Give us your nurses but not your health problems

We do little to help those ravaged by Aids and then winnow out those who bring the threat to ourselves

On some occasions a slew of bad news interconnects so clearly that its cumulative analysis can almost seem like a moment for optimism. Surely, one thinks, with so many things so obviously going wrong for such obviously similar reasons, these problems will now be properly acknowledged and finally fixed. On further examination though, the exposure of interlaced difficulties tends only to emphasise how intractable a situation is. This week, unfortunately, we have just such a series of stories.

On some occasions a slew of bad news interconnects so clearly that its cumulative analysis can almost seem like a moment for optimism. Surely, one thinks, with so many things so obviously going wrong for such obviously similar reasons, these problems will now be properly acknowledged and finally fixed. On further examination though, the exposure of interlaced difficulties tends only to emphasise how intractable a situation is. This week, unfortunately, we have just such a series of stories.

Take the shortage of nurses. We're desperately short of them. That much is common knowledge. But a government department has now exposed just how disquieting its woes have become. The Department of Health says that it is concerned about the amount of HIV there might be among NHS workers. And, in doing so, it has revealed the rather nastily inward-looking short-term solution that the Government has been forced to alight on in solving it.

We're all aware that Britain has found itself in the invidious position whereby it scours other, poorer countries who need trained professionals so much more than we ought to, in order to mask our inability to produce suitably qualified public sector workers. We go to countries that have far less sophisticated healthcare structures than ours in order to meet our own exacting demands.

One result of this is that health care in the countries in which we recruit is suffering even more. No wonder, under these circumstances, that some of the healthcare workers coming in are unaware of the fact that they are carrying HIV themselves. Now, in a review triggered by the discovery that 10 Wolverhampton health authority nurses were HIV-positive, the department is considering proposals for a screening system. What a crushing proof of international alienation that we do so little to help those countries ravaged by Aids, then seek to find ways of winnowing out those among them who may bring the threat home to ourselves.

And if the idea of some kind of discriminatory, compulsory screening looks worrying, then turn to the controversy that has emerged at Guys and St Thomas's hospital in London. Here a top surgeon has been accused of racism and threatened with disciplinary proceedings after stopping an operation because he could not get nurses to understand his requests for instruments.

This one, I confess, really bamboozles me. I'd consider it racism for people to suggest that foreign workers could and should not be expected to be able to speak good English. What a patronising attitude that would be. But instead, somehow, it's the other way round.

My guess would be that those who are suggesting racism at Guys and St Thomas's have cast their minds back to the outrage prompted by the Home Secretary David Blunkett's suggestion that immigrants to this country should be encouraged most firmly to integrate with their adopted culture, to the extent that they should be pressurised into mastering English. If so, they are wrong, and the surgeon is right. "We should not allow political correctness to prevent these problems from being aired," he counsels. Quite true.

Confronted at a Scottish hospital a few years ago, rash-covered babe in arms, with a doctor who relied for information gathering on pointing out questions on a form, and getting me to write down the answers, my reaction was to flee from the ward in tears.

I can feel sorry for the poor chap now, because my infant turned out to have chickenpox. Had it been meningitis, my sympathy would be a little more strained. An ability to communicate with colleagues is surely a prerequisite for any team-working, or public-interfacing, professional. Racism does not come into it.

Except that in another piece of news, racism is encouraged. The Government, apparently, has come nowhere near its "target" when it comes to deporting illegal immigrants. What can you say about this, except that such a target was foolhardy grandstanding in the first place. The Government hoped that it would be able to declare the ejection of 30,000 illegal immigrants by March. Instead it has managed to kick out a mere 11,500.

Now it says its target was unrealistic. Too right. Such a target was just a part of the political posturing that goes on concerning the "problem" of "economic migrants".

Mr Blunkett's calls for English lessons for immigrants was ill-judged because it fed prejudices, not because there was no truth in it. This country in fact has an insatiable appetite for "economic migrants", welcomed, fully work- permitted, and tempted over here by public sector terms and conditions which are attractive to them but not to ourselves. The employment of the uncomprehending nurses points up how the Government is happy to overlook a lack of fluency when it suits them. Thus, the posturing encourages suspicion, when instead what should be encouraged is gratitude and shame.

The argument is that a tough line on illegal immigrants will have the effect of discouraging others from making their way to this country. What's forgotten is that the lavish adverts that appear in the poorest countries, begging skilled workers to head for these shores, is something quite likely to be sending a message abroad that is mixed, to say the least, in the first place.

The illegal immigrant rhetoric, and the tough, tough, targets, are the sort of thing that appeal to the Little England attitude that fears the illusory prospect of a small island being overrun by foreigners. But the truth is that Britain wants and needs immigration and reserves the right to cream off the brightest, the best and the most useful among those who want to come here. And now, moreover, we wish to ensure that we get the healthiest and the most linguistically adaptable.

The prospect of continuing with our aggressive overseas recruitment programme, then subjecting the healthcare workers we thus secure to mandatory Aids testing, and spoken English proficiency testing, alongside the checks on their medical competence they already undergo, is not a pretty one.

But the wider picture is not at all pretty either. How can a rich country such as ours justify spreading its welcome so wide when seeking skilled workers, and clanging its gates when the less skilled show up for a piece of the action too? And how can a rich country such as ours justify its inability to educate its own skilled workers when at the same time it is filching the skilled workers of other countries?

It is situations such as this one that give the lie to all the bold promises that are made about globalisation. Even the most cautious of supporters say that while globalisation may increase inequality within countries (back to the Institute of Directors, which complains about this while supporting the policies which promote inequality), it does foster equality between them. But how can that continue if rich countries carry on in their merry way, cherry-picking the skilled from the poor ones, and then wondering why they're not quite well enough adapted to our mystifying, and contradictory, ways?

d.orr@independent.co.uk