The Migrants And Refugees As Part Of Globalization

This assignment sets out to critically discuss the implications of the increased mobility of the world’s population on the United Kingdom’s (UK) National Health Service (NHS); specifically focusing on migrant and refugee populations. This debate will further extend to critically explore the impact movement of migrant and refugee populations has upon adult nursing roles and the subsequent implications for future adult nursing practices, using research, policy, and other information. The background to this debate will begin by critically analysing political influence both nationally and globally surrounding the movement of migrant and refugee populations.

In accordance with World Health Organisation (WHO,2019), globalisation refers to the increase in global processes and the integration of economic, political, cultural, and environmental aspects between international borders. However, Ukpere (2010) argues that there is no specific answer for how or why globalisation has come about, and the origin remains a subject of argument. Yet, there are beliefs globalisation arose due to reasons such as technological advances- leading to reduced transportation costs and increased speed, the end of the cold war, as well as climate migration, and progression (Wittmann, 2014).

According to the National Geographic Society (NGS, 2005) Human migration is the permanent movement of people from one residency to another for better economic opportunities usually across a political boundary. The Organization for International Migration (IOM,2018) argues that there are approximately 192 million migrants globally because of political factors including, war, the lack of political liberties and rights, persecution, and endemic corruption. These push factors pressure the affected individuals to migrate elsewhere. Whereas, the United Nations (UN) states that refugees are individuals fleeing from their country to escape conflict and affliction (Telegraph,UK. 2015). Therefore, The Migration Policy Institute indicates that Asylum seeking is a direct result of the outflow of political issues and war and Office for National Statistics (ONS, 2016) indicates that in 2016, there were 25.9 million refugees globally. Therefore, the National Geographic Society (NGS,2005) explains that individuals either migrate voluntarily or be forced to leave involuntarily.

Recent studies suggest that apart from political factors, economic conditions at home are thought to be the single most important reason (Thielemann and Schade, 2016). In the 2000s, there was a significant increase in legal immigration for work and study in the UK due to open work permit system for migrant workers from within and outside the EU Royal College of Nursing (RCN) (2015). However, from 1st January 2021, it was made obligatory for all workers (indiscriminatory of whether they are in the EU or not) to gain 70 points in a system which assesses their skills and salary(GOV. UK,2020). Therefore, helping to reduce the number of entries into the UK by removing the low-skilled migrants (GOV. UK,2020). Additionally, The Immigration Act 2014 which amended The British Nationality Act 1981, ensured migrants who reside in the UK contribute to the cost of the health service temporarily as the NHS is national and not international. (GOV.UK, 2013).

Nevertheless, overall immigration into the UK is determined by UK migration policies and immigration policies of other destination countries in Europe and beyond (MPI,2019). Therefore, the role and relative weight of immigration policies in influencing migration flows across the different categories (work, asylum, student, family) is still under-researched (Migration Observatory,2017).

WHO (2004) found that globalization led to an increase in the spread of communicable and non-communicable diseases (NCD’s) in the host country. Tatem et.al., (2006) found that wars, crusades, and migrants have led to the transmission of disease to vulnerable populations which played a major part in shaping world history. Furthermore, The studies by Seedat, Hargreaves and Friedland (2014) demonstrate that migrants accounts for 70% of newly diagnosed tuberculosis, 60% HIV cases with trends of Hepatitis B and C in which London has the highest rate of tuberculosis of capital cities in Europe (Seedat, Hargreaves and Friedland, 2014).

Although there has been an increase number of migrants with communicable diseases, McLennan and Jayaweera (2014) argue that NCD’s are also common among migrants and refugees that are affecting the UK. In addition to this , Britz and McKee( 2016) go onto further state that the vulnerable citizens will be exposed to a greater risk of contracting these infections if there is no control of migrants thus putting pressure on the NHS. (The State of Communicable Disease Law,2002) suggest that adult nurses should be trained to deal with diverse range of diseases and situations and not being prepared could pose a major problem. (Monaghan and Owen, 2002).

Therefore, Keane and Gushulak (2001) argue that there should be a policy assessment and information on the cost effectiveness of existing resources and strategies for health improvements, with migrants coming to the UK (Keane and Gushulak,2001). As a result, the Public Health (Control of Disease) Act 1984 and the Public Health (Infectious Diseases) Regulations 1988 in line with  the International Health Regulations (IHR,2005) a legal framework that defines countries’ rights and obligations to handle public health events and emergencies is put in place; these are applied to individual diseases (IHR,2005). Therefore, NHS (2020) suggests that healthcare professionals should attend training and development programmes to enhance their practical skills and their interests in infection control, preparing adult nurses for challenging situations (NHS,2020).

England and Henry (2013) depicts that many migrants and refugees struggle with the social and cultural change when they are confronted by such a diverse society. Meanwhile, Saggar et al. (2012) also points out that refugees may have an impact on consistency as migration alters the dynamic in a neighbourhood and how the local people interact with each other. Furthermore, Kleyn (2010), argues that refugees place a burden on the resources of the recipient country as it affects the economy and puts a strain on factors such as water availability, housing, and food. Having said this, Cole (2009), states the government has an obligation to respect and deliver rights to all individuals occupied in their territory, irrespective of the costs, reductions, and status. Singleton (2009) explains migration not only impacts on our surroundings such as employment, housing, health, and social interaction but can also prove to cause issues for migrants.

Institute for Healthcare Communication (IHC, 2011) found language barriers to be a significant issue when nursing migrants in the NHS. Garra et al., (2010) depicts that communication barriers could have a profound effect on the quality of care that can be given to patients. In addition, Diamond et al., (2008); Karliner et al., (2007) emphasis that patients’ awareness of the quality of the care they receive are highly based on how well the healthcare clinician and team have interacted with patients. Also, health professionals could end up getting negative feedback because of communication problems. This is supported by Philip (2015) who states that currently, health professionals are providing care, education, and case management to a population that is challenged with a triad of cultural, linguistic, and health learning barrier. In this case, it would however be strongly advised to provide language interpreters (Philip,2015).

According to Cecil (2011), NHS hospitals in London have spent at least £15 million for translation services. Although, there has been an increase in the use of interpreter services(NHS,2020); evidence still suggests that health professionals work in a challenging sector language difficulties impose further worrying concerns as it can result in false and misinformed diagnosis (NICE,2015). Although Nurses uses interpreter services, this would still involve communication errors when providing treatment or gaining consent and will prevent healthcare professionals from delivering high quality of care (Meuter et al., 2015). Therefore, GOV. UK (2017) suggests that wherever practical, arrangements need to be made to meet patients’ language and communication needs in order to support the future nurses to face challenges with communication posed by migrant workers (GOV.UK,2017).

However, the interpreter service within the NHS could also be considered an expensive move as the health sector tries to manage with reduced funding. Moreover, almost £23million is spent on translators across different NHS institutions in England and Wales every year to help overcome communication barriers (NHS,2020). Meuter et al. (2015) argues that not only the cost of an interpreter but also the lack of availability and time limitations may also avoid health professionals from utilizing professional interpreters (Gill et al., 2009). Therefore, using interpreters boosted service cost but this was achievable given the positive clinical outcomes (Jacobs et al., 2004).

[bookmark: _Hlk49725242]Beckert (2012) found that the movement of staff within the NHS would be affected by the increased mobility of the world’s population in relation to migrants. Action for Global Health (AGH) (2011), states that the UK is a major destination for migrant health workers. Even So, shortages are created when skilled personnel leave the country in search of better working conditions and improved quality of life (RCN,2019). However, The International Migration Institute (IMI, 2016) revealed that the UK has been faced with a growing need for health professionals and has therefore attracted professionals, mainly overseas nurses. Trueland (2016) demonstrate that once they are offered attractive possibilities from other countries, the existing British health professionals NHS nurses are slipping through our fingers and migrating to other countries (Trueland ,2016). 

Migration of health professionals takes away highly trained and educated nurses from the host country. Evidence (James et al.,) (2019) suggested that in the UK nursing courses were offered for free and getting educated and once qualified some would leave behind their country for higher paying opportunities in other countries like United States and Australia. Therefore, this could be described as a huge loss in investment in education (James et al.,2019). As A Result, Global nurse migration could then lead to significantly heavy workloads for the rest of the staff and low work satisfaction and low morale which can lead to high levels of compassion fatigue and a decrease in the quality of care delivered(RCN,2018).

There are considerably staff shortages almost 100,000 staff,  across NHS trusts already within the healthcare sector, In 2014-15, 8,000 foreign-born nurses were recruited, mostly from the EEA, the fact that some of these professionals on temporary visas have chance to go back to their country could cause further staff shortages Mundasad, (2017). Being a part of the European Union’s single market allowed healthcare staff to work anywhere within the EU, however as the United Kingdom can no longer win the advantages of cross-country recognition due to Britain leaving the EU, which will consequently make it harder to employ staff from abroad (RPC, 2020). RCN(2019) argue that how the changes in the immigration system are going to affect the retention and recruitment of nurses in future is uncertain, but the Immigration White Paper specified that it should be skilled based and point- based system(The King’s Fund,2019).

Additionally, the removal of the nursing bursary is one of the key risk factors for reducing the application for nursing degree from 52,740 in 2016 to 39,665 in 2019. Although, all these above-mentioned factors influenced shortage of staff in the NHS; evidence suggest that the number of new registrants from outside the EEA has increased between 2013 and 2019 with 23.4%; yet exist biggest shortfalls of nurses in the NHS. (RCN,2019). As Kirwan et al., (2019) suggests due to the NHS workforce, falling numbers of nurses as the UK has left the EU (EU being the supply of a high percentage of nurses), there will be increasing vacancies that make patients care and treatment to be unsafe. Therefore, Auerbach (2013) suggests that enhancement of communication programs, improved employee engagement, positive work environment and funds in nursing education are some of the factors to support the future nurses in their career. As an outcome, there has been a change on the policy and from September 2020 all adult nursing students in the UK will get a maintenance grant of £5,000 a year (RCN, 2018).

In conclusion, the assignment has clearly discussed the impact of migration and refugee population as part of globalization and how it influences the health care system. And, nurses are challenged to meet and to be applied to new ways of critically and effectively meeting health issues that are put into today’s society. However, after looking into the consequences that the global population may have on the NHS, cost and shortage of health professionals continues to be the significant issue and is still yet to be improved (Wahed, 2015). Nevertheless, it is a duty for the people within the NHS to make this move easier and continue offering the same care and work ethic within the hospitals to ensure ultimate satisfaction within the NHS. As the country continue to welcome migrants and refugee population, the healthcare industry should take into consideration of these implications mentioned above and finding a way to minimise the risks.

Referrence:

1. World Health Organisation (WHO, 2019) Globalization; key issues. Available at
2. Ukpere, W. I. (2010). Rationalism, technological innovations, and the supreme mandate in the process of globalisation. African Journal of Business Management,4(4), 467-474.
3. Wittmann, V. (2014). World society and globalisation. Journal for Multicultural Education, 8(3), pp.194.
4. National Geographic Society (2005) what is Human Migration?. Available at http://www.nationalgeographic.com/xpeditions/lessons/09/g68/migrationguidestudent.pdf
5. Organization for International Migration (IOM,2018) Global Migration Trend. Available at
6. Telegraph.co.uk (2015) what is the difference between a refugee, a migrant and an asylum seeker? Telegraph.co.uk.
7. Migration Policy Institute (MPI,2019). Migration information source,2019. Available at
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10. Thielemann, E. and Schade, D., 2016. Buying into myths: free movement of people and immigration. The Political Quarterly, 87(2), pp.139-147.
11. Migration Observatory (MO, 2017) net migration to the UK. Available at https://migrationobservatory.ox.ac.uk/resources/briefings/long-term-international-migration-flows-to-and-from-the-uk/
12. GOV.UK (2013) Immigration Bill Factsheet: National Health Service (clauses 33-34).