Analysis

Should we stay or should we go? Referendum reflections for nurses

With the EU referendum looming, nurses will be weighing up what a vote to stay in, or to leave, the European Union would mean for their jobs and healthcare in the UK.

Those urging people to vote ‘leave’ claim the NHS would be better off; that emergency departments would be less crowded and ‘red tape’ that delays important drug trials could be cut.

Picture credit: Pete Ellis

But those wishing to remain in the EU dispute that and counter that European law has improved working conditions for NHS staff by, for example, boosting protection against sharps injuries and restricting the hours worked in one shift.

As the Vote Leave and Stay In campaigns began in earnest, the Commons health committee last week asked for evidence to be submitted on the effect of membership of the EU on health policy in the UK. Evidence will be published before the June 23 vote.

Brexit campaigners, among them London mayor Boris Johnson and justice secretary Michael Gove, say the UK’s annual net contributions to the EU, which they estimate at £10.6 billion, would be better spent on the NHS.

Labour MP and chair of the Vote Leave campaign, Gisela Stuart, says: ‘If we vote to leave, the money we send to the EU will plug some of the gaps in NHS funding.’

TTIP concerns

Rupert Williams of the Better Off Out group believes that in recent years the EU has assumed increasing control over healthcare and the NHS.

He claims rising demand for the NHS is partly due to migrant workers from the EU using the emergency department rather than a GP.

Mr Williams adds: ‘The EU’s clinical trials directive is now delaying the testing of life-saving cancer drugs. There are also serious concerns that the EU’s proposed Transatlantic Trade and Investment Partnership deal with the US could have a serious impact on the NHS and extend the privatisation of the health service.’

But chancellor George Osborne claimed last week that leaving the EU would have an economic effect on the UK equivalent to cutting the NHS budget by one third. And Unite officer for health Barrie Brown describes the Vote Leave claims as ‘spurious and outrageously misleading’.

Cases for and against

Vote ‘leave’

Money spent in the EU would plug gaps in NHS funding

EU has too much control over health care in the UK

Rising demand in NHS partly due to volume of migrant workers using emergency services

Vote ‘remain’

Ease of migration, with 33,000 EU nurses working in the UK

Legal protections such as the European Working Time Directive

Europe-wide reviews allow easier and better evidence-gathering.

He says the NHS’s financial position has nothing to do with Brussels, but everything to do with successive years of underfunding and a growing population.

Unison and the Royal College of Midwives, which estimates 33,000 nurses and midwives from other EU countries work in the UK, support the In Campaign. The RCN is adopting a neutral stance, but will soon be publishing information to help inform its members’ before the referendum.

An RCN report on the EU and nursing in the UK explains that EU policy and legislation have had a major impact on issues that affect nurses’ working lives, such as employment rights, equal opportunities and health and safety at work.

Working hours

The college says the EU’s key health and safety-related directives provide a legal framework for employers to reduce risks to staff, and the European Working Time Directive, introduced in the 1990s and subsequently updated, has helped nurses by making rest breaks mandatory during long shifts.

Mr Brown adds: ‘If Brexit took place we would not be helped by EU directives that have been important for nurses, and this could leave them without the protections and safeguards currently offered.’

The Nursing and Midwifery Council checks that EU-trained nurses and midwives have the clinical skills required to practise in the UK. But until recently, EU freedom of movement rules prevented the NMC from testing EU nurses’ English language skills.

It was not until January that EU nurses applying to work in the UK had to achieve a high score in an international English language testing exam. This move brought them into line with nurses coming to work in the UK from outside Europe.

An NMC spokesperson said that as an independent regulator, it will not speculate on the outcome of the referendum, but added that ‘we will keep abreast of the referendum and consider the implications for regulation if necessary’.

Anne Marie Rafferty, professor of nursing and dean of the Florence Nightingale Faculty of Nursing and Midwifery at King’s College London, believes the EU has been ‘important in setting the standards for mutual recognition for nursing’.

She says that essential nursing research, such as the major RN4cast study which looks at the state of nursing across Europe, was made possible by EU support and funding.

European Specialist Nurses Organisations president Françoise Charnay-Sonnek says she works on the recognition of qualifications and movement of specialist nurses in Europe and feels it is inconceivable the UK could leave the EU.

She says: ‘Britain has been a member since 1973 and we need a strong Europe in the face of countries like the US, China and India.

‘Britain brings a lot to the evolution of nursing and learns a lot from other European countries. The mobility of nurses between member states is very high so Britain exiting would be a loss.’

In advising nurses on considerations for their referendum decision, International Council of Nurses chief executive Frances Hughes says it is important for nurses to deal with facts and evidence.

Nurses should be able to question politicians to get to the heart of the issues of a referendum vote that will affect them and their patients, she says.

Dr Hughes adds: ‘The economies of countries are strongly linked with what happens to the healthcare workforce. Nurses have a great deal of influence.

‘There will be scaremongering and this is a time when nursing leaders in unions, chief nurses and others can be supportive.

‘Not everyone will get what they want, but there is more chance of nurses getting their point across if they’re part of the process.

‘Nurses in Europe will also be watching what’s happening in Britain. Nursing is a very big family. We have a strong network and regardless of what happens those relationships will still be there’.

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