Published: 02/09/2004, Volume II4, No. 5921 Page 19

Thank goodness August is over. It has not been the silliest of silly seasons - no swarms of killer bees this year (they all drowned), but we are always in danger of being frightened to death by one thing or another when there is little real news.

Among this August's highlights which put my blood pressure up was that report about inadequate NHS treatments for high blood pressure, not to mention the usual crop of warnings about life-threatening medicines. Oh, and nearly 4,000 senior consultants are set to grab their newlyenhanced pensions and retire in the next couple of years (I do not think).

Apart from the disheartening revelation that ambulance-chasing lawyers are offering GPs£175 a time to refer litigious patients to them, the one report which troubled me - you too, I expect - concerned the department of health's latest efforts to close a recruitment loophole.

It was announced by John Hutton, John Reid's deputy, on the day he met his South African counterpart, Manto TshabalalaMsimang, to discuss the steady drain of South African doctors and - especially - nurses to Britain, drawn by higher pay and facilitated by the English language.

UK health ministers of all parties have been making reassuring noises about not damaging developing countries' fragile health systems for as long as I can remember. And it is true that medicine is what Whitehall calls 'a very mobile profession' - which allows young travelling Ozzie dentists to 'bash the nash' (work for the NHS) on their world tour, and UK nurses to do the same in Sydney.

Alan Milburn used to point out that, just as we under-trained in the 90s, so some countries produced a glut of doctors and nurses.He once witnessed an unemployed doctors' demo in Madrid.

But for Spain, France and Germany (which now sends weekend locums to Norfolk as it once sent Heinkel bombers) to export their medical surplus is one thing: South Africa and its ilk do not have a surplus.

You only have to check the local websites: they have 52,000 nurse vacancies in the public sector.

They are losing nurses to their own private sector too. The South African parliament was recently told it was cheaper for rich countries to hire foreign nurses than train their own.

No wonder they're happy to arrest wealthy white foreigners like Sir Mark Thatcher, whom they see as symbols of outside interference in their own affairs.

Guilty or not, such people serve as scapegoats for the new black elite which is not delivering as much or as fast as expected.

There is also HIV/Aids.

Seventeen sub-Saharan states do not have even half the World Health Organisation's (WHO) stated minimum of 50 nurses per 100,000 people.

That is what makes the Daily Mail's 'Third World NHS' campaign such a sick joke.

Nor do developing world recruits have the economic clout that EU citizens have. Paul Burstow, the Lib Dem health spokesman, pointed out in a Commons debate that less scrupulous recruitment agencies not only charge hospitals£1,500 for a foreign nurse, they sometimes charge the nurse twice that amount.

That smacks of legalised people smuggling in my book.

And the Filipino, Caribbean or South African recruits do not always get the contract they expected, or the equal-pay conditions, according to MPs who monitor this issue. For London teaching hospital, read dodgy private nursing home in some cases.

And, with a recruitment fee to pay, there may be no going back.

It is been three years since ministers introduced an 'ethical recruitment' policy (the phrase was Clare Short's).

The Commonwealth has a non-poaching policy too, though we have not signed it. Unison, WHO, the Royal College of Nurses and other parties remain unhappy.

Hence nice Mr Hutton's fresh attempt to close some of the loopholes in Britain's 10,000 a year foreign recruitment drive.

'We are determined not to destabilise the healthcare systems of other countries, ' he promised as he moved to stop recruitment agencies getting round the rules by providing hospitals with 'temporary' staff and offering incentives to the independent sector to join his ethical big tent.

They can provide a backdoor into the NHS. But the DoH confirms that neither private nor NHS foundation hospitals will be required to comply, only invited.

It is optimistic that they will.

But markets have a habit of being porous, so we'll just have to see.