She left the Philippines in search of a better life and a chance to make some real money. Joy Flores, 26, came to work in a UK nursing home two years ago. She and her family had struggled to scrape together the agency's £2,000 recruitment fee and money for the flight, but it would be worth it: the agency had promised her a job as a staff nurse.
But when she arrived, she was forced to sign a completely different contract and perform a £6.25-an-hour care-assistant job doing kitchen duties and scrubbing toilets in a private nursing home.
Other employees at the same home were made to do 60-hour weeks - without overtime pay - to pay steep rent and repay loans taken out in the Philippines. Flores was also horrified by her living conditions: her UK recruiter charged her nearly three times the normal rent to share a double bedroom and only one bed with four other nurses, and often walked in uninvited - threatening the nurses with slashed wages or deportation if their accommodation wasn't kept in "proper order'.
Flores says: "Often I was given work the English staff wouldn't do. I was even made to pay for my own second-hand uniform. When I applied to come to England I didn't think for a moment that I would have to make loads of sacrifices to tolerate racism and exploitation.'
Flores's case is by no means exceptional. Hundreds of highly qualified overseas nurses recruited to work in the UK pay as much as £5,000 to private agencies and employers to secure jobs. Once they get here, they find themselves working long hours in private nursing homes for low wages and denied the chance to complete the "adaptation' courses necessary for them to work as registered nurses. Thus, they are trapped in appallingly paid, low-skilled jobs.
In February it was revealed that 30 Filipino nurses working at two hospitals in Glasgow were working on slave wages of just £8 a day; the agency that supplied them got an £800 "finder's fee' from the NHS for every nurse. Incredibly, the bulk of the nurses' wages was being deducted at source by South Glasgow Universities Hospital Trust to pay for accommodation and high-interest loans provided by the recruitment firm and its associates.
Unison Scotland health organiser Jim Devine says: "We feel very disappointed. Our union was part of the welcoming committee when these nurses came over. They were the first batch of overseas nurses to come to Scotland. They are not unlike the exploited Chinese cockle pickers from Morecambe Bay.'
In Northern Ireland Filipino nurses have even had to put up with harassment by loyalist paramilitaries, who have been targeting them because most of them are Roman Catholics.
Like Flores, many overseas nurses are victims of "contract substitution'. They are given contracts approved by the state regulator the Philippines Overseas Employment Agency (POEA) before they leave the UK, but are then made to sign a new contract when they arrive. Generally, the second contract means Filipino nurses will be paid minimum wages and banned from joining a union.
Critically, many of the private homes the nurses end up working for are not approved by the UK's regulatory body for nurses the Nursing and Midwifery Council (NMC), so they can't provide adaptation training. And even if they can, the training system is inherently susceptible to abuse. The adaptation courses are only really necessary for nurses from the developing world (nurses from places like Australia and New Zealand don't need them). They are supposed to take three to six months to complete, after which foreign nurses must be paid the same as their British colleagues. But the NMC only offers guidelines on how employers should carry out the training, so the adaptation period can be strung out for much longer.
"It's modern-day slavery by the back door,' says Allen Reilly, a retired nurse who's married to a woman from the Philippines and who heads a Filipino organisation in south London. "They can't leave, and they can't earn enough money to rent their own place. It's a way for the employer to handcuff nurses to the company and isolate them from the general community. This prevents them from becoming informed.'
The staffing crisis in the health service hasn't changed much since 1999, when the UK opened its doors to overseas nurses in a bid to solve the crippling nursing shortage in the NHS. The Royal College of Nursing's (RCN) latest survey of UK hospitals suggests there are 25,000 vacancies at the moment and that one in nine nurses plans to quit over the next two years.
The recruitment of overseas nurses was never meant to resolve the shortage in the private sector, but independent nursing homes simply can't employ enough local nurses. Reilly says: "Indigenous nurses are not interested in the low pay and long hours, and for the nursing home the profit margin would be too small. So, when the NHS announced that it would start recruiting from overseas, the private sector jumped in with two feet.'
In the year ending March 2003 nearly 25,000 overseas nurses applied to register with the NMC, with the majority of applicants from the Philippines and India. Only half of them were successful. A Unison spokesperson says: "It doesn't take a mathematician to know that huge numbers are coming into the private sector.'
The exploitation begins in the migrant nurses' home countries. Unscrupulous overseas recruitment agents charge money for placement, fares and documentation. In the Philippines the government actively encourages its population to work abroad as "modern heroes': migrant remittances help prop up the domestic economy; last year, for example, Filipino workers in the UK sent home $236m, mostly to help pay for their families' food and education.
According to the POEA, more than 13,000 Filipino workers were sent to the UK last year - 5,500 of them were registered as nurses. This is having a drastic effect on the Philippines' ability to provide skilled staff for its own health service. The Philippine Nursing Association complained in November that foreign agencies were creaming off all their skilled nurses, leaving Filipinos in the hands of those fresh out of nursing school. Even Filipino doctors are training as nurses because of lucrative opportunities abroad.
When the POEA discovered that its Filipino nurses were having to pay so much in fees it informed the NHS. The POEA now bans Filipino agencies from levying recruitment fees and puts firms that do so on a blacklist. But blacklisted agencies simply reopen under different names.
David Rees, managing director of Global Recruitment Associates, an ethical agency recommended by Reilly, believes UK recruiters are equally, if not more, at fault. "We had no difficulty finding a highly ethical, well-organised recruiter in the Philippines, which doesn't charge fees. The first people UK recruiters blame are the people in the Philippines. That is unjust and incorrect. The private sector in this country has been exploiting overseas nurses for years.'
Unison and the RCN are asking the government for more coordinated regulation in the private sector. Currently, overseas nurses who are recruited by the NHS are covered by the Department of Health's (DoH) code of practice on international nurses, which aims to ensure no nurse is financially exploited in the recruitment process. The DoH also lists all compliant agencies on its website. But critics say the code is flawed because it ignores exploitation in the private sector, and is not legally binding.
There have been noticeable improvements in the way Filipino nurses are treated (both here and at home) since 1999, but only in small part due to government action. Filipinos have become much more difficult to target - thanks largely to the migrants themselves. Reilly says: "Over the past few years, the Filipinos have been organising themselves here. They have networks. So when they run, they have someone to help them.'
Reilly met Father Claro Conde, a Filipino Catholic priest, through the church - a central point of contact for the Filipino community. In January alone Conde received more than 50 calls from health workers pleading for help. "These newly arrived migrants are vulnerable because they are afraid of being sacked or deported,' he says. "Their fear should not be underestimated. They need to send money home to pay off their debts and support their relatives. They're also ashamed to go back and face their families and be seen as failures.'
Conde and Reilly called upon the experience of the Centre for Filipinos in west London, a voluntary organisation established in 1979 to help abused Filipino domestic workers. With Unison, they formed an action group to "rescue' Filipino nurses from the private sector. "We disseminated information to local parishes, and we always ask new Filipino faces who they are, where they are from and if they are happy,' Reilly says. "But the nurses need to make the first step by contacting us.'
This church connection marks an interesting departure for British trade unionism. "Father Conde was the first religious leader we have had speak at a conference, and we have given rosary beads to all our members at our Harrow branch,' says Greater London Unison regional officer Michael Walker. "There are now a number of churches developing relationships with unions, and we have no hesitation in working with them.'
Since 2000 Reilly and Conde have carried out more than 500 "rescue operations': relocating nurses from the private sector into the NHS. To begin with, they try to resolve the issue with the employer while the nurse continues working; otherwise the latter would be out of money and could face deportation. If it is impossible to work things out with the employer, the rescue mission goes about clandestinely arranging interviews for the nurse at NHS hospitals. Reilly has even rented out a safe house for the abused nurses, and Conde asks his contacts - who include single mothers, fellow nurses and the sick - to offer up living space. The process, from the interview to the receipt of the new work permit, usually takes two months.
But Conde says it's no longer enough just to get the nurses out of the private sector and into the NHS. "The nurses need to accept they were exploited and be aware that this is not an individual problem but a result of globalisation, so they will confront their employers and help those who are coming in after them,' he says. "This hasn't really happened.' Conde sees a need for more community-based unions as a way of really integrating migrant workers, citing the east London community-led alliance Telco and its spin-off South London Citizens as examples of what he has in mind.
The unions have admitted they have been more reactive than proactive. "The left in general has a really poor track record on migrant workers,' says Walker. "It's a bit ad hoc across the board. We are going to see a huge influx of workers from eastern Europe, and hardly any of the unions are geared up for it.'
It was Flores's fellow Filipinos and the church that directed her to the RCN and a racial justice group, who eventually helped her. Flores applied for a position at her local hospital seven months into her nursing-home contract. A month later, she made the transition and is now a qualified NHS staff nurse.
But two years later, the agency that recruited her is still working for the care home and is continuing to charge extortionate placement fees and provide sub-standard housing for its nurses. It also started collecting £100 a month in bond money to stop nurses breaching their contracts. The nursing home remains accredited by the NMC.
"We don't have the time or resources to take every case to court,' laments the Centre for Filipinos' coordinator Maria Gonzalez. The centre is lobbying the Philippines government for better pre-departure seminars advising nurses to be aware of the pitfalls of working in the UK.
In the meantime, the agencies have begun preying upon new victims. They have targeted overseas workers in allied professions, such as midwifery and physiotherapy, to work as carers. They have also shifted their attention to more rural areas of the Philippines and to other countries, where workers are less aware of the system. As the floodgates are being shut in the Philippines, they are opening in India.
"Unlike the Filipinos, Indians have nowhere to go,' says Reilly. "We're finding that Africans and Indians are more abused than the Filipinos.'
Flores knows she is lucky. "There are nurses in the Philippines who are so desperate to come here. I pray that because of our experiences they are more aware of their rights.'
"Joy Flores' is an alias used to protect the real identity of the person interviewed