Social work ethics on trial over recr uitment from developing countries

Concern that England is bleeding dry the developing world’s social work talent has prompted the development of a code of ethics on recruitment. Gordon Carson reports

South Africa’s social problems are enormous. About 10 million of its 15.3 million children live in poverty and more than one in 10 of its 47.4 million people, a similar population to England, are HIV-positive.

But it has only 15,000 social workers compared with England’s 75,000.

And more social workers from South Africa – 938 – than from any other country have applied to register in England in the past two years. Another big exporter of social workers to England is Zimbabwe, itself no stranger to major social problems.

Although it is the prerogative of individuals anywhere to decide where they should take their skills, this brain drain of professionals is making it difficult for developing countries to tackle social problems.

There are also concerns that councils and agencies in England are actively recruiting social workers from developing countries to plug workforce gaps here, particularly in child protection.

Ian Wilson, director of social services at Tower Hamlets Council in east London, says it is unethical to actively recruit social workers from developing countries that need them.

But such conduct could soon come under more scrutiny through a code of ethics on the international recruitment of social workers that is being produced by the Improvement and Development Agency, with backing from the Department of Health.

The DH issued a code of practice for the international recruitment of health care professionals in 2001, which was revised in 2004. Linked to this is a list of countries that health employers and agencies should not recruit from, including South Africa and Zimbabwe.

South Africa’s social development department is doing its bit to dissuade its social workers from moving overseas, by improving pay and working conditions. Its spokesperson Kgati Sathekge admits the department is worried by the exodus of skilled social workers but says: “We can discourage them by offering better incentives.”

Merle Allsopp, director of South Africa’s National Association of Child Care Workers, which represents people working with at-risk children, says the country is struggling with a skills deficit in social services.

She believes the South African government could have overestimated the size of the country’s social services workforce, saying there could be as few as 11,000 social workers, and says it is not unusual for an area of 100,000 people to be served by just one social worker.

She adds: “The child protection infrastructure in this country is very basic. The needs are overwhelming.”

Allsopp says South African newspapers regularly contain advertisements for social work jobs in the UK. “I’m not sure about the ethics of the situation,” she says. “It’s complex.”

Ray Jones, chair of the British Association of Social Workers, supports a code of ethics as it would highlight best practice in international recruitment. There is a “legitimate concern” that some developing countries are being stripped of social workers after they have invested in their training, he says.

But this must be balanced against the opportunities that migration presents to social workers to add to their experience, which they could take back to their own countries.

“Often it’s not councils recruiting, it’s individuals doing it through agencies and getting short-term employment in the UK,” he says.

Jones points out that many UK social workers also take the opportunity to work abroad to develop their skills. He is chair of the Marlborough Brandt Group, an international development charity that links Marlborough in Wiltshire with Gunjur in The Gambia. It sends doctors, nurses and social workers to work in the West African state.

Julia Fraser, managing director of the Healthcare and Social Care divisions of recruitment consultancy Hays, says this sort of approach could counter the brain drain.

She suggests that UK government departments or private companies could establish links and exchange programmes with their opposite numbers abroad. Through this, for example, UK social and health workers could learn a lot about HIV care from South Africa.

The prospect of recruiters complying with the code has been boosted by the support of the Association of Directors of Social Services. Its workforce development committee is now preparing a recommendation to this effect to put to members.

However, Fraser, while supporting the idea in principle, has concerns from her experience of the health care code about “who decides what’s ethical and on what basis”.

She argues that sometimes a country is placed on, or left off, the list because of political rather than ethical reasons.

Hays is a signatory to the health care code and has also chosen not to actively recruit social workers in South Africa. But it does recruit South African social workers who move to the UK to look for work.

Fraser says a social work code would help to root out unscrupulous practice. But she says the global shortage of health and social care workers is also a factor.

“If they don’t come here, will they go to the US, which doesn’t have a code of ethical recruitment, or the Middle East or Australia?” she asks. “Are we trying to prevent people from making a better life for themselves if they so choose?”

Subcontinental drift
India is another major exporter of social workers to England as its universities produce more social workers than can be employed domestically.

Councils in England, including Tower Hamlets, have taken advantage of this and brought Indian social workers here to fill vacancies.

All but one of the 16 Indian social workers recruited by Tower Hamlets in April 2005 still work for the council. Ian Wilson, director of social services, says they have fitted in well.

It is now looking at recruiting social workers from Bangladesh, from where one-third of the borough’s population hails.

Health care code
Almost since its inception, the NHS has relied on international recruitment to fill workforce gaps.

The Nursing and Midwifery Council registered nearly 11,500 nurses from overseas in 2004-5 – more than a fifth lower than the peak of 15,000 in 2000-1. Among the top exporters to the NHS in 2004-5 were India (3,690 registrations) and South Africa (933).

After concerns that overseas recruitment was hurting some developing countries, the DH issued a code of practice in 2001 stating that NHS organisations should not target certain countries to recruit permanent staff unless there is an “explicit government agreement”. It was revised in 2004 to include independent health care providers and recruitment agencies.

But the code, which is now the responsibility of employers’ organisation NHS Employers, does state that the international recruitment of health workers is a “sound and legitimate activity if carried out using an ethical and managed approach”.

Linked to the code is a list of more than 150 countries that NHS bodies should not recruit from, based on their economic status and the number of available profess-ionals.

Foluke Ajayi, head of NHS Careers, a division of NHS Employers, says the code has “changed people’s mindset so they automatically now take into account ethical considerations when recruiting”.

She says there have been times when NHS Employers has had to investigate agencies and NHS trusts about recruiting but adds:
“The longer the code of practice has been in place, the fewer investigations there have been.”

Further information
National Association of Child Care Workers
Marlborough Brandt Group