Diane Abbott, MP for Hackney North and Stoke Newington, caused a media storm when she lambasted London's Homerton Hospital for recruiting 'blonde blue-eyed Finnish nurses' instead of local people who reflected the area's ethnic mix.
Since Ms Abbott's outburst three years ago, staff shortages have meant that trusts have continued to recruit from abroad. In fact, the Homerton's neighbour, Barts and the London trust, is about to bring in 75 Filipino nurses and is also looking to recruit staff from as far afield as China. But there are those who believe that Ms Abbott had a point and that trawling for staff overseas is a short-term fix rather than a long-term solution to the recruitment crisis.
Barts and the London trust covers Tower Hamlets where, for the last two years, the Pathways to Access project has been looking at ways of encouraging local people, particularly those from ethnic minorities, to consider a career in the health service or social care professions.
Project manager Helen Bishop, who is based at Mile End Hospital, maintains that the NHS is not doing enough to tackle its under-representation of some ethnic minorities, particularly in areas such as east London.
Only 2 per cent of the 7,000 health staff based in her area are from the Bangladeshi community, yet 27 per cent of local people originate from Bangladesh, she points out.
'That's a pretty startling mismatch, ' she says. 'Local hospitals are crying out for staff, yet they are ignoring some excellent potential candidates on their doorstep. Our outreach worker has also come across refugees who are trained nurses but their qualifications are not recognised here. It must be possible to train them up but, rather than make use of the wealth of local talent, hospitals launch recruitment drives abroad.'
The Pathways project was set up in 1998 by a number of local partners (see box opposite) with funding of£500, 000,45 per cent coming from the European social fund and 55 per cent from partnership organisations.
The scheme employed an outreach worker and set up work placements for its target group of unemployed Tower Hamlets residents who were over 19 and from local bilingual communities. It also trained existing health and social service professionals to mentor the would-be recruits.
Staff were invited into community centres to talk about what they did and urge people to find out more about possible careers in health and social care.
'The idea was to act as a stepping stone for individuals on the margins of the labour market, 'explains Ms Bishop.
'What we found was that local people from ethnic minorities had no idea of the range of jobs on offer.And because there were no role models of people from their own culture working in areas like the health service, the attitude was, 'They don't want us, do they?'.'
Ms Bishop believes that there is a common misconception that if someone is from an ethnic minority and unemployed they must be unskilled, when, in fact, Tower Hamlets has a large pool of jobless ethnic minority graduates. 'Some of the individuals we came across were refugees still learning spoken English. Others were born and bred here, but their English was still not that good.
Clearly, language problems are an issue, but surely not an insurmountable hurdle to recruiting people, as with help they can learn English.'
She says the project found 'a huge invisible wall' keeping such individuals out, with a major barrier being the lack of part-time or employment-based training routes.
There was also widespread disaffection with what she describes as the 'revolving door' of college courses which led to low-level qualifications but no job or effective work experience. The Pathways project found that some adults had spent two or three years doing courses below access level.
Another issue was lack of feedback when people were unsuccessful with a job application. 'After two or three attempts with no response they stop applying, ' says Ms Bishop. 'And their experience can have a knock-on effect because word gets round that it's just not worth trying.'
Paul Ayo, training and development manager at the Royal London Hospital, accepts that employers could do more to recruit locally. He is a member of the Pathways steering group, but is not convinced that such projects are the best way of addressing the issue.
'The problem with Pathways is that it is not a particularly fast method of recruitment. When you're desperate for staff you're looking for bodies to fill posts as quickly as possible. But a lot of people the project has recruited have had to go through lengthy training before getting anywhere near an NHS job.'
He adds that the reason the trust was looking to places such as the Philippines and China was that they could get people who were already qualified.
Pathways had also not been able to meet potential recruits' desire to be paid while they are training for a job in the health service.' Potential local recruits don't want an educational route because they want to be earning a wage.
The employers prefer an employment-based route, too, as it gets them someone to do the job. We just weren't able to solve that one with Pathways.'
Mr Ayo says the biggest lesson the trust learned from the project was that it needed to change its culture to attract local people.' I know that 18 months ago we rejected a nurse because of the type of head-dress they wore. But we can't afford to do that and we need to look at educating our staff to ensure that sort of thing doesn't happen.'
Previously Mr Ayo had the impression that the local community weren't interested in working for the health service.' But the project's research suggests that's not the case. The scheme has also helped to show people that a career in the health service is not just about nursing, so that's been helpful.
'But I do feel that we shouldn't need a project like this - we should be going out into the community with recruitment hit squads focusing on community groups.
We should just be getting on with it.'
John Eversley, senior research fellow at Queen Mary and Westfield College, London University, who is evaluating the Pathways project, says that although it has had its problems the scheme has helped put recruitment from local ethnic communities firmly on the agenda.
'There have been tensions between the partners but that's not surprising given that they had no previous experience of working together effectively. The important thing is they are facing up to the issues.'
He says the lack of Bangladeshi staff in health and social services in Tower Hamlets was 'a glaring anomaly'.
He adds that though it may have been true in the past that Bangladeshis were not achieving the GCSE and A-level results that would secure them a job in the health service, this was no longer the case. 'Now their educational standards are higher than their white counterparts.'
Mr Eversley says: 'It's a myth that Muslims cannot take jobs that involve contact with members of the opposite sex. There are issues around dress code, but sensitivity on the part of the employer can overcome that.'
He suggests the crux of the problem is cultural stereotyping combined with the fact that Bangladesh is don't know anyone from their own community who have gone into jobs like nursing, and the NHS hasn't done enough to go out to schools and colleges to recruit.
The main funding for the Pathways project ran out in June, but the scheme will continue until December on a limited basis. Central and East London education consortium is putting forward a£7m single regeneration budget programme bid for a programme looking at recruiting local people. If approved it will start in April 2001.
Helen Bishop hopes that any new initiative will take forward the lessons of Pathways.'People have told us our efforts are just a small pimple on the face of things.
'But this project has thrown up answers to some of the big questions. It has been a catalyst, and the issues we've raised have effectively challenged every partner organisation to look at their practice and consider what needs to be changed.
'Managers have realised this is something they must get to grips with if they are to solve their recruitment problems and deliver a culturally appropriate service to the local community.'
Shahida Bibi, trainee dental nurse:
'I left school at 16 with three GCSEs and I thought about a job in healthcare, but I didn't really know what. Then I saw an ad in the local paper for the Pathways course and decided to try for it. I got on the course and we had people come in from hospitals and talk to us about working in the health service. It gave me lots of ideas. I was interested in nursing and they sent me on work experience at the London Hospital midwifery centre. I didn't really like it so I was switched to dental nursing and got on really well. I spoke to the other dental nurses about the job and I liked the sound of it. I did one day a week for four weeks and on the other days I was doing course work; we had lectures on issues like equal opportunities. Once I finished the course I stayed on and now I'm training to be a dental nurse. Pathways has really helped me getting a qualification and earning a wage.
Amina Begum, 19, has always wanted to be a nurse but only passed two GCSEs as she had to take a year off to care for her sick grandmother in Bangladesh:
'I came back and had two weeks to revise for my exams so I only managed two A grades and two Es. I knew they wouldn't take me for nursing, so I went and did a BTEC course in design because I was good at art.
But it wasn't really what I wanted. Then I saw an ad for the Pathways project in the local paper and I went to see the outreach worker.
She suggested I did an introduction to healthcare course.
It has been great. It has helped a lot with my writing skills as we have to do a report every time we go on a visit. I had a work placement on an elderly care ward at the London Hospital and we've been out to a day centre for people with a learning disability and a residential home.
I've decided I want to nurse young adults so I'm applying for a Project 2000 course. I speak Sylheti, so hopefully I'll be able to work in the Tower Hamlets area.
I'd prefer that as my family is Interest rates A total of 300 people expressed interest in the Pathways project in 1998. In the first year 31 people enrolled on health courses at Tower Hamlets College. They were supported by NHS mentors and spent one day each week on placements at Bart's or the Royal London Hospital. They received childcare and travel costs. A total of 27 completed their courses and a third went on to university health courses, one-third to further college courses, including access to nursing, and one third applied for jobs.
In September 1999, another group of 30 went into the scheme. Over two years Pathways to Access recorded 650 expressions of interest in careers in health and social services. One third came from the Bangladeshi community.