As the NHS seeks to recruit doctors from abroad to solve staff shortages, Health Correspondant Barry Nelson speaks to a Spanish surgeon making her home in the region.

MUCH is riding on Dr Belen Carsi's shoulders, but you get the feeling that she will take the responsibility in her stride. The Spanish surgeon, who has just travelled in the reverse direction from thousands of North-East holidaymakers to make her home in Hartlepool, is the advance guard of what could amount to hundreds of her countrymen and women.

Health Secretary Alan Milburn's ambitious plans to recruit more foreign doctors depends on people like Belen Carsi successfully establishing themselves in the NHS.

The Darlington MP has set his sights on hiring a thousand foreign doctors and 2,000 foreign nurses over the next two years, to try to meet manpower needs in the creaking health service. And doctors from Spain, where an estimated 30,000 qualified doctors cannot find work, could provide many of the medics that the NHS needs.

In the past two weeks, Dr Carsi, who trained as a surgeon in Madrid, has been meeting her new colleagues at the University Hospital of Hartlepool. The enthusiastic 34-year-old, who has already worked as a consultant surgeon for six years in Spain and America, is the first of a wave of Spanish doctors who have been recruited as part of a pilot scheme.

She is already something of a reluctant VIP, as she was one of a group of Spanish doctors who attended a reception at the British embassy in Madrid last month. After the launch of the recruitment campaign, endorsed by the Spanish government, Dr Carsi was even pictured sitting next to Health Secretary Alan Milburn in the embassy's garden.

Yesterday, on a grey, wet North-East of England day, Dr Carsi is a little surprised at the large media turnout to see Hartlepool's latest foreign import. Introducing Dr Carsi, the Hartlepool hospital's clinical director for orthopaedics, Cathy Lennox, says the young doctor had already made an impression with staff.

"She is a little spark of light. We are very happy to have her as part of the team," said Miss Lennox, who is keen to see Britain's miniscule number of female surgeons boosted by the new arrival.

Speaking in excellent, slightly American English, a language she has been speaking since she was seven, Dr Carsi says everybody had been asking her how she coped with Hartlepool's bracing North Sea climate, compared with back home.

"Everybody is asking me, is it so much colder and darker than Spain? But you know, we have our storms in Spain. It was snowing in Barcelona," she laughs.

In any case, she certainly didn't come to Hartlepool because of the weather. She came to work. Attracted by the principles of the NHS, Dr Carsi decided she would like to work in Britain long before Alan Milburn launched his campaign. She had applied to a number of English hospitals when she saw an advertisement placed in the Spanish equivalent of the British Medical Journal.

"I saw the advert and this was my dream come true," says Dr Carsi, who followed up the advert and, a few months later, found herself in a Hartlepool operating theatre, assisting Miss Lennox.

But the North-East was not her expected destination. When the recruitment drive was launched, it was run by the North-West office of the NHS Executive. A group of surgeons was invited to meet their British colleagues in Manchester - but last minute cold feet on the part of some North-Western hospitals meant that some of the surgeons were up for grabs.

Miss Lennox says: "Several hospitals which had been looking for orthopaedic surgeons withdrew at the last minute. We were asked if we were interested so I went to Manchester with two of our senior people. It was an opportunity to recruit another orthopaedic surgeon, which we need."

Dr Carsi was one of four orthopaedic surgeons who jumped in a minibus and crossed the Pennines for a glimpse of the facilities at the North Tees and Hartlepool NHS Trust. While some people scoffed at the idea of going to Hartlepool, Dr Carsi was impressed by the hospital and by the area.

"The hospital is very nice, you have a lot of resources. For instance, you have open access to MRI scanners, which is very good. And I think the landscape is nicer than Manchester," she says. "I am happy here."

While great play has been made about unemployed doctors in Spain, Dr Carsi was working for the state health service before deciding to come to the UK. She says the Spanish health system is too hierarchical for her liking, and she felt that the only way her ambitions would be encouraged would be to move abroad. "I thought it will not work for me," says Dr Carsi, who feared that she would have to wait until her senior colleagues retired or died before making progress up the career ladder.

Despite acknowledging that many European doctors are critical about the problems facing the NHS, Dr Carsi says she feels strongly about the underlying principles of providing health care for all. "I have experienced the system in Spain and also the American system, where I worked for two years doing a fellowship. The UK is the perfect mix of both systems. It has its heart in the right place, with the patient top of the list," she says.

"I saw a sign here saying the quality of life does not depend on your wealth, but on your health. I feel that is the way it should be."

Dr Carsi is also impressed at the wide-ranging provisions of the NHS Plan drawn up by Alan Milburn, as part of his modernising campaign. "At least you are trying to improve things. In Spain, we don't recognise we have a bad system," she says.

Joining the NHS has also introduced her to the concept of clinical governance, part of efforts by the Government to improve the quality of care provided to patients. "I had not even heard of clinical governance," confesses Dr Carsi.

While she brings youthful experience to the NHS, her qualifications are not to be sniffed at. After six years at medical school and five years of training, she worked as a consultant orthopaedic surgeon in her own country, followed by another two years in an American clinic, working as a surgeon.

"Things are very different from my country, but the practice of surgery is the same, the techniques are the same. A nail is a nail and a screw is a screw in both countries, " says Dr Carsi, who will be closely supervised by senior surgeons until she adjusts to the new regime in this country.

Hospitals in the North-West are already said to be putting on courses so Spanish doctors can understand broad Scouse and Lancashire accents.

So far Dr Carsi has coped. "They say 'thank you very mooch', but it is English," the young surgeon laughs.

Any worries about communication problems with patients would seem to be misplaced. "All the medical text books are in English, it is my second language and I lived in America for two years," she says.

Another sign of her determination to make a go of it in the UK is the fact that she has been joined by her American fiance, information technology expert Mike Betts.

But her mother is not so keen on her daughter being so far from home. "She got me back from America and now I have gone to England," says Dr Carsi.

And she is very aware that, as the first Spanish recruit to actually start work here, everybody is watching her. "I get e-mails from all the other people who have been recruited asking how things are going," she says.

But she is positive that she is here to stay. "There are so many unemployed doctors at home. If this works I know there is going to be a rush to come here."

She has a pang of regret at being so far from her family but, as she says: "I can still be eating paella every Sunday, even in Hartlepool."