Sunday 11 December 2016

Brain drain: No end to great Irish medical exodus

The British NHS plans to recruit thousands more Irish nurses and doctors... and we're not doing anything to stop the exodus. We report from three London hospitals

Graham Clifford

Published 31/05/2015 | 02:30

Irish invasion: Lisa Dolan from Limerick and Aoife Lawrence from Kerry at Charing Cross Hospital. Photo: Gerry McManus.
Irish invasion: Lisa Dolan from Limerick and Aoife Lawrence from Kerry at Charing Cross Hospital. Photo: Gerry McManus.
Matron, Josie Gladney (Carlow) and Deputy Chief Nurse, Eamonn Sullivan (Waterford) at University College London Hospital in London's Euston Square - Tuesday 26th May 2015 -

A young mother stares blankly into the middle-distance, her baby son asleep on her lap. A few seats on an Indian couple whisper loudly as their daughter, clutching her teddy, watches on from her pram All along the snaking multi-coloured seating in the lobby of London's Great Ormond Street Hospital parents, from different ethnic and social backgrounds, sit and wait to be seen, some calm, others clearly on edge.

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Voices of the world interweave and then familiar soothing tones rise above them all. There's been an influx of Irish nurses to the prestigious Great Ormond Street in recent months and they've settled in quickly.

"We love it here, there's so much respect between the staff and an eagerness to succeed," explains 23-year-old paediatric nurse Matt Colbert, from Fermoy, in Cork.

Matt was one of 25 Irish-trained nurses to be hired in the latest wave. "We (Irish) made up half the new intake. It's a bit of a joke within the hospital that half the nursing staff are from Ireland. We even have local London-born nurses using words like 'grand' and not even realising it now."

The flow of Irish nurses to the UK over the decades has always been brisk, but in recent years it has been upgraded into something of a mass exodus. And the NHS is to recruit thousands more nurses in line with government policy there.

"Over the last five years we've lost at least 5,000 nurses, most of those to the UK," says Claire Mahon, president of the Irish Nurses and Midwives Organisation (INMO).

And medical recruiter Kate Cowhig told the Review she'd found posts for over 3,000 nurses in the UK since 2009 when the moratorium on recruitment was enacted here. "Sure half of Cork are working in the Royal Free Hospital, and the Royal Berkshire in Reading take 100 Irish nurses every year. They're crossing the Irish Sea in their droves. Most young Irish nurses could only hope for the odd bit of work here or there at home with no prospects for career advancement or further education. In the UK they get a full-time, well-paid job and further training is encouraged. Sterling is so strong against the euro, and in the UK senior hospital staff can spot the talent in our nurses and nurture it."

And a large number of our young doctors are also heading for the airport soon after their training in Ireland is complete. A recent study led by researchers at NUI Galway, of more than 2,000 medical students in Ireland, found that almost 90pc of them are either thinking about emigrating once qualified or had already made plans to leave.

"This outflow of qualified personnel represents a financial loss to the Irish healthcare system when one considers the costs involved in training medical students, the cost of recruiting replacements and the service delivery constraints if replacements cannot be found," said the study's principal investigator Pishoy Gouda.

It's estimated the State pays an average of €75m a year subsidising the cost of educating medical students, around €125,000 per student over the course of their training.

Dr Ray Walley, president of the Irish Medical Organisation, told the Review that Ireland needs to be able to compete with other English-speaking nations if we want to hold on to our doctors.

"In rural Australia a GP can earn €340,000 a year before tax while the UK are short 10,000 GPs and are desperate to fill those vacancies," he said. "Young medical graduates see that these options exist and many don't think twice about going. We need to incentive them to stay and work here. Investment in primary care is vital if we are to hold on to our doctors."

And a recent study, carried out by staff at the Royal College of Surgeons, of young Irish-trained health professionals working abroad, found that working conditions, a lack of training and career progression were the three main contributing factors which led them to leave Ireland in search of work.

Next Thursday, the Irish Medical Council will launch its annual report and will release further data on the emigration and career intentions of trainee doctors in Ireland.

Back in Great Ormond Street, Matt Colbert tells me during a break: "I studied in Trinity and then trained in Tallaght. I'd already decided I was coming to the UK after my studies finished. I wanted to improve, to train, to learn about new working practices and feel valued. This is such an amazing hospital that you get all that and more. If I'd stayed at home, I'd be treated very differently, hopes of advancing would have had to be put on ice."

Matt's comments are echoed by his fellow Irish nurse colleagues Claire Horan, from Malahide in Dublin, and Amy Reidy from Bishopstown in Cork.

"The staffing levels here are much more appropriate than at home," explains Claire, adding: "The nurse to patient ratio is one nurse to three or four patients. When working as an intern in my final year in a hospital at home I could have up to nine patients on my own. The staff aren't run off their feet here and have time to help whereas at home the nurses barely have time to have a break some days due to their unmanageable workload."

In Charing Cross Hospital in West London, newly recruited nurses Aoife Lawrence, from Finuge in Kerry, and Lisa Dolan, from Lisnagry in Limerick, tell me why they're so delighted they came to London to train.

"I wanted to study nursing as a mature student in Ireland but didn't have enough points and instead came to London to do it - it was the best move I ever made," says Aoife Lawrence. "I now work in the acute stroke ward and am learning so much each day. The conditions, lifestyle and chance to advance your career are just so different to at home. Our accommodation is subsidised and there are great opportunities if you want to take them. Like I'm going on holidays next month and I'm working weekends as an agency nurse to raise some money for it, at £33 an hour (€46) it's a great way to boost the holiday fund."

While Aoife plans to return to work in Ireland at some stage, she says going back as a general nurse is not an option. "There's still a very hierarchical attitude to staff in Irish hospitals so if I do go back I want to go back with a speciality in a proven field with a masters behind me. Otherwise I could be stuck at the same level in Ireland for 20 years," she says.

And Lisa Dolan (25) concurs. Over coffee on Fulham Palace Road she tells me: "I started in my position on the ENT and Plastics ward three weeks ago and already they're sending me on courses for this and that - can you imagine that happening in Ireland? All the courses are paid for so you can take them, improve your ability and move up the pay brackets quickly. They absolutely love the Irish nurses here. One of our lecturers, who is head of recruiting, goes over to Ireland twice a year looking for new nurses. They even go into secondary schools to tell them about what's here."

The workforce director at University College London Hospital (UCLH) on Euston Square, Ben Morrin, tells me the hospital will be recruiting 900 nurses in 2015 with 300 of those coming from abroad including some from Ireland.

"It's widely accepted that we haven't trained enough nurses in the UK over the last number of years and so we need to employ from outside to make up that shortfall. Irish nurses are always sought after and in the coming weeks we will be recruiting again in Ireland," says Mr Morrin.

Indeed, so strong is the link between UCLH and Ireland that last year, on his state visit to Britain, President Michael D Higgins came here to meet Irish staff members. Amongst them was Pat O'Brien, a consultant obstetrician and gynaecologist, who has earned a reputation as one of the best in the business at safely delivering babies where there's a significant risk to the life of the infant or her mother.

Pat, originally from Cork city, tells me that for young doctors the opportunities that exist in hospitals like this are almost unlike anything they might experience in Ireland. He said: "I know great work, including important research, is being carried out in some Irish hospitals but in a massive cosmopolitan city like London there inevitably will be more complex and varied cases for doctors to deal with. I would always advise Irish doctors to travel after they qualify and improve themselves by seeing how medicine is carried out elsewhere."

Pat delivered the conjoined twins Hassan and Hussein Benhaffaf, from Cork, in 2009. In the doctor's mess, he tells me: "I looked around and in the delivery room there were two senior Irish nurses, Mae Nugent and Mary Dinan. Then of course the two boys were later separated by paediatric surgeon Edward Kiely, another Cork man, at Great Ormond Street."

As we chat, another Irish member of staff stops by after hearing I was here. Eamonn Sullivan, from Waterford, is the UCLH's deputy chief nurse. The father-of-two came to study in London 25 years ago and has never looked back, even though a few years ago his head was turned. "During the Celtic Tiger years I thought about moving home," he tells me. "My wife was expecting and it felt like the right thing to do but just as we were about to look into it, the Irish economy crashed and that was the end of that."

And six weeks ago, when Eamonn's mother was admitted to hospital in Ireland, he saw close up how stressed Irish consultants, doctors and nurses are here.

"She was in intensive care for a time," he said. "The medics and nurses who treated her were outstanding but some were clearly exhausted, fatigued and demoralised. The hospital infrastructure and quality of equipment was so unlike what we use here in UCLH. It really saddened me to see such great quality staff working in those kind of conditions."

And this week a Department of Health-commissioned peer review analysis of the national cancer strategy warned that nursing shortages in chemotherapy delivery units were a major concern in terms of patient safety. It said the lack of "advanced nurse practitioners in this area was startling compared to other jurisdictions."

And INMO president Claire Mahon says while hospitals here are advertising for nurses again, many are being recruited from overseas. She told the Review: "Over the past few months we have won agreement for at least 500 nursing posts in hospitals like Our Lady of Lourdes Drogheda, Naas General, Mullingar, Beaumount and others but we have shortages in many hospitals. In fact some hospitals have gone overseas to places like the Philippines to recruit. It's not just the acute hospitals that are short. Also we need nurses in many of our older person services and we estimate we are short over 600 midwives."

As evening falls over London and Irish doctors and nurses clock off, after another hectic day at work, I can't help think of their Irish-based peers who hold on to the hope that things will improve soon... and they too will get their chance to shine.

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