Analysis

Brexit and the NHS: ‘four out of five nurses fear the health service will suffer’

Nursing Standard and Sunday Mirror survey reveals nurses' concerns for NHS staffing and patient care, post-Brexit

Nursing Standard and Sunday Mirror survey reveals nurses' concerns for NHS staffing and patient care, post-Brexit

  • More than 3,000 nurses took part in the online survey in June and July
  • RCN says results reflect political uncertainty about negotiations
  • Staffing and supply of drugs and equipment are major concerns

Picture: Daniel Mitchell

Four out of five nurses believe Brexit may damage the NHS, according to a Nursing Standard survey.

In total, 3,073 nurses responded to a question asking whether they thought the UK's leaving the European Union (EU) would damage the NHS.

The online survey, carried out with the Sunday Mirror between 21 June and 4 July this year, found just 649 nurses (21%) thought Brexit would not harm the health service.

In contrast, 1,236 (40%) of nurses said Brexit would undermine the NHS, while another 1,188 (39%) said they were unsure.

Political uncertainty

The RCN says that it is unsurprising that the survey reflects political uncertainty about the outcome of Brexit negotiations.

'It is a disaster and we will miss our "family" of nurses from diverse cultures'

Mental health nurse

One mental health nurse working in the private sector told the survey: 'Staffing levels will plummet as EU colleagues return home. Agency staff will be used more – impacting on finances and continuity of care. Safety will be compromised due to more fragmented staffing levels and communication will suffer.

'It is a disaster and we will miss our "family" of nurses from diverse cultures.'

A charge nurse in an acute trust in England agreed: 'The loss of EU staff will be catastrophic for the NHS.'

Meanwhile, a practice nurse said: 'I hope EU staff will be secure but lately talk of problems with drug and technical supplies does give cause for concern – a case of "be careful what you vote for".'

Another nurse wrote that everything about Brexit and its likely effect on the NHS is 'unclear and confusing'.

Health and social care secretary Matt Hancock said the NHS in England was preparing to stockpile medicines and blood products in case of a 'no deal' Brexit when he appeared before the Commons health and social care select committee at the end of July.


Niall Dickson: Healthcare must be
priority number one

Brexit Health Alliance co-chair Niall Dickson says: 'Ministers are right to plan for the worst while doing everything to make sure the worst does not happen, but now is the time to start spreading the word about the scale and nature of the challenge and to enable NHS trusts and others to prepare.

'This has to be the number-one priority. We may be able to accept delays for some goods crossing borders, but that is simply not acceptable for medicines and other materials on which patients rely every day.

'Whatever happens in the negotiations, there is an absolute requirement on all those in office to make sure patients continue to receive the medicines and the treatment they need.'

Prime minister Theresa May published the Brexit white paper on 12 July, outlining the government’s desired UK-EU relationship after Brexit.

Part of the proposal is mutual recognition of professional qualifications, including in healthcare, which would allow EU nurses to continue to register in the UK without a requirement to retrain.

However, there is a lack of clarity on future immigration arrangements, with the white paper stating only that the future agreement ‘would end free movement, taking back control of the UK’s borders’.

Full details are to be published in a delayed, second white paper that deals specifically with post-Brexit immigration.

Red lights


Susan Williams: The right to remain
is still unclear. Picture: David Gee

RCN senior international manager Susan Williams says: ‘It doesn’t surprise me that so many people are effectively saying they are concerned or don’t know, because too many things are still up in the air.

‘The RCN identified five priorities for Brexit, all related to health, which will impact on the NHS, and we have rated each one with a red, amber and green traffic light score to show how far we think government has got.

‘They are all still amber or red because it is not clear whether the government has made a commitment or whether Brussels will agree.’

Ms Williams points to the fact that EU nurses’ future right to remain is still unclear, despite the government announcing a settlement scheme for EU citizens in June. The scheme will begin later this year.

‘Many nurses have already returned to Spain and Portugal because there were not sufficient guarantees for them’

Susan Williams, RCN senior international manager

The college says the right of EU nurses to stay in the UK must be guaranteed, even if the UK leaves without a Brexit agreement.

29 March 2019 

date Britain is set to leave the EU

‘Our number-one priority is workforce as that is the issue having the most immediate impact,’ explains Ms Williams.

‘The fact it has taken so long to get the settled status issue resolved and to get that system up and running means that many nurses have already returned to Spain and Portugal because there were not sufficient guarantees for them.

‘Because of the major issues we have with safe staffing and the lack of workforce strategy, we know we are still going to need to recruit after Brexit, both from the EU and internationally.

‘It is important the government focuses on getting a deal that allows us to continue to operate in all those areas, because if we don’t that could have a negative impact on our health services.’

Danny Mortimer, co-chair of the Cavendish Coalition, says it is imperative that the settled status scheme is a fast and simple process for people.

The coalition is a group of 36 health and social care organisations, including the RCN, working together to ensure the sector maintains an effective and sustainable workforce until Brexit and beyond.

Mr Mortimer says: ‘We look forward to engaging with the Home Office as it develops the final stages of the system and its plans for communicating with employers and staff.

‘Getting this right will be essential to a successful implementation.’

The RCN's Brexit priorities

Shortly after the 2016 referendum on whether the UK should leave the European Union (EU), the RCN highlighted its five priorities to ensure Brexit worked for nursing and did not harm health services in the UK. It has rated these priorities with a traffic light system of red, amber and green scores, indicating how much progress it believes has been made on the issue during the Brexit negotiations. 

The five priorities are:

  1. A coherent domestic health and social care workforce strategy, that includes preserving the rights of European Economic Area (EEA) nationals working in the sector and allows for future migration. 
  2. Continuing with appropriate education and professional regulatory frameworks for nursing and close alignment with EU legislation supporting healthcare. 
  3. Continue to collaborate with the EU on cross-border threats to public health.
  4. Safeguarding decent working conditions, health and safety at work and employment rights, many of which were adopted EU-wide. 
  5. Maintaining important opportunities for collaboration across Europe on research and between nurses.

The RCN has scored the first priority – on European nurses' right to practise in the UK – with an ‘amber’ warning, indicating there has been a UK government commitment or statement, but still no agreement with the EU on practical application.

Points two, three and four all carry a ‘red’ warning, indicating there has been no firm commitment by the UK government on the issues and how to resolve them.

For the final priority, on maintaining opportunities for collaboration across Europe, it has given a split score of red (because UK participation in EU research and exchange programmes has not been guaranteed by the UK Government after Brexit) and amber (because whatever the Brexit settlement, the RCN will continue to collaborate with other nursing organisations in Europe). However, the RCN's Susan Williams points out that 'our influence in these networks and alliances could be diminished if we aren’t in the EU anymore'. 

 

Wish list

RCN associate director of policy and public affairs Lara Carmona says the white paper provides some reassurance about the government’s plans for healthcare and nursing.

‘Planning is underway at the centre of government, but it will be important for the sake of patients that NHS hospitals, clinics and community services are all prepared for every possible scenario’

Niall Dickson, Brexit Health Alliance co-chair

But she warns: ‘We are not over the finishing line, this is still a wish list. In the remaining negotiations, the government must put patient safety at the heart of its thinking.’

27 

number of countries in the EU once the UK leaves

Niall Dickson of the Brexit Health Alliance says the ‘ambition’ of the white paper is fine, but the group awaits its execution.

‘We should be under no illusions about the consequences for patients if we fail to plan properly and do not reach a good agreement.

‘That could result in a significant threat to the health of both UK and EU citizens.

‘Planning is underway at the centre of government, but it will be important for the sake of patients that NHS hospitals, clinics and community services are all prepared for every possible scenario.’

No deal

The RCN's Susan Williams says the nation hasn't got much time.

77% 

fall in new registrations by nurses and midwives from the EU between 2017-18, equivalent to 881 nurses leaving the UK workforce

Source: NMC

She adds: 'A deal needs to be struck and explained properly to people.'

UK-EU negotiations are expected to end on 19 October, although an emergency summit may be called in November to finalise any deal, according to former Brexit secretary David Davis.

Failure to reach agreement with the EU is clearly a scenario that is growing ever more likely and health leaders will have to consider the possibility of a no deal Brexit. 

What this might mean for the NHS is anyone's guess at this stage.

Nurses' views

Comments from the RCN's survey results

As a foreign nurse I feel much less welcome compared to when I arrived – I seriously considered leaving and so did many other European colleagues. Also, the number of European nurses arriving in my hospital has dropped drastically since the Brexit referendum.
A staff nurse in an acute trust

Brexit will damage the economy and therefore there will be even less money to fund the NHS.
Retired staff nurse who used to work at an acute trust in London

[I am] concerned we will lose a number of good staff because of [Brexit]. I am not sure what other issues will affect it, as we have no idea yet how it will look.
A staff nurse in a Yorkshire mental health trust
 
Lots of nurses from Europe have gone back home as they don't know what will happen after Brexit. Also, [fewer] nurses from Europe are coming to fill the nursing vacancies in the NHS as they don't know what will happen after Brexit.
A staff nurse at an acute trust in south west England 
 
Brexit has never been adequately explained.
A community services trust staff nurse

Brexit could be a good thing. If we stop giving money to Europe and invest it in the NHS, things might be a whole lot better.
A staff nurse in an acute trust in Wales



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