Brexit: make or break for the NHS?

With the NHS reliant on EU nurses, Brexit plans must cover all areas of healthcare

With the NHS reliant on nurses from abroad, Brexit plans must cover all areas of healthcare

Picture: iStock

With less than 100 days to go before Brexit, ministers claim plans are in place to ensure the health and care systems can recruit and retain enough staff.

Early on in the process, the government promised that people from European Union (EU) countries already living in the UK would be entitled to stay under the ‘settled status’ policy.

Then, before Christmas, the government unveiled an immigration white paper, which proposed a new route to allow skilled workers to be recruited on five-year visas. There is also provision to allow less skilled workers in for a year.


Number of nurse vacancies in NHS at the end of June 2018 in England

Home secretary Sajid Javid said it would ensure the country could attract the workers it needed while keeping migration down to ‘sustainable levels’.

But do the plans go far enough for the health and care sectors? After all, the NHS is hugely reliant on staff from abroad, with more than one in 20 posts being filled by people from other EU countries.

The situation is even more acute in social care; there are more than 40,000 nurses working in this sector, and 16% of them are from the EU.

NHS Providers deputy chief executive Saffron Cordery has her doubts because the plans include proposals to set an earnings threshold of £30,000 to qualify as a skilled worker.

Saffron Cordery

Deep concerns

She says: ‘We are deeply concerned about what is going to happen. High skills do not equal high pay.

‘You have got starting salaries for nurses, paramedics and midwives at £23,000, junior doctors at £27,000 and healthcare assistants at £17,000. All come in way below that £30,000 cap.’

So how bad could things get? Making predictions about what might happen is difficult given that it is still unclear what sort of Brexit the UK will end up with.

But a report for the Cavendish Coalition, a group of health and social care organisations committed to provide the best care to communities, patients and residents post-Brexit, late last year attempted to make a forecast; and for nursing rotas it did not make pretty reading.

It suggested that, by the end of the transition period alone, the NHS in England could be short of 51,000 nurses, enough to staff 45 hospitals.

The report, Brexit and the Health and Social Care Workforce in the UK, was compiled by a team from the National Institute of Economic and Social Research.


more vacancies could open up by 2021

It came up with the 51,000 by looking at the number of nurses leaving and joining NHS jobs in the 12 months before and after the referendum and then projecting forward.

It showed that, while there were small improvements in UK and rest-of-the-world trends, the European Economic Area (EEA) workforce saw a significant swing from a net increase before the vote to a net decrease afterwards.

The researchers predict a continuation of this trend will see the current number of vacancies, 41,722, worsen by between 5,000 and 10,000 by 2021.

'The sector is deeply reliant on talented colleagues from across Europe and the rest of the world'

Danny Mortimer

What is more, the Cavendish Coalition report says the message Brexit gives, that the UK is pulling up the drawbridge, will turn people off working in the NHS regardless of any assurances and exemptions.

Looking even further ahead, The Healthcare Workforce in England: Make or Break?, a report by the Nuffield Trust, King’s Fund and Health Foundation, states that the shortages could more than double by 2030.

Both pieces of research were published before the government unveiled its white paper, but took into account the fact the government had already said it was minded to set up a skilled migrants route of the kind put forward.

NHS Employers chief executive Danny Mortimer says the figures are startling and should be taken extremely seriously.

Danny Mortimer

‘The sector is deeply reliant on talented colleagues from across Europe and the rest of the world, so it is disheartening to see these projected workforce gaps at a time of rising demand.’

The National Institute of Economic and Social Research associate research director Heather Rolfe, who was one of the authors of the Cavendish Coalition report, says more also needs to be done to ensure a healthy domestic supply of nurses, pointing out that the problems with recruitment and retention pre-date the Brexit vote.

Workforce gap

But she says it would be wrong to assume such measures can plug the gaps entirely.

Stephanie Aiken

‘Measures designed to increase recruitment from within the UK have potential. However, they will take some time to take effect and are very unlikely to produce sufficient numbers to make up for a shrinking EU workforce.’

Royal College of Nursing deputy director of nursing Stephanie Aiken says the situation is alarming.


of social care nurses are from the EEA

(Source: Brexit and the Health and Social Care Workforce in the UK)

She believes it could be even worse than is being forecast, pointing out that evidence from the Nursing and Midwifery Council register suggests there is an ‘over reliance on an ageing workforce that is choosing not to leave’ and that the full impact of the decision to remove the bursary has yet to be felt.

‘The number of students accepted to university nursing courses has fallen. The hope of increasing student numbers by scrapping the bursary has failed conclusively. The future of patient care is at stake.’

New ways to recruit and retain NHS staff

NHS trusts have been working hard to come up with their own solutions to the recruitment and retention problems, from introducing flexible working and secondment opportunities to providing bespoke support to newly qualified staff.

Crucial to the work has been NHS Improvement’s retention programme, which was launched in 2017 to combat the fact that one in ten nurses walks away from the health service every year.

More than 100 acute and mental health trusts have received direct help from the regulator to draw up action plans.

There have also been masterclasses open to all, a resource to share best practice and an online diagnostic tool launched to help trusts draw up strategies.

Evidence from the first cohort of 35 trusts to go through the programme shows there has been a 10% improvement in turnover.

Southend University Hospital NHS Foundation Trust

One of the trusts that has benefited is Southend University Hospital NHS Foundation Trust.

It has carried out detailed focus group work with nurses, particularly the over-50s because of high numbers leaving. It resulted in a series of measures being introduced, including ensuring that all jobs are advertised as eligible for part-time or flexi-working and that retire-and-return opportunities are actively promoted.

Turnover is starting to fall. Head of human resources Sue Bridge says the key is ‘good engagement’ and making sure ‘every member of staff feels like they belong’.

Mid Yorkshire Hospitals NHS Trust

Mid Yorkshire Hospitals NHS Trust launched a rotation programme to give nurses opportunities to further their career.

It lasts for 16 months and gives nurses the opportunity to work in four different specialisms. At the end of the programme, they are given the opportunity to apply for a permanent role in their preferred area.

Beyond the work on retention, other trusts have started to look at innovative solutions to recruitment.

For example, North Tees and Hartlepool Hospitals NHS Foundation Trust has worked with a local charity to identify local refugees and asylum seekers who are qualified healthcare professionals. It then supports them with training, preparing for exams and English language testing so they can register to work in the UK.


Further information

Dolton P, Nguyen D, Castellanos M et al (2018) Brexit and the Health and Social Care Workforce in the UK.

Nuffield Trust, King’s Fund, Health Foundation (2018) The Healthcare Workforce in England: Make or Break?


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