WHEN PRIYA* LEFT Delhi to come to Ireland and work for the HSE last September, she knew she was going to miss her daughter’s second birthday the following month. It was a sacrifice she was prepared to make for her family to have “a better quality of life”.
The 33-year-old wanted to get away from the air pollution, crowded streets and soaring temperatures of India’s capital city, where the effects of climate change are being felt more and more each year.
Having grown up in a Catholic household in a village in southwest India, Priya thought that Ireland would be “a peaceful place where we could fit in easily”.
Seven months on from her arrival, after a three-month delay to her starting work in a new community nursing unit in Cork city, the mother-of-two hasn’t been able to find a house to rent so her family can join her.
As a result she has been away from her five- and two-year-old children for far longer than she expected on coming here, and has missed her youngest learning how to talk.
“I wish that the agency I came through – or the HSE – had warned me about the housing crisis here. I was not prepared to spend this much time away from my husband and kids. I still don’t know when they will be able to come and join me,” Priya said.
She is currently renting a single bedroom from an Irish family in Blackrock, which is 40 minutes away from Heather House, the new nursing unit on Cork city’s Northside that offers long-term and palliative care to roughly 60 older people.
Priya came here in a group of nine nurses that were selected to work in the HSE’s Community Health Organisation 4 (CHO4). The group comprised seven from India and two from Zimbabwe.
They went through an extensive recruitment process that started with an online interview last February.
Moving to Ireland to work as a nurse is expensive. Between the Royal College of Surgeons in Ireland (RCSI) aptitude exam fee (€2,800), visa fees (€100), the Nursing and Midwifery Board of Ireland (NMBI) registration fee (€145), the cost of sitting the language exam and the fee to have your previous qualifications recognised (both amounting to €350), it costs migrant nurses a substantial amount of money. Applicants often have to take a loan out or borrow from family and friends to cover the costs.
Priya claims that she and the other nurses from India she travelled with paid for flights, tests, qualification recognition and their visa, which they were told would be reimbursed in full. They were also promised one month of paid accommodation when they got here by the HSE.
However, she said that a substantial amount of her down payment was not reimbursed, to the tune of roughly €1000, including the English language test fee and the fee to have her qualifications recognised. She also claims that the agency only covered a portion of the flight ticket price.
“We waited from our last interview in April last year to find out when we could come over. Eventually we were told in September that we would be travelling to Dublin to sit the aptitude test.
“I asked the recruitment company repeatedly to book the flights in advance, but they ended up booking business class flights the week before we left that cost over €1,000. We were then told that there is a maximum they can pay for flights, and they took the difference out of our initial payments.
“I have asked when I will be reimbursed for the rest of the money, but there has been no answer,” she said.
When Priya and the others got to Dublin they stayed there for a few weeks in order to sit the RCSI aptitude test, which is required for migrant nurses to practice in Ireland.
Applicants get two attempts to pass the test, which consists of a theory paper and a practical assessment. If they fail the second time, they have to go back to the country they came from.
“That was the most stressful experience of my life, and I worked as a nurse for 10 years in India. There are 14 stations for us to perform tasks at, with 10 minutes at each and no break. The pressure is so immense because you know that if you fail you will have to go back home, and your family has invested so much in you being here,” Priya explained.
After passing the test she was told that she’d been assigned to CHO 4 in Cork, where she would be working in community nursing.
“We were given the address and phone number for the family we would be staying with. We got on the bus and then asked a taxi to take us there. I thought I’d be starting work in the next week, but even though I kept asking, there was no reply,” Priya said.
When the month was up and Priya moved into a single room in another family’s home, she still wasn’t working and she had no money left to pay rent.
“We got together as a group during October and went to the INMO [Irish Nurses & Midwives Organisation] trade union and asked them to help us. They negotiated with the HSE and managed to get them to pay us a basic salary, but they still wouldn’t tell us when we could start working,” she said.
As building works dragged on for the new ward at Heather House, Priya was told at the end of November that she would be starting her induction in another community hospital in Farranlea, but she didn’t know how long she’d be there for. A few weeks later, she was told that she would be moving to work in Heather House.
Nearly four months on, Priya is finding working life in Cork tough without her family.
“I enjoy my work, but it is very hard to find a time when I can talk to my children when I am on duty, because of how busy I am, and the time difference.
I either work from 7.45am until 8.15 pm during the day, or from 7.45pm to 8am overnight.
“My shifts involve administering medication, helping with feeding people, looking after their hygiene, helping my patients get from their bed to their wheelchair, dressing their wounds, helping them with GP appointments and sending for their prescriptions. At night I get our residents ready for bed with the help of healthcare assistants.
“Like anyone working in the health service, sometimes I am too busy to take a break. Some of our residents have dementia and they will ring the bell for us to come every few minutes.
“Even if I could get away to call my kids, it doesn’t work out with the timing,” Priya said, becoming upset.
“The hardest part, I think, is when I do get to talk to them and see them on video on my days off, and they walk away from the phone. They are children so they don’t realise, and any parent will know what it is like trying to get kids to stay on video calls, but when I have not held them in so long… that is very hard,” she said.
After spending over a year on the effort to work and live in Ireland, Priya is not prepared to give up on her family’s plan for their future here.
“I hope they can come soon, I am doing everything that I can,” she said.
In response to The Journal, a HSE spokesperson said that the HSE’s relocation package last year included the reimbursement of flight costs and up to 28 days of accommodation costs to a maximum combined value of €4,710 for nurses relocating from non-EU countries.
It further stated that its relocation package allowed for the reimbursement of the language test and examination required for NMBI registration and recognition of qualifications, as well as “other costs”.
The Government has ramped overseas recruitment of healthcare staff in recent years in an attempt to try and solve the overcrowding crisis that is pushing the country’s hospitals to breaking point.
In recent weeks, Minister for Health Stephen Donnelly unveiled his Department’s plan to bring an additional 1,500 hospital beds on stream over the course of this year and next.
Representative groups have stated that this plan will fail to combat the pressures the health service is currently under unless it is accompanied by an urgent staff recruitment and retention campaign.
As healthcare professionals educated in Ireland, including nurses, have left in increasing numbers to work in Australia and other countries in recent years, recruitment companies working for the HSE have turned to places like India and the Philippines to fill empty positions.
There are over 12,000 Indian nurses in Ireland at present, and Indian nurses are being recruited more so than any other overseas nationality.
However, the INMO and several nurses working with advocacy group Migrant Nurses Ireland (MNI) have expressed real concern about the lack of Government oversight involved in the recruitment process, and the kind of accommodation provided to overseas recruits, both in the public and private sector.
Jibin Soman, who is a nurse at Cork University Hospital (CUH) and the chairperson for the international nurses section of the INMO, said that he is currently in contact with around 15 migrant nurses working in CUH who have had to delay bringing their families and children to Ireland because they cannot find rental accommodation.
These nurses came from India after an extensive recruitment process and were put up in paid accommodation by the Health Service for the first month following their arrival.
Many were living in spare rooms of families who live near the hospital and had signed up to host HSE nurses.
“These nurses had nowhere to go after their month of staying in provided accommodation was up. Most of them have continued to rent from their host families, but some have had to stay with friends. Meanwhile, their families and children are still in India, waiting to join them.
Some of these nurses have been in this situation for five months, some upwards of six.
“It takes a lot of time and money to come here – it is not something you do overnight. These nurses are in their 30s and 40s as the HSE is now specifically recruiting more experienced staff, many of whom have children, who they did not know they would be waiting so long to see again,” Soman explained.
He further said that he believes the HSE will have to invest in accommodation specifically for overseas healthcare staff, as more and more are being recruited into the country.
“Nurses will end up returning to their home country if they cannot bring their children here. They are not being warned properly about how severe the housing crisis is,” Soman added.
In February, 25 nurses who came to Dublin from other countries to work in St Vincent’s University Hospital were told that they would have to leave their provided accommodation after three to seven days, despite being promised that they could stay for six weeks.
The nurses went to the INMO for help. They also turned to MNI and an appeal was sent out to see if anyone could house the nurses on an urgent basis in spare rooms or on their sofas.
After the trade union got involved, the hospital took immediate action to meet with the nurses and resolve the issue.
A spokesperson for St Vincent’s said that the hospital was not initially aware that the nurses were asked to leave their accommodation after the first week by the recruitment agency that it had employed. They further stated that the nurses were reimbursed for “out-of-pocket expenses”, such as B&B fees.
The spokesperson explained that the hospital works with an agency in order to recruit “significant numbers” of nurses from overseas countries, including India and the Philippines.
The hospital has stated that since the incident, it has set up a new “care pathway” for nurses from overseas that will see the recruitment agency which facilitated their journey to Ireland coming in to meet the nurses on the first day of the induction programme in the hospital. They will be joined by the Director of Nursing and key senior management staff to ensure “all is in order”.
The INMO has stated that it was particularly alarming for this group of newly recruited nurses to be told that they would have to find somewhere to live on such short notice, as they were not fully aware of the “full extent of the housing crisis in Ireland” at the time.
“It is clear that proper checks and balances are not in place if promises made at the time of recruitment are not being fulfilled when these nurses arrive in Ireland,” the union said.
Varghese Joy from MNI has welcomed St Vincent’s Hospital’s decision to set up a new “care pathway”, but added that there needs to be further regulation and oversight introduced on a national basis to ensure that migrant nurses are being treated properly.
While some nurses are having trouble finding accommodation after coming to Ireland to work for the HSE or large hospital groups, they are at least provided with temporary paid accommodation and they are recruited by mainstream agencies that adhere to Ireland’s employment agency regulations.
But Joy said that the most worrying instances of migrant nurses being exploited are occurring when nurses from India and the Philippines are being recruited through Indian agencies, which have agents working in Ireland, to work in the private nursing home sector here.
Many of these agencies are charging nurses an additional fee for their services, which often amounts to the equivalent of €5,000, on top of actual costs, which amount in turn to roughly €4,500.
“It was very different when I came to work as a nurse in 2007. I was provided with free accommodation for six months, and I went through one of the well-known HSE contracted agencies. I had to pay for my flights, my visa and my aptitude test, but that was it,” Joy said.
In the last few years, international healthcare staff recruitment has become a booming industry in India, with many different agencies vying to recruit Indian nurses for nursing homes in the UK, Ireland, New Zealand and Australia in particular.
Since Brexit made it more difficult for migrants to go to the UK, however, these agents have increasingly focused on Ireland.
Joy said that the number of agencies supplying nurses to Ireland, and the number of migrant nurses here, has changed drastically since he started working in the health service.
It was around 2019 that Joy started to get involved in helping nurses who were experiencing issues with recruiters and employers.
“I got a call from a friend telling me there was a young nurse at the Indian embassy who had nowhere to go because she quit her job in a private nursing home after being asked to do another shift after working seven days in a row, and the manager of the home went to the accommodation they were providing her with and put her belongings into bags that were thrown out into the street.
“Nurses coming from Kerala and other areas in India are very vulnerable to this type of exploitation because their work permit requires them to have the same employer for a year.
This is a strange rule.
“In many cases they have paid thousands to come here, they have taken out loans and borrowed money from friends and family in order to pay recruiters, who are promising a new chance in life.
“Employers know how much it has cost these nurses to get here, and it is being used as leverage to get them to work unreasonable hours, to save paying agency staff,” he claimed.
Due to flights being cancelled during the pandemic, the young nurse who Joy was called to pick up from the Indian Embassy ended up living with him and his wife for three months until she was able to get back home.
“That girl was brave. There are others who just accept it, and work to the point of exhaustion, because they don’t want to go back to their family in India, who supported them getting here, and say ‘Sorry, I have failed’,” Joy added.
Vinu Kaippilly, another Indian nurse who has lived and worked in Ireland for years, set up MNI in 2020 alongside Joy and others to try and bring public awareness to the difficulties that nurses are experiencing.
He said that it is unclear what the Department of Health, or the Government at large is doing to try and combat recruitment agents here helping agencies based in India who are charging nurses extortionate fees to come here – a practice which is not allowed in Ireland.
“I don’t know where the data is on this.
I don’t know who – if anyone – is attempting to keep track of it.
“Maybe it is because tackling these issues is like opening pandora’s box, and the reality is migrant nurses are needed here to staff the HSE and the private nursing homes, because the system is under pressure,” he said.
MNI has helped multiple nurses working in the private sector who are having to share rooms, or even a bed, with a colleague, either in accommodation arranged by their employer, or because they have gotten themselves into debt already in order to come here, and cannot afford to rent a room on their own.
Kaippilly himself took out a loan against his family home in India in order to afford the basic fees that it costs to complete the aptitude test, and secure a visa.
“It was a huge amount of money for me, but thankfully, the housing market wasn’t as bad in 2012 as it is today.
“Now that it is so difficult to find somewhere to live in Ireland, it is not really enough for the HSE to offer four weeks of paid accommodation, because many nurses will struggle to find somewhere on their own afterwards,” Kaippilly added.
The INMO has stated that as Ireland is becoming “more and more reliant on recruiting overseas nurses”, there is a need to ensure we can continue to recruit and retain nurses by providing suitable accommodation.
“The rising cost of living in tandem with the shortage of affordable suitable accommodation has had a detrimental impact on recruitment and retention of nurses,” it stated.
“We need an immediate response to the accommodation issues faced by frontline staff to maintain a frontline service. We simply won’t retain nurses if the accommodation shortages and costs are not addressed,” the union added.
In relation to international relocation packages, the HSE spokesperson told The Journal that as of 1 January 2023, it has changed the flight and relocation allowance so it can be used to cover rent for up to three months. But the maximum value has remained set at €4,710.
“The relocation package is reimbursed to individuals who take up duty i.e. start employment,” they added.
The Journal has asked the HSE if nurses who do not pass the RCSI aptitude test and therefore do not start employment in Ireland are also reimbursed.
The HSE spokesperson stated that it makes potential candidates aware of what they might “practically expect when they arrive in Ireland”.
They said that there are “widely publicised accommodation difficulties nationally in Ireland” and for that reason, the HSE is not at present acquiring any form of accommodation for staff members coming from overseas.
The HSE spokesperson said that Zimbabwe has recently been added the World Health Organisation’s list of countries who need their health workforces to be safeguarded, and therefore, at present, the HSE’s “suppliers” are not actively recruiting there.
The Journal has asked the HSE for a summary of any recruitment activities in Zimbabwe before it was added to this list in March of this year.
*Priya is not the actual name of the nurse interviewed by The Journal, this name has been used for confidentiality reasons.
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