Analysis

Exclusive: Falling EU nurse figures spark fresh concerns over Brexit

New figures show fewer EU nurses in post at certain ‘high-risk’ trusts and fewer joining the register in the UK.
brexit

New figures show fewer EU nurses in post at certain high-risk trusts and fewer joining the register in the UK.

Concern about the effect of Brexit on the UK nursing workforce could intensify, with new figures showing fewer EU nurses in post at certain NHS trusts and fewer registering to work here.

The new minority government is expected to start Brexit negotiations with Brussels on 19 June, but there are still no guarantees for EU nationals about their right to remain. Newly reappointed health secretary Jeremy Hunt says the status of EU nationals working in the NHS will be top of the governments list as negotiations start.

Tougher language requirements for nurses from overseas have also been blamed for recruitment problems.

All this means further workforce uncertainty for the health

...

New figures show fewer EU nurses in post at certain ‘high-risk’ trusts and fewer joining the register in the UK.

brexit
Many trusts have lost EU nurses in the past year. Picture: iStock

Concern about the effect of Brexit on the UK nursing workforce could intensify, with new figures showing fewer EU nurses in post at certain NHS trusts and fewer registering to work here.

The new minority government is expected to start Brexit negotiations with Brussels on 19 June, but there are still no guarantees for EU nationals about their right to remain. Newly reappointed health secretary Jeremy Hunt says the status of EU nationals working in the NHS will be top of the government’s ‘list’ as negotiations start.

Tougher language requirements for nurses from overseas have also been blamed for recruitment problems.

All this means further workforce uncertainty for the health service, which is already facing a severe shortage of homegrown nurses and, according to the RCN, 40,000 nursing vacancies.

Future supply

Last year, the Institute for Employment Studies (IES) warned – in a worst-case scenario – that Brexit represented a ‘severe interruption’ to the UK’s future supply of nurses.

IES researchers identified 20 NHS trusts in England likely to be most vulnerable to twin pressures caused by Brexit and a projected high rate of growth in the number of people aged over 85.

It suggested NHS workforce planners implement ‘a radical re-think’ of the recruitment, training and deployment of nurses.

The 20 trusts identified were:

  1. Milton Keynes Hospital NHS Foundation Trust 
  2. Royal Brompton and Harefield NHS Foundation Trust
  3. Burton Hospitals NHS Foundation Trust
  4. Luton and Dunstable University Hospital NHS Foundation Trust
  5. Wrightington, Wigan and Leigh NHS Foundation Trust
  6. West Suffolk NHS Foundation Trust
  7. Papworth Hospital NHS Foundation Trust 
  8. Mid Essex Hospital Services NHS Trust 
  9. Buckinghamshire Healthcare NHS Trust 
  10. Queen Elizabeth Hospital King's Lynn NHS Foundation Trust 
  11. Oxford University Hospitals NHS Trust
  12. Imperial College Healthcare NHS Trust 
  13. Whittington Hospital NHS Trust
  14. Hampshire Hospitals NHS Foundation Trust
  15. Bedford Hospital NHS Trust
  16. Frimley Health NHS Foundation Trust
  17. Royal Free London NHS Foundation Trust
  18. Salisbury NHS Foundation Trust
  19. Weston Area Health NHS Trust
  20. London North West Healthcare NHS Trust

96%

drop in the number of EU nurses registering to work in the UK in the past year
Source: NMC
 

Nursing Standard’s own exclusive data, obtained from the 20 trusts under freedom of information laws, reveals that 58% of these at-risk trusts – 11 of 19 who provided figures – have already lost EU nurses in the past year.

West Suffolk NHS Foundation Trust executive director of workforce and communications Jan Bloomfield said the organisation had a number of ways to attract nurses, including recruiting from outside the EU.

Staff retention a priority

She said: ‘We are aware of the possible outcomes Brexit may have on our workforce but will try to mitigate any issues it may bring, ensuring staff retention is a priority.

‘We employ a number of nurses from the European Economic Area who do superb work here at the hospital, and long may that continue. However, it’s not an easy process and we sometimes struggle to complete the registration of some due to the complexity of the IELTS test they need to pass.’

A Royal Brompton and Harefield NHS Foundation Trust spokesperson said: 'Until there is some certainly over the status of EU nationals, we cannot speculate on the impact Brexit will have on nurse recruitment and retention.'

Meanwhile, there has been a 96% drop in the number of EU nurses registering to work in the UK in the past year, according to Nursing and Midwifery Council data.

The number of EU applicants fell from 1,304 in July last year – the month after the referendum on Britain leaving the EU – to just 46 this April, figures obtained by the Health Foundation show.

These combined figures suggest the worst case may already be happening, even before Brexit negotiations have got off the ground.

Migration policy

The IES analysis said that if nursing supply from Europe is squeezed by Brexit, pressure will fall on migration policy to look towards non-EU immigration.

It said relying on recruitment of nurses from outside of the European Economic Area (EEA) to help stem the loss of EU nurses is a risky strategy for the UK, given the reduction in the overseas supply.

About 15,000 nurses from outside the EEA joined the UK nursing register each year in the early 2000s.

This plunged to 775 nurses by 2008-09 and has not recovered since. In 2014-15, just 665 non-EEA nurses were registered in the UK, meaning a 95% drop in 15 years.  

4.5%

EU nurses currently make up 4.5% of the total nursing workforce in England, up from just over 1% in 2009. In some trusts the figure is 20%

International Council of Nurses director of nursing and health policy Howard Catton warns of ethical issues ahead for workforce planners and recruiters.

Dr Catton says: ‘The world is short of nurses and this is predicted to grow in response to an ageing population.

‘This means nurses looking to migrate have choices and employers wanting to recruit have to compete, which could drive investment in the EU nursing workforce.

‘But there is also a risk of a return to targeting nurses from lower- and middle-income countries. 

‘The ethics must be as important as the economics of recruitment over the coming months.’

Workforce planning

Instead of poaching sorely needed nurses from lower-income countries, many believe the answer lies in improving what Britain offers to future nurses.

IES senior research fellow Rachel Marangozov, who led the analysis identifying the 20 at-risk trusts, says the UK has long relied on international nurses as a stopgap.

Dr Marangozov says: ‘How sustainable is it to continue to recruit from outside of Europe, just because the government cannot put in place adequate workforce planning for the long term?

‘We should be focusing on growing our own domestic supply of nurses that is more resilient to shocks such as workforce dips, Brexit and cuts to student bursaries.’

665

nurses from outside the European Economic Area joined the UK nursing register in 2014-15, down from around 15,000 each year in the early 2000s

She says that although EU nurses account for only 4.5% of the workforce nationally, this masks the true picture, as at some trusts the figure is as high as 20%.

RCN general secretary Janet Davies says the UK relies on EU staff and warns the latest drop in numbers could have ‘severe consequences’ for patient care.

‘Our nursing workforce is in a state of crisis,’ she says. ‘These figures should act as a wake-up call to the government as they enter Brexit negotiations. EU staff should be left in no doubt that their contributions are welcome and valued.’

Too early

Workforce expert James Buchan says the latest figures highlight ‘a mixed picture’ for the EU nursing workforce at local level across the UK.

Professor Buchan, of the school of health sciences at Queen Margaret University in Edinburgh, says: ‘It is too early to know the full impact of Brexit on EU nurse recruitment and retention.

‘We know it will have an impact, but until we have the detail on how EU nurses will be treated, we – and they – can only guess what that might be.’

Niall Dickson, chief executive of the NHS Confederation, which represents NHS organisations across England, Wales and Northern Ireland, says: ‘We continue to urge the government to guarantee the rights of EU nationals as soon as possible.’

English test

The NMC said in February last year that all foreign nurses, whether from within or outside the EU, must score at least a seven on the nine-band International English Language Testing System before they could join its register.

After complaints about the stringency of the requirement the NMC is now reviewing the tests to see if the pass grade should be lowered, and evidence collected in the review will be presented at the next NMC council meeting in July.

NMC chief executive Jackie Smith said in May that changes were 'very unlikely' before autumn, adding: ‘That is if we make any changes at all, and I do need to stress that. People are running away with the idea we have lowered the score, and we just haven't.’

Nurse from Italy looks to plan B

West Midlands’ locum emergency nurse practitioner Hamen Bekele came to the UK from Italy in 2013.

Ms Bekele says she wanted to work in Britain because of ‘stability and opportunity’ but now has a ‘plan B’ to emigrate to Switzerland, Australia or the United Arab Emirates if her right to remain is not guaranteed.

‘Brexit has affected a lot of my colleagues,’ she says. ‘One of my Spanish colleagues left within two weeks of the referendum, saying to me “They don’t want us, so I might as well go back”.

‘For me, and most EU nurses I know who came to stay and live in UK pre-referendum, our future in the UK is uncertain. Are we going to be facing expulsion from the UK?’


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