The Migrant Workers and Overseas Filipinos Act of 1995: ‘The State shall allow the deployment of overseas Filipino workers only in countries where the rights of Filipino migrant workers are protected. On November 1, 2011, the Philippine Overseas Employment Administration (POEA) Governing Board (GB) published Resolution No.7, which specifies a list of 41 countries where Philippinos cannot be deployed for non-compliance with the guarantees required under R.A. 10022. As of November 2011, the POEA lists 125 countries as being compliant with the guarantees.

The UK is a compliant country.

In effect, UK hospitals can place ‘orders’ for Filipino nurses with the POEA, as evidenced on, March 10th, 2015: ‘The demand for Filipino health care professionals in the United Kingdom continues to step-up as 270 more Philippine Overseas Employment Administration-approved job orders were received by a Philippine-based international manpower agency. Following her statement last month about the increased demand for Filipino nurses in the United Kingdom, Labor and Employment Secretary Rosalinda Dimapilis-Baldoz yesterday announced that Omanfil International Manpower Development Corporation has received 270 more job orders for nurses in three UK hospitals. “Apart from the 220 job orders for nurses we have reported in January this year, this latest overseas employment opportunity augurs well to our globally-competitive health care professionals,” said Baldoz. Omanfil Chairman Leonardo B. De Ocampo wrote Secretary Baldoz a letter saying the 270 openings with approved job orders by the POEA are for Whittington Health NHS Trust, Cambridge University Hospitals NHS Foundation Trust, and King’s College Hospital NHS Foundation Trust. Omanfil International Manpower Development Corporation is a Presidential Awardee of Excellence and as a recipient of this distinction, its job orders are exempted from overseas labor office verification and approval. Recruitment agencies who are conferred with Presidential Awards of Excellence are exempted from evaluation in terms of volume and quality of deployment, technical capabilities, compliance with recruitment rules and regulations, welfare programs and allied services, human resources development plan, industry leadership, marketing capability, social awareness, and proof of responsibility. Baldoz said that with Omanfil’s credence, the overseas deployment of Filipino healthcare professionals will be in good hands’.

Thus, one of the agencies involved in recruiting Filipino nurses for the UK has been exempted from evaluation!!! By whom?, on what process? Has this process been independently scrutinised? There is obviously a process of evaluation, as the POEA cancelled licenses of 55 recruitment agencies in 2014 for unethical recruitment practices. Has the Omanfil International Manpower Corporation undergone the same scrutiny as these other agencies? Who owns Omanfil? Do they have any links to government?

POEA head Hans Leo Cacdac posted the list of non-licensed agencies on his Twitter account, saying these firms violated Philippine migration laws and regulations. To what extent, if any, were these agencies in competition with Omanfil? Have any of the owners of these agencies ever worked for Omanfil, or now do so subsequent to their licenses having been withdrawn?

Cacdac said the recruitment firms include: 1. A-M Phil. Professional Services Corporation 2. Al-Siq International Placement and Manpower Services, Inc. 3. AFT International Manpower Services 4. Aguila Management and Resources Corporation 5. Al-Ahram International Group Services, Inc. 6. Al-Sadiq Manpower Corporation 7. Apex Grande International Labor Agency 8. Asian International Manpower Services Inc. 9. Asmara International Placement Agency, Inc. 10. Batie International Manpower Services, Inc. 11. Bobstar International Recruitment Agency, Inc. 12. B & E Overseas Manpower Services Corporation 13. Chronos International Manpower Corporation 14. Creative Artist Placement Services, Inc. 15. Dalandan International Manpower Inc. 16. Dream Fame International Manpower Corporation 17. Dywen International Manpower Agency 18. Expeditor International Manpower Services Co. 19. Experts Placement Agency Inc. 20. Findstaff Placement Services, Inc. 21. France Asia International, Inc. 22. Global Care International Manpower Services 23. Global Unlimited International Manpower, Inc. 24. Globrec Manpower Services Inc. 25. Gerardo J. Santos Manpower 26. Goodman International Manpower Incorporated 27. IDM Manpower Services 28. Inter-Globe Manpower & Consultancy Services, Inc. 29. Jade Jobwell Philippines, Inc. 30. Japhil 2000 International Agency Corporation 31. Jenar Maritime, Inc. 32. Jovineria Manpower Services 33. Kabayan Ko Overseas Manpower Placement 34. Kookies International Recruitment Agency, Inc. 35. Meccaj Manpower International Services 36. M.G.M International Recruitment Services, Inc. 37. Mind Resources Corporation 38. Nahed International Manpower Services 39. Non-Stop Overseas Employment Corporation 40. Pacific Mediterrenian International Manpower Agency, Inc. 41. Perfect Employment Agency Corporation 42. PERT-CPM Manpower Exponents Company, Inc. 43. Renaissance Staffing Support Center, Inc. 44. Ridzkey Human Resources International Services 45. Sacred Heart International Services, Inc. 46. Sand-dune International Manpower Services 47. Saranay Philippines, Inc. 48. Seven Ocean International Manpower Corporation 49. Sherine Manpower Services, Inc. 50. Sunshine Recruitment Agency, Inc. 51. Sky Top Service Contractors, Inc. 52. Sunshine Recruitment Agency, Inc. 53. Tuem International Manpower Corporation 54. Wandy Overseas Placement Agency, Inc. 55. YMC International Manpower Services.

A perspective from Singapore (, May 19, 2015) … ‘Detective Superintendent Simon Barraclough, who led the (Chua) investigation, … said, “I have no confidence in the qualifications he has provided via the Professional Regulation Commission” (which verifies the qualifications of nurses) … a source close to the Stepping Hill case said: “Vetting of nurses in the Philippines is very, very poor. A lot is done on the word of the Philippines regulatory authorities. They rely on stamped documents as proof of proper qualifications. This is why police can’t be certain that Chua’s qualifications are genuine.” Another said: “We can’t be certain that the Philippines’ Professional Regulation Commission has exercised due diligence with regard to the NHS. Once you have a PRC stamp, you are more or less guaranteed a job in the UK”.

NMC chief executive Jackie Smith said that its vetting system was now “robust” and that her staff insisted on seeing original education documents from prospective foreign nurses.

What is “robust”? The most professionally forged certificates come with a guarantee of not being detected. Insisting on seeing ‘original education documents’ is a statement out of the top bracket of gullibility. (I have previously published links to the websites of bespoke professional forgery gangs).

Testing overseas nurses by webcam is an easily manipulated process. You do not need to be Sherlock Holmes to realise how.

People claiming to be qualified nurses usually have some (or a great deal) of experience of nursing, and can pass practical tests in the UK.

This is not a problem confined to the Philippines. Fake certificates, and all ‘verifying’ documentation, can be bought pertaining to African, Indian, and European ‘qualifications’. (Some of the best nurses I worked with were from the Philippines).

Does the NMC use professional agencies, as in California, to check accreditisation? Do they employ foreign language experts of their own to make enquiries overseas? Or, do the NMC simply rely on a PRC stamp? No prizes for guessing correctly. The NMC’s process of checking nurse qualifications is obviously a sham, if ‘once you have a PRC stamp, you are more or less guaranteed a job in the UK’ (police source!). The PRC stamp mark is as easily forged as any fake document it ‘authenticates’. Do the NMC merely do the equivalent of checking for a British lion mark on an egg?

Have they asked why an agency engaged in the recruitment 490 nurses for UK hospitals has been ‘exempted from evaluation in terms of volume and quality of deployment, technical capabilities, compliance with recruitment rules and regulations? !!!

Are we actually saying that there are no newly qualified UK nurses who could have filled these posts, instead of ‘globally-competitive health care professionals’?

Are Filipino nurses employed on ‘bulk’, minimum pay contracts? Is an advantage of employing any foreign nurse that they can almost be guaranteed not to ‘blow the whistle’, and work any amount of long and unsocial hours?

A common Filipino blog comment is: UK checks should be more stringent … ‘We are talking about the nursing profession here, not just some boring office secretary typing on her keyboard with red polished nails’.

My general impression is that the NMC is checking for red polished nails.

An overiding impression is that something stinks, and there should be a government enquiry into the whole sorry business of UK nurses being trained without a guarantee of a NHS job, and the conveniently easy system of ‘globally-competitive health care professionals’ being bought, as clothes from a hanger, marked with a PRC stamp, with the assistance of an ‘exempt’ agency.

I call for the urgent checking of all documentation, by an independent, professional agency, of the 490 Filipino nurses recently fast-tracked into UK jobs.

lenin nightingale 2015





I remember it as if it were yesterday, a report of 2008 stating that ‘More than 25% of student nurses in the UK do not finish the course, at a cost of more than £98m a year’. Some 26.3% due to finish in 2006 left early, according to figures obtained under the Freedom of Information Act for Nursing Standard magazine. Of 25,101 students who started either degrees or diplomas, 6,603 did not finish their programmes’ (1).

My concern about this subject increased after reading a report of 12 March, 2015, by Nicola Merrifield: ‘An “urgent” assessment of the reasons student nurses leave their undergraduate degrees is required to stop NHS education funding from being wasted, according to the chair of a major review of nurse training’. This was referring to the Shape of Caring Review, chaired by lord Willis, which found: ‘the average drop out rate for student nurses at universities in England was more than 20%, but warned some places in fact had up to 50% attrition’ (2). The review suggested that health care assistants should have a portfolio of competencies recorded on a computer data base. (If HCA Maureen can do it, no need for Nurse Maureen).

But, praise the Lord, things are not all what they seem! Responding to a report by chief executive of Healthcare Management Solutions, Tony Stein, that 40% of nursing students drop out in the first year, Lizzie Jelfs points out that: ‘Higher Education Funding Council for England data for nursing shows a 90% continuation rate from year of entry to the following year’ (3).

This, of course, does not contradict the findings of the Willis review; it is to be assumed that a further 10% on nursing students drop out of their course from the second year onwards. Different time scales, different statistics, and, of course, averages mask some very high rates (40%?,50%?) of attrition in some courses. Or should we accentuate the positive, and say 60% and 50% continuation rates?

An important point might be this: it is not nursing, per se, that students leave, it is the low pay, low staffing levels, long, unsocial hours, and ever-hovering threat of litigation that is left. At least, that is what students inform me.

Another important point is a political one, and, at the mention of politics, many nurses bury their head in a Saharan sand dune. This was always the case, with the RCN being seen as almost radical in ‘sitting at the table’ with government to influence their policy. This was the strategy once taken by Tony Benn, who thought that governments could be influenced by campaigns, debates, and petitions, quoting the Suffragette Movement as an example. This era of politics has died, as I once suggested to Mr. Benn, who, seeing the ever increasing power that corporate dogma had over government, tended to agree.

Therein lies the problem. The neoliberal dogma that government serves dictated that nursing was subject to a radical ‘skills-mix’ review. It was decided that cheaper levels of training to nurse will be implemented, whether expanding the role of Senior HCA’s to be the ‘nurse tecnicians’ of Florida, or having a shorter, and cheaper nurse training programme, comprising of SEN qualification in speciality areas of nursing. Some level of degree nursing will be maintained, of course, but nursing will be carried out by a broader, and cheaper, staffing mix.

This is neocon dogma, and dogmatists do not debate. To think that nursing will be immune from such politics is akin to believing that the EU will abandon its free movement of people principle – i.e. free movement of cheap labour.

This tide is coming in. There is no point in the RCN being Canute. The government despise the RCN (and UNITE and UNISON), and have no place at their table for them, except for being beneath it, like some dog waiting to be thrown a scrap. (Taking this analogy further, if the dog does not get its bone, will it bark like an alsation, or whine like a poodle?).

The real question is this: what do the RCN propose to do in a ‘not negotiable’ world?

They will not engage government in a table tennis game of selected statistics. The government have their own selection, which mostly concentrate on cost reduction, a pre-privatisation strategy.

The game is over.

lenin nightingale 2015

(1), 10 April 2008

(2) Nicola Merrifield,, 12 March 2015

(3) Lizzie Jelfs,, 26 May 2015


There are significant regional variations in the cost of care within the UK, whether that is to provide care with or without a nursing component:

Region/Cost per week   Care home   Care home with nursing

East Midlands                £555            £687
East of England             £604            £788
London                          £625            £825
North East                     £515            £591
North West                    £480            £673
Northern Ireland            £476            £656
Scotland                        £596            £743
South East                    £641            £874
South West                   £592            £791
Wales                           £497            £603
West Midlands              £513            £694
Yorkshire                      £489            £655

Source: Laing & Buisson Care of Older People, UK Market Report 2013/14.

The common factor is the cripplingly high cost of care for the individual of limited means. Whether that cost is born by the government, or by an individual or their family, who have perhaps been forced to sell the family home to meet costs, the question of affordability takes on an increasingly keener edge.

A solution, for some people, is to arrange for themselves or their relative to be nursed overseas. In 2011, when first researching this subject, I came across an article in, which told of the experience of Steve Herzfeld: ‘After three years of caring for his increasingly frail mother and father in their Florida retirement home, Steve Herzfeld was exhausted and faced with spending his family’s last resources to put the couple in a cheap nursing home. So he made what he saw as the only sensible decision: He outsourced his parents to India.

Today his 89-year-old mother, Frances, who suffers from advanced Parkinson’s disease, gets daily massages, physical therapy and 24-hour help getting to the bathroom, all for about $15 a day. His father, Ernest, 93, an Alzheimer’s patient, has a full-time personal assistant and a cook who has won him over to a vegetarian diet healthy enough that he no longer needs his cholesterol medication.

Best of all, the plentiful drugs the couple require cost less than 20 percent of what they do at home, and salaries for their six-person staff are so cheap that the pair now bank $1,000 a month of their $3,000 Social Security payment. They aim to use the savings as an emergency fund, or to pay for airline tickets if family members want to visit.

Every time he looks at the bills — less than $2,000 a month for food, rent, utilities, medications, phones and 24-hour staffing — Herzfeld thinks he’s done the right thing for his parents and himself.

“It can be done,” he said. “This is working.”

These financial savings can be put into perspective: In The United States the cost for assisted living in a community will run about $4000-$5,000 a month to say the least, in some cases depending on the community up to $10,000 month.

Savings on the cost of care can also be gained in the Philippines. Individuals and their families can access to read that: ‘Mabuhaii Nursing Home offers unique and high quality nursing for elderly from America, Europe, Australia and Asia … We offer four different nursing service categories which differ in the level of intensity of healthcare provided. Prices differ depending on the house and room … Board and lodging without healthcare (Assisted Living) can be booked at lower alternate prices for those who don’t need care … Meals, laundry, cleaning and caregiving are of the same quality in all three categories and houses. Special requests such as air conditioning, flat screen TV, refrigerator and telephone can also be arranged.

Intensive Care
House Price per Month (USD)
Riao $2,130 to $2,590
Mandu $2,470 to $2,790
Molo $2,630 to $2,970 (c. £1,900)

Two (2) nurses per day or four (4) nurses per week take care of only one single resident in 12-hour shifts. Four (4) professional nurses are assigned for one single resident per week. Our healthcare team comes in on two (2) alternate shifts per day in a 7-day period taking care for only one resident. Our nurses and caregivers work for 12 hours a day, 3 to 4 days a week, so they can provide their services effectively in their full potential.

The 24-hour professional care includes:
catering, cleaning, laundry and room service.
house accommodation with high quality European standards.
massage and a full range of activities with the elderly.
trips, entertainment, etc.

Compared to the high costs of being in congestive nursing facilities in Western countries, where there is a sad reality of less quality care, you will save for up to 70% by staying with us for a sophisticated and heavenly nursing home service.

The cost of Intensive Care is slightly more than that of Standard Care, but it provides 100% more health care intensity.

Standard Care
House Price per Month (USD)
Riao $1,360 to $1,840
Mandu $ 1,690 to $2,020
Molo $1,870 to $2,190 (c. £1,350).
Two (2) registered nurses per day or four (4) nurses per week take care of two residents in 12-hour shifts. Standard Care includes high quality medical and social care

Cheaper care services are also offered in the Philippines: At it is stated: ‘We are strategically located at higher elevation and cooler part of San Juan, and of the entire Metro Manila. Thus, our home is safe from the rain and flood in Manila. We are very close to Carnidal Santos Medical Center.

Two-Bedroom House, One Patient per Room.

Our family-oriented staff consists of a supervising nurse and one caregiver for every elderly. The … services include 24-hour care, regular meals, and laundry. A doctor is on 24-hour on-call for emergcy cases. Visiting hours is between 6pm to 9pm everyday or by appointment.

(We) provide a 24-hr communication channel between the elderl(y) and their families … a secure web camera of the client’s room will be shown … to the concerned family.

The following are the detailed services we provide:
– one supervising nurse and two nursing assistants per elderly
– regular meals and laundry included
– 24-hr on-call to doctor, nearby hospital, and concerned families
– scheduled daily visits for client families
– telephone, email, and chat are allowed channels of communication
– secure web camera access for care supervision

Total cost per month for one elderly patient is PHP 30,000.00 (around USD 721.59). (c. £470).

In giving details of these services, I am not endorsing them. I can say that I have worked with very caring Philippino and indian care staff, and the possibility of care being monitored by a web-cam is a positive indication of good care being provided.

What I believe to be the main ethical issues surrounding overseas care are as follows:

Outsourcing a parent (or disabled child/adult) is not the same as relocating a call centre, at least not to most people. An individual struggling to meet care costs might face an agonising choice of sending themselves overseas – “it will help my family, I will be able to leave them my house”. Most would move ‘heaven and earth’ not to send their mum , dad, son, or daughter abroad. Some would not make such effort.

Will government eventually insist on overseas care? This is the main question for the future. The weasel-speak of divide and rule can be imagined: “In times of austerity it is wrong for the elderly and disabled to be a burden to hard working, apiring families. This government will provide the transport costs to high quality ‘care in the sun’ for all”.

The logic of ‘market forces’ makes this inevitable.

Those in possession of absolute power can lie and make their lies come true.

lenin nightingale 2015




When Jeremy Hunt recently attacked the Royal College of Nursing (to be called, henceforth, Cecilia), by calling “ridiculous” its perceived threat to recommend nurses strike over plans for a seven-day NHS, he sent a warning shot over Cecilia’s bow. This worked, for Cecilia, wetting her knickers, soon sent out clarification of her position, her spokesman explaining: “There’s a big difference between industrial action and strike action. Nurses are never going to do anything to damage patient care and the RCN’s own rules would not allow that. What we want to do is sit down with the Government to work on how to take this forward in the interests of better patient care”. Cecilia is reprieved, no chopping block for now.

Some words to Cecilia: Of course, the issue of ‘unsocial’ hours payments for nurses is being considered by the government, but there are far more dangerous plans under the government’s microscope, one of which is the issue of split shifts. Nursing colleagues in Australia have battled against this ‘market friendly’ imposition for years, as headlined: ‘State Government proposals for nurses to work split shifts are an attempt to pass on cost savings being forced on hospitals, the nurses union says'(, 2011).

This report quoted ‘State secretary of the Australian Nursing Federation, Lisa Fitzpatrick, (describing) as unbelievable a government proposal for nurses to work split shifts from 7-9.30am, then midday-3.30pm, as part of enterprise bargaining negotiations. Fitzpatrick hit the proverbial nail: ‘All of the shift reduction initiatives the government is proposing are about reducing the nursing pay budget … If you pay less nurses for less hours then hospitals can make the savings the government is forcing them to make because of the decreased budgets they are receiving this year‘. Sounds uncanilly like  UK 2015.

Dear cecilia, before you curtsy to those who will ordain such a system on British nursing, please consider the full extent of it. The government’s plans mirror those found in restaurants – cooks and waiting staff often work only during mealtime rush periods, which means they might work the lunch shift, clock out for a few hours, then return for the dinner shift. A nursing split shift might mean being on duty from 7am-10am, then 2pm-7pm.

This is not the worst case scenario, as gaps between ‘shifts’ might only be two hours. In California, nurses with more than one hour between shifts receive a split shift premium of an extra hour’s pay. Union contracts also sometimes mandate special benefits for split shift workers, such as a minimum or maximum amount of time between shifts. There will be no such ‘benefits’ in the UK, for such as Cecilia will merely curtsy to the lord on whose table they wish to sit.

But a double commute will reduce personal time, and be expensive, especially if you live far from work. Tough luck on any partner or children.

Computer programmes for split shifts in nursing are already used throughout industry: ‘The Split-25 Excel spreadsheet creates schedules where each employee can be assigned to 1 or 2 categories … 1 or 2 locations … and 1 or 2 times (10:30 AM – 1:30 PM and 4:00 PM – 8:00 PM) each day for up to a month. Shift assignments are made from drop-down menus of qualified employees. The spreadsheet can … also keep track of your payroll budget based on employee wages and scheduled hours’.

Factoring in agency nurses is not a problem: ‘One option for scheduling a difficult-to-fill shift is to “split” the shift so that it is worked by more than one provider. For example, if no single provider is available to work the entire shift, the first half could be worked by one available provider and the second half by a different provider. Split shifts in EPSKED are shifts that are normally worked by only one provider, but are instead being split between two or even three providers’ (

The salient point here is cost reduction. These systems can find the cheapest mix of staff.

Hours of work may not be known in advance. Nurses await a text message.

Another facet of the torture to come is that these split shifts may be ‘floating split shifts’, which mean that a nurse starts their shift in one unit and then at some point during the shift is moved to a different unit. If you are late at the next unit, you get a bollocking. No time, then, for a full report to the next nurse, thus, patients’ continuity of care is likely to suffer. This system is quite common in America, and will be introduced under the Americanisation of British Nursing Plan being fine-tuned by the corporation-serving UK government. (These ‘reforms’ will also include doctors and care assistants).

Some nurses, rather like Boxer of ‘Animal Farm’, will embrace such change, internalising government rhetoric into their belief system: “I’m a flexible, modern nurse, fit to meet the demands of a changing society” – to paraphrase Wordsworth, people think what they must, then call it by another name. Some nurses will leave, the strain on their social and family life being intollerable. The army of foreign nurses will just get on with it, and jump through whatever hoop is put before them, as long as they can continue sending money home.

Cecilia, meanwhile, will continue to chant: ‘What we want to do is sit down with the Government to work on how to take this forward in the interests of better patient care’, whilst quoting selected studies which the government does not care a rat’s ass about, for they will commission studies showing right to be on their side.

Oh my dear Cecilia, they so dislike you that you are not even told of their plans. Do you honestly think they give another rat’s ass if you sit down with them or not? You are like a little girl in a school yard who is not part of the gang.

Cecilia will not do anything to damage patient care?

Leave that to the government, as long as Cecilia can negotiate the best terms of nurse ‘flexibility’, thus damaging patient care!

Must not strike like naughty Australian and American nurses!

Will Cecilia recommend that ‘enterprising’ nurses work in McDonalds between their split shift? “Get those fries down you, I’m due to give an injection in 10 minutes”!

Oh Cecilia, have you ever considered that nursing exists within a starkly political world, in which the only defense of nursing is a robustly political one?
lenin nightingale 2015




It was very heartening to see that the New South Wales Nurses and Midwives’ Association (NSWNMA) commissioned a television advertising campaign in February, 2015,to warn of the perils of Australia adopting an American-style health system.

The campaign went under the banner of ‘Patients before Profits’. ‘General Secretary of the NSWNMA, Brett Holmes, said ‘the Liberal-National Government’s current health agenda of privatising public hospitals and services could result in a public health system in NSW where patients pay more and corporate shareholders make profits on taxpayer-funded services’ (1). Mr. Holmes spoke of the Americanisation of the Australian public health system, and detailed the present scope of this policy: “Sub-acute mental health services are being privatised, new palliative care services have been gifted to the for-profit sector and disability services will cease to be government-run by 2018” (2).

This is the same process which is being planned for Britain. When politicians use weasel-words to advocate why and how the British public health system should be ‘modernised’, they really mean ‘Americanised’, which is to fragmentise and corporatise.

The plan is to introduce a seven-day NHS, but as with everything gushing from the mouth of neoliberal politicians, the devil of the lie is in the detail. There will be seven-day GP services, but if the gullible think that equates to getting a weekend GP appointment, they are deluded. The service to be offered will be a ‘local’ one, serving a relatively wide area – you will be able to see a doctor at a regional clinic, some 10-20 miles from your home. Will there be public transport available for the sick, elderly, young, and disabled who do not have access to a car? Will they be able to afford a taxi? Will a ‘Big Society’ neighbour come to their assistance?

All other services, once under the roof of the local hospital, will be similarly dispersed, with patients being asked to attend far-flung speciality clinics, catering for diabetics, pregnant women; those in need of physiotherapy, and radiotherapy. These services will be privatised. At first, private companies will be paid by the government,but such changes will be accompanied by offering a queue-jumping, two-tier standard of service, built on private health insurance, currently experienced by Australians, and commented on by them in blog posts:

‘The mix of insured and medicare only patients in hospitals is already producing a two level system. A single mother, public patient with no private health insurance falls down the operating list behind those with health insurance even when this involves the hospital’s own protocols are being ignored. A surgical procedure which is determined should be carried out in 24 hours after admission can be delayed for a non-privately insured patient. In one instance where the delay was a big factor … this resulted in death. We already have a two tier system of health care because of the involvement of private health insurance – paying customers are given priority over the non or low payers’.

‘Patients in private emergency departments who get investigations that are absolutely not required, an example , serial ECGs, for presentations that are blatantly not even remotely cardiac, that adds up to a pretty large amount when 80-100 patients run through the department each day. Proceedures that aren’t even performed, for example claiming for a fracture manipulation under a form of regional anaesthesia (known as a Biers Block) when then fracture had no manipulation and had a simple cast applied by a plaster technician (not even a doctor)’.

‘We already have a two level system. Recently a friend found out she had a tumour that needed to be urgently removed. She is not privately insured and was told by her surgeons that to receive the best outcome from the surgery she should have the procedure done as a private patient. Faced with a very delicate and dangerous operation she felt she had no alternative but to pay over $40,000 for the operation in order to ensure the best outcome. I was shocked and suprised that our health system cannot guarantee the same quality of service for both private AND public patients when dealing with serious and/or life threatening conditions’ (3).

The plan for seven-day hospitals is also a sham, predicated on the prediction that seven-day services would save lives. However this may be, it is a Trojan Horse, the real aim of which, as elucidated by David Cameron, is to see NHS staff work “different shift patterns” (4). This is weasel-speak for ‘split-shifts’, with ‘flexible’ staff waiting to be summoned to work via a phone or text message. It is also the precursor of ditching unsocial hours payments, for, without this cost-cutting measure, ‘reforms’ would not be funded. This was what Cameron meant when he said people should “not automatically assume” increasing services would cost more, without any explanation (5).

These ‘reforms’ will also bring about a ‘skills-mix’diminution of nursing – ‘nurse technicians’, trained in specialities over one year, will replace nurses, whose three year degree covered a Jack-and-Jill spectrum.

It should not be expected that such as the RCN will take a political stance against the cultural vandalism planned for the NHS, repeating the sentiments of Mr. Holmes: “The American health system is not a model we want replicated here in Australia or, importantly, in NSW. It is plagued by unethical corporate interests and health outcomes for patients are far worse as a result of exorbitant medical costs” … “Rather than criticising the workforce who stand at the frontline of our health system, the Liberal-National Government should listen to the nurses and midwives who endeavour to deliver safe patient care and the best health outcomes possible to the people of NSW” (6). RCN members will pass resolutions at their ‘coffee and bun’ conferences, but these will go as unheard as farts against a gale.

The context of the aforementioned ‘reforms’ is the Americanisation of Europe, taking place under what is euphemistically called the Trans-Pacific Partnership trade agreement, otherwise known as TPP. In its simplest terms, “free trade” means one thing only — the ability of people with capital to move that capital freely, anywhere in the world, seeking the highest profit. It’s been said of Bush II, for example, that “when Bush talks of ‘freedom’, he doesn’t mean human freedom, he means freedom to move money’ (5). Under this plan, all national sovereignty is lost, as the treaty terms are enshrined in law, with its own court system, the TPP court, in which American corporations will be able to sue participant countries for “lost profits”, that is, profits denied them by not allowing unfettered access to markets; whether that ‘market’ is fracking or health care. No national court will be able to overturn a TPP court decision. Corporations of the American-World-0rder rule.

Thus,however the forthcoming debate about Britain’s membership of the EU is conducted, however much disinformation is given, the one certain thing is that it is a meaningless sham – Britain will be forced to abide by its TPP treaty obligations, with all its ramifications for nursing.

A question for all nurses is this: should the RCN enter the political arena in which health care is determined, as gladiators, or should they sit at Caligula’s table and nod at every downward thrust of his thumb? It should be added that being a groveling, obsequious, sycophant was not a guarantee of survival – (Caligula had recovered from being very ill). A senator: “I offered my life to Jupiter to spare our beloved Emperor”! Caligula: “Jupiter accepts your offer”. Caligula, turning to his guards, “Execute him”!

You who are about to be struck, strike first!

lenin nightingale 2015


(1), 8th February 2015.
(2) ibid.
(3), 13 August 2013.
(4), 18 May 2015.
(5) ibid.
(6), supra.
(7), 2013


Following the unacceptable treatment of his father within a care home, and his subsequent ban from being able to visit him, Paul Doolan campaigned alone to secure changes. His initiative has finally come to fruition- after he secured some lottery funding. There are others who similarly campaign alone, albeit with different goals.
What must be admired is the sheer persistence of these individuals against all odds- with little support from others, in addition to personal psychological or financial hardship that may ensue.
Paul has established based in Somerset which has launched their “Fair in Care” campaign for trained Lay Visitor Volunteers who are to be given access at anytime to Care establishments and Hospitals with powers to access records. Paul Doolan their Chief Executive says the Public have lost confidence in the CQC as an Inspectorate and we need a pro-active system rather than like CQC mainly reactive. Homes and Hospitals are frequently given Notice of Inspections and recently Weston General Hospital delayed a CQC Inspection at Christmas as they were too busy! The Inspection is now due to take place next week. Care Providers and Hospitals know too well that Inspections are extremely unlikely to take place at night, week-ends and Bank Holidays. Trained Volunteer Lay Visitors can fill this gap and reassure the Public and restore confidence in the Service. As Paul Doolan states, the whole care system needs more vigilance and outside checks. The group are lobbying the government to achieve the same powers for lay assessors who will be statutory, as CQC inspectors. As Paul asks “will anyone really disagree with their loved ones being checked on more regularly?”
We will watch the development of this group with interest- it may well lead to other things.

Details of Help-in Care and requests to sign the petition calling for lay inspectors as discussed above , are here


It seems relatively easy to gather information on how many recently qualified nurses are given permanent, full time contracts in the NHS. Just send an email to Freedom of Information Co-ordinator of the Hospital Trust. This is where the fun begins, because if the information you require is not contained in the Trust’s Publication Scheme, you will be typically asked to stump up £25 per hour for research into your question.What is more, under the Freedom of Information (FOI) Act and Data Protection Act (Appropriate Limit and Fees Regulations 2004), if your request is deemed to take more than 18 hours of work to complete, then your request can be turned down.

One Trust’s contact details regarding FOI was hidden within a pdf document that was so large a NASA computer would have difficulty in downloading it. A clever ruse, this, and probably one designed by the Trust’s chief executive, who receives an annual salary of 20 times that of a first year staff nurse. You may be interested to know what a part of his £500 a hour job entails. If you are denied information that you feel you are entitled to, he will listen to your complaint, before sending it off to the mile-tall grass of the Information Commissioner.

In order of fairness, it should be pointed out that the top five executives of this Trust receive a cummulative total of £3 Million per year. Where there is an open honey-pot, more than one bear will dip its paw in it.

I had decided to contact the 20 largest Hospital Trusts, because an initial survey of their job notice boards showed that no more than 15% of jobs were at staff nurse level, and a third of these stipulated that the applicant should be experienced, that is, not a newly qualified nurse.

On all job application forms, there was information giving advice to overseas nurses on how to apply. The NMC deploy some of its 440 staff in assisting non-Eu nurses to obtain a temporary work visa whilst preparing to take the NMC’s equivalency test. It could be added that many nurses from abroad end up working as agency staff, who are under intense pressure to accept shifts at very short notice, both within the NHS and private nursing homes – the necessary opt out of the EU Working Hours Directive having been signed. The ill being care for by the exhausted. The future revealed.

The agencies that assist foreign nurses to work in the UK typically insist of ‘1 years experience as a registered nurse’ … a ‘need to be fully registered with the NMC’ … they ‘can assist with this’… no CV, no problem – ‘please use our free CV Creator’… once registered, we will send you ‘a shortlist of suitable vacancies’ … ‘If your details are accepted by the hospital , we will arrange a time and date for an interview. If you are overseas the interview can be conducted via telephone’! (No face-to-face quiz, then? Get someone to sit next to you who knows the answers, a bit like ‘Who Wants To Be A Millionaire’s ask an expert!) … After this rigorous process (don’t all laugh at once!) ‘the employer will issue you with a Skilled Worker certificate’ … nowhere to live, no problem! – ‘Many of our clients offer nursing accommodation’. It beggars all belief. What chance has Joe or Jill New-Nurse?

The NMC will insist on receiving: ‘Registration certificate, Birth Certificate, Copies of Diplomas References from previous employers, Transcript of your training from your training provider. This should include details of the amount of practical training you have had. 2. Payment’. This is a farce – there is no way of detecting state-of-the-art forgeries, or if an employer or nursing college has been bribed to include someone on their records. The international gangs of criminals that run the forgery racket give a no-detection guarantee. (Lenin has previously published where to find this information on the web – the NMC’s required documentation can be bought for £300). Would the BBC be prepared to acquire such documentation for an overseas emloyer, perhaps a typist, and film them turning up for their first shift on a casualty department? Great tv, but political dynamite. Who is aware of what?

When foreign applicants are advised that it may take 3 months for the NMC to verify documents, they are not referring to a painstaking process involving foreign language experts, as is the standard adopted by many American states; the delay is only a consequence of too few staff being allocated to a mountain of applications. (Lenin has asked the NMC to detail how many expert staff deal in document verification – 2?, 4?, no reply. The government have replied – none of our business, it’s up to the NMC!). If the most rigorous, and costly, methods of verification were used, it is Lenin’s belief that UK universities, hospitals, and nursing homes would lose 50% of their ‘students’ and ‘nurses’. Before anyone bleats about Lenin being racialist, the fact is that he has a long record of defending the human rights of all nationalities. This is accompanied by a similarly long record of exposing scams.

The description of the desired personal profiles of candidates for NHS Trust jobs is couched in a plethora of superlatives. The successful candidate would have to be a cross between Wonder Woman and Mother Theresa, or, not to be sexist, between Batman and the Pope. An old hospital matron once told me that when we stop being human, we become ridiculous, and deserve ridicule, an apt comment to those who use ‘management speak’ to ask for Batman or Wonder Woman, when a decent and caring human being is all that is required.

What was evident is that NHS Hospital Trusts also advertise job vacancies in clinics run by private contractors. The future is revealed – poor pay, work when told, long hours, collapse from exhaustion, and all this whilst being expected to be ‘super’,’passionate’, ‘outstanding’, and any other such bullshit adjective.

I have been concerned about the number of nursing students who drop out of their courses, having been contacted by students who claim that academic requirements are too much a strain on other roles, typically, that of being a parent. Those who do complete their training are all too often not being given a first staff nurse job, because they lack the necesary practical experience, a situation also prevalent in America and Australia. One American blogger is now advising newly qualified nurses to ‘to explore other employment settings and non-traditional specialties’, i.e. get out of nursing, or look for a ‘privatised’ job in the community, the hospitals of the future becoming nothing more than core ICU sites.

When such as Andy Burnham is repeatedly regaled by the fact that ‘only’ 7% of NHS Services have been contracted out’, his reply should, with respect, be a bit more memorable than what he has managed so far, something like, “the Trojan Horse was much smaller than the walls of Troy, but once inside it gates began to destroy everything within them”. This round of contracting out is only the opening gambit – we follow American corporate health policy as surely as we followed them into Iraq.

A young man wrote about the £3 million a year honey-pot NHS Trust, explaining that he did not think there was a shortfall of nurses, and, as a newly qualified nurse, he had applied to the Trust several times for a job, only to be told he did not have the necessary ward experience. Perhaps he should apply to be the butler of the Trust Chief Executive; he could soon pick up how to crack oysters and serve caviar and truffles.

All training should equip students with the necessary ward experience. It is useless if it does not! The RCN’s position of calling for more nurse training places, without conducting a survey of the drop-out rates of nursing students, and the reasons given, and without enquiring what percentage of nursing students get a full time, permanent NHS contract, and the reasons given, strongly suggests that they are only concerned about protecting their members who are university lecturers, those most eligible for RCN awards and grants.

The NMC and the RCN have enough money to pay NHS Trusts £25 per hour to conduct research – nurses give it to them! Their associates in the universities should, of course, give information for free, unless you do not expect turkeys to vote for Christmas, that is. (The drop out rates of some nursing courses are shockingly high, but such as the RCN want to keep this quiet; their call for more nursing students is like a world War One general saying “the more we send over the top, the more might get through”!).

Dear friends, the RCN, in reply to Lenin’s repeated suggestions for improvements in such as their nurse revalidation (by employers!) system, has sent him a copy of their Policy Document! It is like saying, “dear Lenin, just read our bible and all will be crystal clear – you will be converted to the true path”! It is a condescending and deflectory reply – a cowardly one.

As George Orwell might have wrote: As nurses look from NMC to RCN, they realise they can no longer distinguish between the two. This Establishment-approved alliance oversee a system that is sending nurses to the knackers’ yard. Many are already there, of course, their use ended, their blood sucked from them. Bring on the new batch of cannon fodder – Joe and Jill New Nurse.

This may seem like an article of unconnected issues, but there is a common theme running through it – we live in a world of half-truths, cover-ups, and outright lies.

Who is aware of what?
lenin nightingale 2015