THE problems faced by Worcestershire's health service have been well documented in recent months.

One of the main reasons given for the debts the region's health trusts face is the cost of employing agency nurses.

A chronic shortage of British nurses has made life increasingly difficult for recruitment managers in Worcester and beyond.

The policy of going abroad to recruit nurses has been criticised in the past, but our hospitals simply would not be able to function without foreign nurses.

With this in mind, Worcestershire Acute Hospitals NHS Trust has had to travel far and wide to keep the region's hospitals fully staffed.

Two years ago, it headed for The Philippines and brought back 75 qualified nurses.

Now it has found a rich source of talented workers in India. Trust managers have made three trips to different parts of the country over the past year, recruiting 64 nurses in the process.

Many are already well-established on hospital wards, another group has just arrived in Worcester, and the final group will be flying over in the near future.

Clinical service manager Mel Rayson and recruitment and retention adviser Suzanne Hardy found no shortage of applicants on their travels, as they visited hospitals in Chennai, Delhi and Bangalore last year.

After advertising nursing vacancies in India, they drew up shortlists, set a one-hour test paper and finally interviewed the best applicants.

"We were looking for a mixture of sound clinical skills and good communication and comprehension skills," said Ms Rayson.

"If the public are going to complain about anything, they will complain about communication skills.

"They all have good English - we've had no problems with the nurses we've had so far."

She said the new recruits had impressed everyone with their skills and knowledge.

"We're extremely fortunate to be able to recruit nurses of this calibre," she said.

The nurses are supervised for six months before being recommended for full registration in the UK, after which they are given two-year contracts.

The young workers have to leave their families behind for these first six months, making it a daunting experience as they adjust to a new culture and new jobs.

Some have had to leave their children behind as they seek to further their careers, but they seem to have a pragmatic approach to the whole business.

Shelby Simon, a 26-year-old nurse from Kerala in southern India, was working in one of Delhi's biggest hospitals before moving to Worcester in May last year.

"I came because there are better professional opportunities here," she said. "In India, you have to get permission from doctors to do everything. Here, you have more responsibility.

"It's a big move, but you have to adjust when you move to any new hospital."

One of the main differences the nurses have noticed between health care in England and India is the problem of "bed blocking" in this country.

"In India, when patients were ready to be discharged, they just went," said Ms Rayson.

"There was no question of the family not coming and taking them home. In this country, people can stay in hospital for weeks. There's a different social structure here."

While it may seem as if India gets a raw deal out of this arrangement, it does help to boost the country's economy.

Many of the nurses send a portion of their earnings back to their families in India, and some return to their homeland having learnt new skills.

All the new recruits are highly qualified, and while they may be new to this country, they are no strangers to hard work.

Many Indian hospitals employ a skeleton staff, and nurses have to work miracles to keep all their patients happy.

Those who have come to Worcestershire have adjusted well to the hospitals' demands. Miss Simon is already in line for promotion, while others, such as 24-year-old haematology and chemotherapy specialist Ashly Punnoose, are already in advanced positions.

The nurses' managers are well aware of the importance of their foreign imports.

"There has been a shortfall in workforce planning," said Ms Rayson. "Nationally, we've not trained enough nurses to meet our needs, so we can't fill all our vacancies.

"We need these nurses. We're thankful we can go out and recruit them. We would be in a far worse situation without them.

"We would have had to close wards."