"The cost overall has halved, I think, over the last two or three years," he said. "Being able to recruit in this way directly with the government of Kerala, rather than through expensive third party agencies, also makes a contribution to making sure that the money we're investing in the workforce is spent wisely." First Minister Eluned Morgan signed a similar agreement with the Keralan government when she was health minister. "There's a long tradition that we're proud of in Wales about ethical international recruitment into the NHS from right across the world," said Mr Miles. "I'm in India because we have an established relationship here which is working very well. "The important skills which they're bringing to the NHS workforce can be put to work as quickly as possible to make sure patients get the care they need." But the RCN has concerns that recruitment is difficult due to financial pressures the NHS is under. "The financial crisis is affecting the ability to recruit into those posts, to enable staff to undertake essential continuing professional development and again keeping people in the NHS," she said. She called for more action to fill nursing vacancies and improve patient care. "We know that pay terms and conditions are having a real detriment to the nursing profession in Wales, and we also know that the working environments that people are working in at the moment is again having a detriment to their health and wellbeing," said Ms Hughes. "We've been very open as the Royal College of Nursing in calling out the corridor care and the care in inappropriate places that's happening at the moment. "When you're constantly going into areas where there's more patients being placed in areas that shouldn't be cared for, and you have no more staff to care for them, you go home feeling that you haven't done your best. That's when nurses leave."