimination.

17.13 If it is clear that there is no effective way of representing members withinthe confines of the nurses’ existing contract or the situation is too extreme toleave the nurses exposed, UNISON will attempt to intervene to find alternativeemployment within the NHS and arrange for the nurses to leave their place ofwork and accommodation safely. UNISON Regional Officers need to be satisfiedthat the employer’s conduct is unacceptable and that the contracts ofemployment are irregular or breach labour laws. It is important that UNISONdoes not openly encourage nurses to break their contracts. Such activities areonly used as a last resort, when local discussion and/or procedures cannotaddress the situation; the UNISON regional office must be informed.

17.14 The rescue missions often start from meetings arranged secretly withnurses outside of their place of employment. Copies of their employmentcontracts and evidence such as “separate” duty rotas are brought along.Alternative employment for the nurses can be found either through WorkforceDevelopment Confederations or the individual trusts. The trust through theUNISON regional office can arrange interview dates and the trust carries outthe interview procedures and applies for the work permits.

17.15 The region or branch may also organise transportation to assist thenurses to move home. Often the nurses’ accommodation is tied to theiremployment. The move can be very traumatic or frightening and anyassistance in helping with transport, such as hiring a mini bus, can speed upthe process of moving and is a demonstrable and tangible way of helpingreduce fear and anxiety.

17.16 Sometimes nurses may have already run away and will be in touchwith their respective embassy. Local community associations may also help byproviding “safe housing” until UNISON can assist with settlement with a newemployer.

Post Termination Remedies17.17 UNISON strongly advises members not to resign their jobs without firstconsulting a UNISON representative as they may be in breach of Home Officeregulations. However there are some circumstances in which the member isforced to resign or dismissed before help can be sorted:


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■ Unfair Dismissal: Most employees have the right to complain ofunfair dismissal, though there are a number of exceptions which arelisted on the Department of Trade and Industry’s website atwww.dti.gov.uk. However there are a number of circumstances in whichanyone can complain of unfair dismissal regardless of age or length ofservice. These include dismissal for trade union membership, for takingtime off for dependants or for taking certain specified types of action onhealth and safety grounds among a number of others.

■ Constructive Dismissal: If a member is determined to leave theiremployment immediately, UNISON can advise them of their freedom toresign followed by the possibility of a claim of constructive dismissal. Anemployee who resigns because of conduct by his or her employer maybe shown to have been ‘constructively dismissed’. For a tribunal to rulein this way the employer’s action has to be such that it can be regardedas a significant breach of the employment contract e.g. the employeewas demoted to a lower rank or a poorer paid position.

17.18 We would not advise members to resign from their jobs withoutseeking advice. if the member intends to leave immediately regardless, theymay lose nothing by considering the possibility of a claim based onconstructive dismissal. However unfair dismissal cases are complex. AnIndustrial Tribunal would normally expect to see evidence that an applicanthad tried all possible avenues to resolve the issue and was left with noalternative but to resign. It is important that all such cases are treatedindividually and advice sought from the relevant regional officer at a minimum.Sometimes, the employer will have breached an express term in the contract(e.g. not paid the due rate for overtime) but sometimes there will be noexpress breach. In these cases, we should look to see whether the employerhas breached the implied term that the parties maintain mutual trust andconfidence. In the latter case, it is worth remembering that the claim is notthat the employer has acted unreasonably (for there is no legal duty to bereasonable) but that it has so undermined the duty to maintain trust andconfidence, that the employee had no option but to resign.

17.19 One of the difficulties with constructive dismissal is that the employeemust resign in response to the breach. If the employer breaches an express orimplied term and the employee dislikes it but nonetheless continues to work,they are taken to have affirmed the contract. In these cases, the employerwould argue that the matters about which members are complaining arematters that they have tolerated for some time so that the importantrequirement in establishing constructive dismissal – that the employeeresigned in response to the breach – is not satisfied. But where the membersare working in an oppressive environment and abusive treatment is continuousor regular, we cannot advise them to remain in employment and wait for thenext major breach before resigning. We could still claim constructive dismissalby arguing that the most recent actions of the employer came at the end of astring of similar actions and were simply the “last straw”. It would be advisableto draft a letter of resignation citing examples of abusive behaviour ormisconduct by the employer, mentioning the most recent. In most situationsthere are plenty of examples such as intimidating behaviour, threateningdeportation, withholding of passports, delayed registration, long working hoursand so on. Branches and regions should always seek legal advice whereverpossible as each case should be assessed individually.

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ROLE OF GOVERNMENT DEPARTMENTSAND REGULATORY BODIESDepartment of Health (www.dh.gov.uk)

UNISON has worked closely with the Department of Health to improve theworking conditions of overseas nurses employed in the NHS. As a result theDepartment has produced the following publications aimed at standardisingboth the terms and conditions under which the nurses are employed and theprocedures in recruiting them:

i) Guidance on international nursing recruitment, 1999ii) Code of Practice for NHS Employers, 2001iii) Guidance for the Provision of Adaptation for Nurses, 2003.

All these publications are available on the Department of Health website.

UNISON is also in discussions over how the Department of Health can assist inthe allocation of rescued nurses to NHS Trusts.

Work Permits UK (Home Office) (www.workingintheuk.gov.uk)

UNISON has had discussions with Work Permits (UK) concerning the allocationof work permits and the sanctions that may be taken against employers whoare flouting employment law. These discussions have already resulted in theremoval of work permits from unscrupulous employers. However the HomeOffice can only act if they have grounds to believe the employer or employeeis in breach of the conditions of Work Permit or UK Employment law.

If an employer is found to be operating illegally, WPUK may take action againstthem, which may result in the employees leave to remain being revoked. Anyemployee in this situation should seek UNISON or legal advice immediately.

UNISON believes that if an employer is reported to Work Permits UK, ourmembers’ interests should be protected. The employee’s right to stay in thecountry depends on their employment, but UNISON feels they should not bepenalised if they are working for an unscrupulous employer.

Nursing and Midwifery Council (www.nmc-uk.org)

It is important that suspect employers are reported to the Nursing andMidwifery Council (the professional regulatory body for nursing andmidwifery).The NMC may remove their approval for the employer to providesupervised practice, or where the nursing homeowner is a nurse they can bereported for professional misconduct. If the owner is a doctor they should bereported to the General Medical Council.

If an employer’s personal conduct is found to be inconsistent with the Code ofConduct of the NMC, it should be considered whether to report them.

Higher Education Institutions

As a means of commissioning, preparing and monitoring placements,education audits are conducted in each clinical area where students are


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placed. The auditors are Registered Nurse Teachers who are linked to HigherEducation Institutions. Concerns about the standard and content of supervisedpractice placements should be raised with Higher Education Institutions.

Care Standards Commission and Local Authorities

Local Authorities are responsible for the licensing of nursing homes, residentialcare homes and independent hospitals, while the Care Standards Commissionis responsible for their regulation and standards of care.

Department of Trade and Industry (www.dti.gov.uk)

Concerns about recruitment agencies can be raised with the EmploymentAgency Standards Inspectorate, part of the DTI.

Workforce Development Confederations

Workforce Development Confederations (WDCs) are local NHS membershiporganisations consisting of NHS Trusts, Primary Care Trusts, Health Authorities,Care and Ambulance Trusts. They enable Strategic Health Authorities to delivertheir franchise plans through:

■ planning and development of the healthcare workforce

■ working with Postgraduate Deaneries to commission education andtraining

■ managing the Department of Health Budget in training

WDCs play a key role in increasing NHS staff numbers and changing the waystaff are trained and developed. They are also responsible for developing anddisseminating improved ways of tackling problems of recruitment andretention and enhancing the working lives of staff.

INTERNATIONAL BODIESUNISON has the largest international department of any UK trade union. It isactive worldwide, assisting our international sister trade unions through arange of activities, including programmes of capacity building, twinning andestablishing links with health sector trade unions across Central and EasternEurope.

UNISON is affiliated to several international trade union organisations the mostimportant of which is Public Services International (see overleaf).

UNISON works closely with overseas trade unions, including the PhilippinesNurse Association and has formal partnership agreements with the Finland’sUnion of Health and Social Care Services (Tehy) and Spain’s ComisionesObreras (CCOO). These innovative agreements ensure that any nurse memberfrom Tehy or the CCOO has an automatic membership of UNISON. This resultsin continuity of trade union membership and direct access to support shouldthey need it.

As the biggest union in the United Kingdom, UNISON is in a powerful positionto assist our international trade secretariats and its affiliates. In addition

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UNISON has a strong voice in terms of shaping the global health and nursingagenda. UNISON has contacts within the World Health Organisation andthrough PSI holds a powerful position on the European Public Services Union.

In 1990 the United Nations General Assembly approved the Convention on theProtection of the rights of all Migrant Workers and Members of their Families.This suggests that migrant workers should be given a basic understanding ofthe language, culture, legal, social and political structures of the states towhich they are going and in a language they understand. They should also beinformed in advance of the wages and general working conditions. Neither theUK nor any EU state has signed up to the convention. UNISON believes it istime the UK set an example and signed up to the convention.

Public Services International (PSI) (www.world-psi.org)

This is an international trade union federation for public sector unions and isan officially recognised Non-Government Organisation - NGO - for the publicsector within the International Labour Organisation. It is made up from morethan 600 public service trade unions in more than 140 countries, togetherrepresenting more than 20 million public sector workers. PSI has recentlypublished a comprehensive report based on its research entitled ‘Women andInternational Migration in the Health Sector’. Copies of the report are availablefrom the PSI website.

Overseas Nurses Network(www.unison-scotland.org.uk/nhs/overseas/index.html)

Launched at the end of 2002, the Overseas Nurses Network operates inScotland and provides an opportunity for nurses and care workers fromoverseas to meet others in the same situation. It also serves as an informationpoint, a conduit for consultation, provides access to training as well asproviding a means of networking on a professional and social level.

International Council of Nurses (ICN) (www.icn.ch)

The International Council of Nurses is a federation of national nurses’associations representing nurses in more than 120 countries. Operated bynurses, the ICN works to ensure quality nursing care for all, sound healthpolicies globally, the advancement of nursing knowledge, and the presenceworldwide of a respected nursing profession and a competent and satisfiednursing workforce.


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“Without overseas nurses,the NHS would struggle towork efficiently, which iswhy it is vital that wecontinue to support andpromote their rights, andmake the UK an attractiveplace for nurses to work.”

Karen Jennings, UNISONHead of Health

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USEFUL CONTACTSUNISON Head OfficeUNISON, 1 Mabledon PlaceLondon WC1H 9AJContact: Gail Adams, Head of NursingTel: 0845 355 0845Fax: 020 7551 1101Text tel: 0800 096 7968www.unison.org.uk

Eastern RegionUNISON, Church Lane HouseChelmsford, Essex CM1 1NHTel: 0870 889 0373Fax: 01245 492 863Text tel: 01245 499 135

East MidlandsUNISON Regional CentreVivian Avenue, Nottingham NG5 1AFTel: 0115 847 5400Fax: 0115 847 5422

Greater LondonUNISON, Congress HouseGreat Russell Street London WC1 3LSContact: Michael WalkerTel: 020 7535 2100Fax: 020 7535 2105

NorthernUNISON, 140-150 Pilgrim StreetNewcastle upon Tyne NE1 6THTel: 0191 245 0800Fax: 0191 245 0899

Northern IrelandUNISON, Unit 4,Fortwilliam Business ParkDargan Road, Belfast BT3 9JZTel: 02890 770 813Fax: 02890 779 772

North WestUNISON, Arena Point, 1 Hunts BankManchester M3 1UNTel: 0161 211 1000Fax: 0161 661 6710

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ScotlandUNISON House14 West Campbell StreetGlasgow G2 6RXTel: 0870 777 7006Fax: 0141 331 1203Text tel: 0141 248 3981

South EastUNISON, Glen House, High StreetBanstead, Surrey SM7 2LHTel: 0870 770 1112Fax: 01737 733 328Text tel: 0870 777 9877Email: [email protected]

South WestUNISON House, The CrescentTaunton, Somerset TA1 4DUTel: 01823 288 031fax: 01823 336 013

Cymru/WalesUNISON, Transport House, Third Floor1 Cathedral Street, Cardiff CF11 9SBTel: 02920 398 333Fax: 02920 220 398Email: [email protected]

West Midlands

UNISON, 24 Livery StreetBirmingham B3 2PATel: 0121 685 4200Fax: 0121 685 4400Text tel: 0121 685 4410Email: [email protected]

Yorkshire & HumbersideUNISON, Commerce HouseWade Lane, Leeds LS2 8NJTel: 0113 244 9111Fax: 0113 244 8852Text tel: 0113 234 6911

SCOTTISH OVERSEAS NURSESNETWORK

Glasgow Resource Centre 2, Fitzroy Place, Glasgow G3 7RH Contact: Sofi TaylorTel: 0141 243 2119www.unison-scotland.org.uk/nhs/overseas

NHS CAREERS

This is a specialised serviceproviding information on careers inthe National Health Service (NHS) inEngland.

Tel: 0845 60 60 655www.nhscareers.nhs.uk/

FILIPINO COMMUNITY OFCOULSDON & CROYDON

113 Chipstead Valley RoadCoulsdon, Surrey CR5 3BContact: Allen ReillyEmail: [email protected]

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CHECKLIST FOR INTERNATIONALLYRECRUITED NURSESThis checklist is for overseas nurses applying to work or already working inthe UK

1. If you are interested in coming to work in the UK:

i) You should contact the Nursing and Midwifery Council to ask for an Overseas Nurse pack.

ii) Complete and return the pack to the NMC.

iii) You can look for employment in the UK, but you should not commence work until you have received an approval letter from the NMC

iiii) If a recruitment agency or an agent acting on behalf of an employer approaches you should ask the following questions:

a) Who pays for my adaptation programme?

b) Who pays for my airfare?

c) Who pays for my accommodation in the UK?

You shouldn’t have to part with any money. If asked to do so by anemployer or agent you should note that it might mean they are actingunethically or illegally.

2. Have you been asked to pay for anything other than the specified amount ofmoney for the registration fee?

■■ Yes ■■ No

3. Has your contract of employment or terms & conditions been changed from what you were led to believe they would be before starting?


4. Have you been asked to apply for a student visa to undertake youradaptation programme?


If you answered yes to one or more of the above questions you must seekadvice immediately from a UNISON representative as there is a high riskthat aspects of your contract may be illegal or you may be treatedunethically by your employer.

WORK PERMITS

5. Is the employer stated in the work permit different from your actualemployer?


6. Does the job description in the work permit differ from what you areexpected to do?



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7. Is the location of your job different to the one stated on the work permit?


8. Does the spelling of your name, date of birth or terms and conditions on thework permit differ from those shown on your passport and/or visa?


If you answered yes to one or more of questions 4-7 you should seekUNISON or legal advice immediately as you may be refused entry when youarrive in the UK or if you are already working in the UK your work permitcould be invalid.

CONTRACT OF EMPLOYMENT

You should ensure that you obtain a written contract from your employer,which should contain the following information:

■ your name and the name of your employer

■ date when you started work and the period of continuousemployment.

■ your rate of pay, how it will be calculated and how often it will bepaid.

■ hours of work.

■ holiday entitlement and holiday pay.

■ job title.

You should be made aware of your entitlement to:

■ sickness leave, pay and pensions

■ notice provisions and disciplinary procedures (where there are 20 ormore employees).

The contract should not contain any unlawful items, gagging clauses orfinancial penalties that may be imposed on you should you break yourcontract.

Airfares and registration feesUNISON suggests that you should only deal with employers who pay for yourairfare and for your initial NMC registration fee.

GradingEnsure that you are being paid at an appropriate grade. UNISON recommendsa minimum of grade D; the Department of Health recommends a minimum Bgrade.

Registration and adaptationMake sure you are familiar with the requirements to be fulfilled in order toachieve registered status as a nurse. If you are required to undergo a period ofsupervised practice or adaptation, check that the placement matches therequirements stipulated in the NMC’s letter to you and will lead to youachieving registration.

Ensure that you have a mentor who fully understands their role. (eg. Whatsupport you will need and what responsibilities they will have.)

31

13580 Doc. 25/8/04 12:02 pm Page 31

Pre-deployment orientation and inductionYou should be given pre-deployment orientation and then given an adequatelevel of induction. The deployment orientation and induction between themshould contain information on:

■ your role as a nurse

■ the role of the NHS and other bodies such as the NMC

■ differences in nursing practice between the UK and your country of origin.

■ education and training needs including PREP (Post RegistrationEducation and Practice)

■ cultural differences and information

■ climatic variations

■ cost of living

■ advice, assistance and guidance on accommodation

■ details about pay

■ opening a bank account

■ obtaining a National Insurance number

■ telephoning home

■ registering with a general practitioner and dentist

■ joining a trade union

■ equal opportunities policies

■ local cultural, religious and social centres.

AccommodationComfortable and affordable accommodation is vital for your well-being. Youremployer should give maximum assistance in providing or obtaining adequate,reasonably priced and secure accommodation.

If you want to work in the UK you should investigate the subject thoroughlyand access information from the overseas nurses web page on the NMC siteor look at the NHS careers site (see Useful Contacts section).

You should consider joining a union when you arrive so that you are fullybriefed and aware of your rights within your workplace.

An application form to join UNISON can be found at the end of this guide.


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13580 Doc. 25/8/04 12:02 pm Page 32

CHECKLIST FOR UNISONREPRESENTATIVES WHEN DEALING WITHINTERNATIONALLY RECRUITED NURSESWork PermitsIt is the employer that applies for the work-permit, not the employee. Howeverit is important to prompt employees to check that their work permit isaccurate and reflects their employment situation accurately. It should also bechecked that:

■ the employer stated in the work permit is the actual employer

■ the job described in the work permit reflects what the nurse is doing

■ the location described in the work permit describes where the nurseis working.

■ the spelling of names, date of birth and terms and conditions arecorrect on the work permits as any differences between the work permitand the passport and/or visa may result in the person being refusedentry when they arrive in the UK. If the work permit is not accurate, itcould be invalid and place the nurse in breach of landing conditions.

Contract of employmentCheck that the nurse has a written contract containing:

■ names of employer and employee

■ date when the nurse or employee started work and the period ofcontinuous employment.

■ rates of pay, how it will be calculated and how often it will be paid.

■ hours of work.

■ holiday entitlement and holiday pay.

■ job title.

The employee should be aware of their entitlement to:

■ sickness leave and pay

■ pensions

■ notice provisions and disciplinary procedures (where there are 20 ormore employees).

The contract should not contain any misleading or unlawful items, gaggingclauses or financial penalties.

Airfares and registration feesEnsure that the employer pays for a recruit’s airfare and for a nurse’s initialNMC registration fee.

GradingCheck that the nurse is paid at the appropriate grade. UNISON recommends aminimum of grade D; the Department of Health recommends a minimum Bgrade.

33

13580 Doc. 25/8/04 12:02 pm Page 33

Registration and adaptationEnsure that the nurse understands their registered status, the differencebetween a registered and non-registered nurse and their requirements toachieve registration.

If a nurse is required to undergo a period of supervised practice or adaptation,check that the placement matches the requirements stipulated in the NMC’sletter to the nurse and that it will lead to the nurse achieving registration.

Check that the nurse has a mentor and that the mentor fully understands theirrole, so that they may support the overseas nurses fully during theiradaptation programme.

Pre-deployment orientation and inductionCheck to see if a nurse has undergone any form of pre-deploymentorientation. Then check that the nurse is given adequate induction. Thedeployment orientation and induction between them should containinformation on:

■ the role of the nurse

■ the role of the NHS and other bodies such as the NMC

■ differences in nursing practice between the UK and their country oforigin

■ education and training needs including PREP (Post RegistrationEducation and Practice)

■ cultural differences and information

■ climatic variations

■ cost of living

■ advice, assistance and guidance on accommodation

■ details about pay

■ opening a bank account

■ obtaining a National Insurance number

■ telephoning home

■ registering with a general practitioner and dentist

■ joining a trade union

■ equal opportunities policies

■ local cultural, religious and social centres.

AccommodationComfortable and affordable accommodation is vital for the well-being of thenurse. Ensure that the employer provides maximum assistance in providingand obtaining adequate, reasonably priced and secure accommodation.

Extreme circumstancesIf a nurse is working in the private sector and the circumstances areparticularly worrying or their working conditions seem extreme, you shouldconsider helping them move to the NHS.

Senior nurses and Human Resource departments within the NHS who havebeen made to be aware of such extreme cases have in a number of instances


34

13580 Doc. 25/8/04 12:02 pm Page 34

waived the need for a reference from the UK employer, allowing the nursesjust to undergo an interview.

(see section on Rescue Missions, page 24, 17.2 to 17.16)

In these cases you should collate as much evidence and get full details oftheir case. In some instances nurses may be afraid to be seen entering unionpremises, so a meeting should be arranged on neutral territory.

You should notify your branch secretary and your regional officer as their maybe other cases in the region, or even in the same work place which will builda stronger case against the employer. Advice can also be sought from GailAdams, head of nursing at National Office by emailing:[email protected]

Legal action should be considered in extreme cases.

35

13580 Doc. 25/8/04 12:02 pm Page 35

36

For further information about UNISON, call

0845 355 0845Textphone users call freephone

0800 0 967 968 Lines open from 6am to midnight, Monday-Friday and 9am to 4pm Saturday.

You can visit our website at

www.unison.org.uk

UNISON—your friend at work...

...UNISON—your friend for life

Regional offices

EasternChurch Lane HouseChurch LaneChelmsford Essex CM1 1NHTel: 0870 889 0373

East MidlandsVivian AvenueNottingham NG5 1AF Tel: 0115 847 5400

Greater London1st FloorCongress HouseGreat Russell StreetLondon WC1B 3LSTel: 020 7535 2100

Northern 140-150 PilgrimStreet, NewcastleUpon TyneNE1 6THTel: 0191 245 0800

Northern IrelandUNISON Centre Unit 4 FortwilliamBusiness Park 10 Dargan RoadBelfast BT3 9JZTel: 028 9077 0813

North WestArena Point1 Hunt’s BankManchester M3 1UNTel: 0161 211 1000

ScotlandUNISON House14 West CampbellStreet Glasgow G2 6RXTel: 0870 7777 006

South EastGlen HouseHigh StreetBansteadSurrey SM7 2LHTel: 0870 770 1112

South West1st FloorVintry HouseWine StreetBristol BS1 2BDTel: 01823 288031

Cymru/WalesSuite AThe CourtyardWind StreetSwansea SA1 1DPTel: 01792 467218

West Midlands24 Livery StreetBirmingham B3 2PATel: 0121 685 4200

Yorkshire &Humberside3rd FloorCommerce HouseWade Lane Leeds LS2 8NJTel: 0113 244 9111

Cuta

long

dotte

dlin

e

13580 Doc. 25/8/04 12:02 pm Page 36

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Cut a

long

dot

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line

13580 Doc. 25/8/04 12:02 pm Page 37

Designed and produced by UNISON Communications Unit.

Published and printed by UNISON, 1 Mabledon Place, London WC1H 9AJ.CU/September 2004/13580/Stock no. 1671/UNP ref 7717.

13580 Doc. 25/8/04 12:02 pm Page 40

Overseas Nurses Guide

Documents

Transcript of Overseas Nurses Guide