NHS nursing crisis: Lili is from Romania & works at GWH - but the flow of EU nurses has now dried up
Lili Baleanu is a Romanian nurse working at Great Western Hospital - one of the steeply declining number of EU nurses to arrive since the Brexit referendum.
Lili graduated as a nurse in Romania in August last year and arrived at GWH in late November. She passed the obligatory English language test (the IELTS - more of which later) and will become a fully registered nurse in a matter of days - getting her Pin number from the Nursing & Midwifery Council (NMC).
Recruitment is a complex procedure: before she got to GWH, Lili had three interviews - including a face-to-face one with a GWH manager in Bucharest - and a mock English test.
She lives in a rented house in Swindon with two other women from Romania and is a Staff Nurse on GWH's Woodpecker Ward - a medical ward specialising in geriatric cases - and by all accounts is a very popular nurse with patients.
She has left behind in Romania her husband (who is a Christian Orthodox priest) and three children (aged seven, five and three) who are being looked after by their father and his parents.
Lili hopes to be able to bring her family to England. (We met Lili before the post-Brexit future of EU citizens working in Britain finally limped to the top of agenda with Mrs May's offer (June 22) to the EU.)
The UK-wide shortage of nurses - standing at about a 30,000 deficit - is not of course solely to do with Brexit. But the number of EU nurses registering with the NMC to work in the UK has plummeted after it peaked at 1,304 in July 2016.
In the following months, applications dropped significantly - with a steep fall by September to 344 applications. The decline continued, dropping to just 46 EU nurses registering in April 2017. [See graph below.]
In addition last year more than 3,480 EU nurses left the NHS - a 38 per cent rise on the previous year. Partly down to the government's decision not to give a unilateral guarantee of the rights of EU staff to stay working in the UK.
A number of hurdles have been placed in the way of recruiting nurses for the NHS. Aside from decisions to cut the number of training places, these are making the job of hospital human resources directors like GWH's Oonagh Fitzgerald, almost impossible.
GWH have a ten per cent vacancy rate across their whole staff. And they are currently short of 165 newly registered nurses.
The referendum has had a major impact - partly because of the 'ugliness' of the post referendum culture and abuse some EU staff have suffered. The post referendum drop in the value of the pound has become another deterrent: "We're not an attractive prospect for EU staff", says Ms Fitzgerald. She has seen EU nurses moving on from England to Ireland.
One of the main hurdles is the IELTS exams (International English Language Test System). EU nurses have to pass this masters level exam before they can be registered. It is the same level of exam that EU students coming to do a masters course at Oxbridge have to pass.
Lili passed her test first time: "But I had a lot of nightmares while I was waiting for the results."
As Oonagh Fitzgerald puts it: "Lili did fabulously well to be one of the two GWH candidates to pass first time." Twenty-one GWH candidates have failed first time. Six attempted it again - and failed again. Two had a third attempt and failed once again.
This is not only a set-back for the nurses - they are on basic pay till they can pass. But GWH have to pay these nurses and have to employ agency staff to do the work they are not yet registered to do.
Recruiting in Europe costs money and then GWH gives them a great deal of English language training before the test - as well as medical training and teaching them about the way GWH works.
Most of their candidates pass the spoken language test and fail the written test. Ms Fitzgerald - who has a first degree and a masters degree - tried an IELTS paper herself - and found it really difficult.
Her first comprehension paper was an article about the Falkirk Wheel - the rotating boat lift connecting Scottish canals: "It was full of engineering technicalities - and had nothing to do with health. The second was a paper on bio-engineering." She laughs - despairingly. "Doctors coming here from the EU don't have to do this test."
There are plenty more hurdles to overcome. Since April this year, hospitals have to pay a sort of poll tax on every EU nurse they recruit (whether or not they pass the IELTS.) That stands at £1,000 per nurse for every year they stay here - surely not quite what the EU meant about free movement of people.
Then there is a nurse's pay packet. Before inflation hits it more and more each month, it will have been reduced by increased pension payments. And for many it is stuck on the one per cent pay cap imposed by the government.
Oonagh believes this policy decision is having a really negative impact: "I've never seen such strength of feeling - this year they've had a hard winter on top of a hard year. It's really grated with staff - they feel very hurt."
And as the shortage of staff hits the numbers working on wards - it also hits morale: "You can't go on going home at the end of a shift unhappy because you can't do your best for your patients."
Then there was the decision to cut bursaries for nurse training courses. GWH has a close and successful relationship with the Oxford Brookes University campus in Swindon. There they have 120 nurse training places for September - and have so far with barely two months to go, filled only seventy of them.
Are the government's policies joined up? These hurdles fly in the face of both government moves to put more nurses on the wards as required by the report into the Mid Staffs scandal, and in the face of government moves to reduce the number of expensive agency nurses hospitals can employ.
Lili tells me: "I really am happy. And I'm grateful I got a lot of support from everyone."
Oonagh Fitzgerald sums it up: "They want a better life - we need their skills - and we're stopping them."
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