The NHS must end the use of ‘reimbursement clauses’ in contracts for international healthcare workers, MPs have said.
Members of the House of Commons Health and Social Services Committee came to this conclusion after a Observer A survey in March found that some workers were being forced to pay thousands of pounds if they wanted to quit before their contract ended. Widely used in both the private health and social care sector and the NHS, the clauses are designed to help retain workers and recover the costs associated with overseas recruitment.
In extreme cases, workers are tied to their role for up to five years and told they face charges as high as £14,000 if they want to leave or return home early. Some remain trapped working in conditions that human rights lawyers and trade unions have likened to debt bondage.
A report from the select committee, chaired by Tory MP Jeremy Hunt, the former health secretary, said the use of reimbursement clauses was “part of a wider picture of worsening exploitation of international workers”. He said the NHS must review its recruitment processes to ensure “no international health and care staff are subject to punitive reimbursement clauses in their contracts”.
The report, published last week, continues: ‘Those subject to reimbursement clauses must be released from them, and future NHS contracts should not contain reimbursement clauses.’
He also pointed to an increased risk of modern slavery, adding that labor law enforcement bodies must work with councils, employers and recruitment agencies to tackle exploitation.
The recommendations come amid a rise in suspected cases of modern slavery in the health and social care sector. The Care Quality Commission has so far recorded 16 cases in 2022 – more than double the figure for all of 2021, when seven cases were identified, and around five times the figure for 2020.
The Department of Health said it would issue updated guidance on the use of reimbursement clauses shortly and took any reports of unsafe and illegal employment practices in the health and care sector “very seriously”. .
A spokesperson for NHS England said the health service was committed to ensuring that all international healthcare staff were “supported to thrive”, adding that it was considering whether further guidance was needed with partners “to across government and the health system.
Repayment clauses are contractual clauses that stipulate that workers will have to pay money if they leave their job within a certain period of time.
Practice varies by employer, but clauses often cover hiring costs such as flights to the UK, visas, and language and proficiency test costs. Some also include the costs of compulsory training, which workers hired in the UK are not routinely required to pay. Often the breakdown of costs is unclear.
Workers affected by repayment terms have been indebted or locked into long-term payment agreements to cover costs. Others find themselves trapped in their jobs despite illness or poor working conditions because they are unable to repay.
The select committee’s report cited Observer investigation as well as evidence from NHS officials, unions and other industry players.
Gamu Nyasoro, clinical skills and simulation manager at Kettering General Hospital NHS Foundation Trust, said in her testimony that she knew of cases where workers wanted to go home but couldn’t “because they were given contracts farm that you can’t leave until you pay them”. something like £10,000”.
Union Unison said the clauses were used to “exploit migrant workers and intimidate them into staying with poor employers”.
Clauses penalizing workers who leave their jobs have already been ruled illegal. In 2019, an employment tribunal ruled that an Indian nurse had been made subject to an “unenforceable penalty clause” after the care home she worked for deducted £2,000 from her pay for “training costs “when she left before the end of her two years. Contract.
The recommendation to remove clauses in the NHS is part of a report into wider workforce issues in the health and social care sector, which identified a critical shortage of more than 50,000 nurses in the NHS, with 490,000 additional social care jobs. probably needed over the next decade.
Hunt, the chairman of the committee, said tackling the crisis must be a “top priority for the new prime minister”. The government is expected to provide a full response to the report within two months.