There are many establishment narratives around immigration that largely go unchallenged: think of all the asylum seekers “fleeing war” from, eh, Georgia, or the false claim that our “international obligations” mean we can’t limit the number of people we allow to claim asylum, even though that’s not actually the case.
Another is the assertion, now being made on a daily basis, that Ireland would collapse without the continuation of a large influx of migrant workers. This is trotted out ad nauseam, in relation to healthcare in particular, and digging deeper into that claim should be taken as no disrespect to the many fine nurses, doctors and other healthcare practitioners that have come to work here to help provide essential services.
This a major problem with modern discourse, especially on thorny subjects like immigration. Attempts to undertake a necessary examination of fundamental claims, or to spark public discussion on central aspects of important issues, are met with charges of bad faith or racism – with the aim, of course, of shutting down discourse and effectively censoring the actual facts of the matter from being disclosed. It’s part of what has been called a creeping authoritarianism: fast becoming the most notable hallmark of modern liberalism.
That explains the muted coverage of what should have surely provoked significant public discussion: that after the HSE announced a recruitment freeze on nurses, midwives and junior doctors in October 2023, it continued to hire health staff from abroad right into 2024.
The recruitment freeze was strongly criticised at the time by the Irish Medical Organisation (IMO) who said it would “inevitably impact negatively on patient care” and “add to the chaos in a system which already does not have enough doctors to deliver safe patient care, where many teams across the country are not fully staffed and where NCHDs are still working illegal and unsafe hours”.
The IMO also said that the recruitment freeze lead to doctors “emigrating in increasing numbers”, exacerbating a situation where “the working conditions, hours and complete disregard for their wellbeing in Ireland” were driving young medical professionals out of the country to work in health systems in Australia and Canada.
This steady brain-drain has been happening for years, and the housing and cost-of-living crisis has made things worse. Back in 2010, the Irish Nurses and Midwives Organisation (INMO) was rightly complaining that the UK’s National Health Service (NHS) was recruiting “whole classes of graduating nurses” from Ireland because the state was then also implementing a recruitment embargo.
Most of the 1,600 nurses and midwives graduating in 2010 from Irish universities would emigrate, the INMO estimated, even though some 12,000 nurses from the Philippines, India and elsewhere had been recruited by the health service since 2001 to work in Ireland – at an estimated cost of recruitment of more than €7,500 a head.
What was striking was the revelation that the shortage of nurses in Ireland which led to those recruitment campaigns aboard had arisen precisely because Irish medical professionals had also previously been forced by “past mistakes” to go abroad for work, Liam Doran of the INMO said at the time.
So the recruitment of foreign workers from abroad was only made necessary because of the actions of the HSE in the first instance – yet the HSE did not remedy the system that was driving Irish people out: in fact, it repeated the same actions that had led to a reliance on migrant workers in the first instance. That’s more than a little peculiar.
It could just be astonishingly poor planning on behalf of the Irish authorities, but why does the pattern persist? You could be forgiven for wondering if this ridiculous situation is just down to bad management, or whether other factors are also at play.
When asked why they left Ireland, nurses said that they were being offered agency work instead of permanent contracts – meaning that they were not guaranteed work despite the shortages in staff, didn’t get paid for holidays, and they were left with limited opportunities for career progression and further training. They also said that the health service was overstretched, which always makes working conditions difficult.
In one interview, a nurse said only 10% of those who had trained and qualified with her stayed in Ireland – and posited that the working conditions they faced here, including “massive burnout”, were driving qualified medical professionals away. She also said that despite having “what society considers ‘good jobs'” – it was almost impossible “to save for a mortgage or have any quality of life in Ireland”.
That pattern can be seen elsewhere. Research by Dr Niamh Humphries for the Royal College of Surgeons in Ireland found that in 2022, 442 Irish doctors were issued with temporary work visas for Australia. “This is a significant number of doctors compared with the total that Ireland trains each year (725 graduated in 2021),” she observed.
In 2018, she interviewed 40 Irish hospital doctors who had moved to Australia in the previous decade, and found that they said “unsustainable ways of working in Ireland also led them to decide to emigrate”.
“They described Irish hospitals as understaffed and overstretched workplaces within which extreme ways of working had become normal,” she wrote. Only one in three planned to return to Ireland.
There are many such stories, both anecdotal and gathered in research, with some featured in the media. In 2019, 250 Irish nurses living and working in Australia famously gathered outside the Sydney Opera House with a massive banner with a message to the Irish government: “Give us a reason to come home”.
More than 250 Irish nurses staged a demonstration at the Sydney Opera House yesterday in support of their striking colleagues https://t.co/6RDBFljOvL
— RTÉ News (@rtenews) January 20, 2019
Their plea was largely ignored. There was no follow-up campaign that I’m aware of where the HSE visited Australia and asked Irish nurses to come home, guaranteeing the kind of working conditions that would make that possible – despite the fact, as mentioned above, that some €7,500 a head had been spent on recruitment costs to bring 12,000 nurses here from abroad between 2001 and 2010. That’s a total cost of €90 million euros, by the way, and those costs have only increased since.
Clearly, the notion that our health service is so short-staffed primarily because our young graduates want to make tracks permanently for sunnier climes just isn’t true. We know from the INMO statements, and the testimony of nurses, that the shortages were caused because working conditions – and now the housing and cost of living crisis – have pushed Irish staff out of the country. So its very clear that the shortages which have left us reliant on migrant staff occurred partly because of the ridiculous, never-ending, destructive mismanagement of the health service and the wider economy. But is a preference for hiring staff from abroad also at play?
When announcing the latest HSE recruitment freeze last October Chief Executive Bernard Gloster “emphasised that any offers made and not formally accepted, or contracts that had not yet issued should now be withdrawn”.
This meant the recruitment freeze – supposedly a cost-saving measure – was “meant to apply to all other categories of staff, including overseas recruitment of nurses, midwives and junior doctors”. But there was an exception, the Business Post revealed.
“[A]n internal clarification was issued to HSE managers, confirming that “international recruitment orders which were previously underway should progress where there was already a commitment for 2023 and 2024”.
Up to 1,400 posts across nursing, midwifery and health and social care will therefore continue to be filled into 2024 from overseas candidates, despite the recruitment freeze in place domestically.
How can that possibly seem fair? Clearly, to many Irish nurses and other healthcare professionals it wasn’t – and isn’t – equitable. We’ve received messages from numerous medical professionals during this latest recruitment freeze frustrated that the positions that they presumed would be theirs at the end of training were put on hold while nurses were brought in from abroad – or angry that the state seemed so reluctant to take positive steps to hire or retain Irish staff.
A website giving guidance to African nurses who wish to come to Ireland advises that a relocation package of up to €4,160 for EU/UK candidates and up to €4,710 for non-EU candidates is available from the Irish authorities, and that additional financial supports are also available.
“Beyond the basic relocation package, several other initial costs can be covered on behalf of the candidate”, the site advises. These include: Registration fees to Regulatory Bodies; Visa Fees; Royal College of Surgeons in Ireland (RCSI) Aptitude Test Fees; and Recognition Fees.
There is, of course, nothing wrong with claiming or seeking relocation costs, and the failures in the system are clearly not the fault of the decent, hard-working, medical staff who are recruited to work here.
But Irish staff are now starting to publicly question why the system seems stacked against them. A healthcare professional told The Journal this week that she was “horrified” and “in shock” to find out that she and others had been “bypassed” by international candidates for positions during the most recent recruitment freeze, even though she and her colleagues were on panels – in line – for the roles.
The HSCP who spoke to us said she was placed highly on a panel for a role in Dublin last year, shortly before the recruitment freeze began in October. Since she graduated, there have been two recruitment freezes in the HSE. These embargoes affected her job progression and, as a result, she started working in the private health sector despite wanting to remain in the public system.
Noting that the recruitment embargo was “all about cost-saving”, she questioned the logic of hiring people abroad as it is typically much more expensive than hiring staff within Ireland.
She’s absolutely right to question the logic. Maybe its not that the HSE can’t get Irish staff, maybe its that they don’t want them. Why might that be?
Is it the case that the HSE might prefer to hire staff from abroad precisely because they don’t make the same demands or have the same expectations, especially if they see working here as a temporary measure, and therefore aren’t fazed by the difficulties Irish workers face regarding mortgages and home ownership and setting up families.
There might be a clue in as to the mindset in the HSE in a discussion around the difficulties faced by one recruiter who noted that “while the HSE is losing Irish staff to Australia and elsewhere, it is also actively recruiting in places where we can compete better on wages and working conditions, such as India and the Philippines.”
That’s an interesting insight, isn’t it? The HSE is “actively recruiting” in countries where Ireland can offer better wages and working conditions – even though our own medical professionals say the same working conditions are driving them out of the country. In other words, the HSE is recruiting in poorer countries amongst people who are willing, perhaps, to put up with the chaos that’s leading to longer hours and a pressurised work environment. That comes close to a kind of exploitation, in my opinion.
(This is what critics of globalism find most objectionable: the outsourcing of jobs in an endless race to the bottom in terms of cheaper labour and costs. Family and identity and the importance of building communities are swept aside, people are uprooted – it’s an economic model that’s definitely not centred around the wellbeing of people or human flourishing. And so, thousands of workers are brought to Ireland to work at fruit-picking or in factories, often living in bunked, crowded accommodation, and we’re all meant to pretend that its because companies can’t get workers rather than about squeezing down costs to boost profit margins. The left, whose brains are addled by an obsession with ‘refugees welcome’ chants, seem curiously uninterested.)
There are other factors at play too. What about the brain-drain for poorer countries and the disruption to the development of their health services by the endless mining of their skilled people for the benefit of richer countries? Last year, the NHS in Britain was accused of acting unethically by the Royal College of Nurses after it was found to be recruiting nurses from countries who are grappling with their own staff shortages.
Prof Nicola Ranger, the RCN’s chief nurse, said: “The government’s over-reliance on unethical international recruitment from red-list countries has become the norm and cannot continue. It’s a false economy. The government should invest in nursing staff in the UK, funding nurse education and fair pay – not destabilising other healthcare systems.”
That seems an entirely fair and reasonable request to make of both the NHS and the HSE. But the opposite seems to be happening, not just in recent years but for decades. (There’s also the fact that young people feel increasingly pessimistic about ever having the opportunity to own a home and raise a family here, another potentially catastrophic outcome the government mostly ignores while finding niche issues to pronounce about.)
According to the INMO’s 2024 pre-Budget submission to the government, a shocking 73% of nursing and midwifery graduates they surveyed were considering emigrating when they qualify. “Practical solutions must be employed to ensure retention,” the INMO says. The survey found that staffing, pay and working conditions – specifically lack of adequate breaks, unmanageable pressure, exhaustion, and a lack of safe staff-to-patient ratios across the health service – were “significant factors” that led to the interns considering emigration.
Why would those conditions be any more acceptable to workers arriving from overseas? It’s likely that they aren’t – certainly, if workers rights were being protected, they shouldn’t be – and so the obvious question remains: is it to the government’s advantage to turn a blind eye to the huge numbers of Irish medical professionals leaving the country because they can replace them with workers from overseas who are willing to accept sub-standard pay and conditions? If it is the case, isn’t that exploitative and manipulative?
That’s the question that actually needs examining. Enough with the clichés trotted out in the Dáil and on the airwaves for the purpose of shutting down debate. We must look at the real reason why we are bringing in huge numbers of healthcare workers from abroad while our own are emigrating in droves.