The "nurses for cars" deal

Guardian logo December 9, 2004 -- Today the Guardian carried John Carvel's piece reporting that the U.K. government has vowed to close a loophole that had allowed hospitals and care homes to "poach" nurses from developing nations by offering them temporary contracts. Meanwhile, on December 6 the French newspaper Liberation ran Michel Temman's piece "Tokyo échange autos contre infirmières," which reports that Japan has agreed to expand the ability of Filipino nurses to work in Japan in exchange for the Philippines' agreement to ease restrictions on the importation of Japanese cars.

Liberation logo Temman's story in Liberation does not describe exactly how the Philippines' import restrictions will be eased, and it quotes an unnamed source stating that the role and number of nurses to work in Japan has yet to be determined, though it will apparently involve "several thousand" nurses. The piece briefly explains the interests of the two sides in making the agreement. Japan's population is rapidly aging; according to the piece, by 2010 25% of its population (35 million people) will be older than 65, and many will have significant health care needs. For its part, the Philippines reportedly relies heavily on foreign remittances from the approximately three billion Filipinos who work abroad and send back an estimated 7-10 billion dollars each year. The piece quotes the Philippines' Tokyo commercial attache as noting that the accord underlines the need for Asia to pursue the kind of economic integration seen in Europe.

However, the piece fails to note that the nursing shortage is not limited to wealthy nations with aging populations, but, as a recent report of the International Council of Nurses made clear, is a public health crisis in a number of developing nations, including the Philippines. Many such nations devote scarce resources to training nurses, only to see many of the most highly skilled depart for better-paying jobs overseas, leaving already overburdening local health systems on the verge of breakdown. Of course, these are complex issues, but the article might have shown some awareness that it was not merely a straightforward trade of goods for services (or people). Indeed, since the piece had space for several quotes from government officials, it might have benefited from comment from Filipina or Japanese nursing leaders, an omission that--like the jokey "cars for nurses" name--underlines the impression that nurses are chattel. Comment from affected automobiles would have been optional.

Some developed nations, such as the U.K., have recognized that there are ethical issues to be confronted in recruiting nurses from developing nations who may need them desperately. Carvel's balanced piece in the Guardian reports that the U.K. government's loophole closing was the result of pressure from nursing unions, who have pushed to bring private sector health providers under the government's current code for ethical recruitment. The article notes that the move was welcomed by the Royal College of Nursing, which has "been campaigning to stop the [National Health Service] stripping poor countries of scarce nursing skills." Carvel notes that about 40,000 overseas nurses have registered to work in the U.K. in the past three years. Under the new plan, independent companies (including recruitment agencies) providing NHS care would have to sign the ethical code, and a revised code banning the recruiting of temporary staff from developing nations would come into effect in December 2005. The code does not foreclose individuals from seeking U.K. employment "of their own volition."

See John Carvel's article "Nurse poaching loophole closed" in the December 9, 2004 edition of the Guardian.

See Michel Temman's article "Tokyo échange autos contre infirmières" in the December 6, 2004 edition of the Liberation. Translate it with Babel Fish into English.