Five years ago, when a global pandemic was the last thing he envisaged, csar del prado gave up hope of finding a job in his native spain. like thousands of other spanish health professionals, the nursing graduate boarded a flight to the uk.

There were no jobs to be had then, said mr del prado, now 29: spain was in an economic crisis. there had been lots of cutbacks in the health budget. they were not hiring nurses.

His departure was part of an exodus spain is now trying to reverse. it plans to enlist 10,000 more medical staff as it struggles to fight the worst coronavirus outbreak in europe with a health service that many said is understaffed, under-resourced and under strain.

We dont have a lack of nurses because of covid, said mara jos garca, a senior official in spains nurses union. we have a chronic lack of nurses, and with the pandemic you can see the difference it makes.

She says spain is 88,000 nurses short of eu levels of staffing. the countrys general nursing council, the body legally entrusted with co-ordinating the profession, thinks the gap is 125,000.

Meanwhile, as of january this year, more than 5,500 spanish nationals worked for the uks nhs alone.

Many professionals like mr del prado moved to countries such as britain and france because of austerity policies and other factors, including the spanish health systems reliance on temporary contracts that can run for just a few days or weeks.

Nurses have had to go to other countries looking to get longer term contracts that just werent available here, said ms garca, who added that up to 70 per cent of spanish nurses are on temporary contracts.

Mr del prado responded to an nhs recruitment advert when he was teaching english and working for a removal business in his home city of santander to make ends meet. within hours of sending his cv, he was offered an interview in madrid and the next day was on his way to the capital.

Within weeks he had his paperwork completed and a job in portsmouth. after two years he moved to a big london hospital. in the uk, he earned more, saved more and had better working conditions than his counterparts in spain.

Bar chart showing numbers of nurses per 1,000 people in various countries

I really enjoyed working in the nhs, mr del prado said. you get longer holidays, more breaks. and workers rights are much better.

He and many others left behind at home what critics said is a hollowed out health service, which now has to contend with a once-in-a-century emergency that has infected more than 63,000 spanish medical professionals proportionally one of the highest levels in the developed world.

The roughly 280,000 nurses working in the country represent one of the lowest proportions in the eu just 5.9 per 1,000 compared with the blocs average of 9.3.

We need doctors and nurses, isabel daz ayuso, the leader of the madrid regional government, said recently. we cant fool ourselves: there are no doctors in spain.

In fact, spain has around four doctors per 1,000 inhabitants above the eu average, and its annual crop of medical graduates is also above the norm for the oecd. but gabriel del pozo, secretary-general of spains doctors unions confederation, details the same problems for his profession as for nursing.

Theres a high level of precariousness, he said. instead of permanent contracts, there are often contracts by the day and by shifts.

There is a further problem as retirements loom: almost a third of the roughly 220,000 active doctors in the country are between 55 and 65.

In one indication of the pressures, spains national dentists association last week offered the services of its more than 40,000 members to prescribe and carry out coronavirus tests and perform contact tracing.

The spanish governments decree last week that temporarily changes the rules on medical staff is a further acknowledgment of the problem. it seeks to enable the hiring of 10,000 doctors and nurses by allowing posts to be filled by people who passed exams to be specialists, but failed to do well enough to win the competition for specific posts.

The decree permits the recognition of the qualifications of specialist health staff from regions outside the eu, such as latin america.

Since the pandemic began, prime minister pedro snchez has stepped up calls for increased health investment. as an emergency measure, his government has this year transferred 9bn to spains regions, which each run their own health services, to strengthen staff and systems.

But his move to bring in more doctors and nurses has already raised the ire of doctors unions, who have called a strike in protest against an initiative they say will undermine the regulation and professionalism of the sector.

People cant work if they have not had the relevant training, said mr del pozo of the doctors union. this would put the quality of the system at risk and put patients at risk.

Nevertheless, unions agree that getting spanish personnel back from abroad would be a big step towards healing the health system.

Brexit is one reason that might happen. before britain left the eu, working in uk hospitals helped spanish nurses qualify for jobs back home. but with the brexit transition period due to expire on december 31, that is set to end.

Mr del prado, the nurse from santander, has returned home after his years in britain and is now applying for a post in spain.

A lot of spanish nurses have come back, he said. and they will keep coming back. because it is easier to get a job, because the pound is weak, and because of brexit.