Andy Cowper discusses the possible consequences of a likely “no deal” Brexit for the NHS

A variation on the late primary care pioneer and socialist Julian Tudor Hart’s “Inverse Care Law” applies to the subject of respect: those people who focus on it most, deserve it least. This group of people also consistently fail to notice or understand that respect is never automatic: it is always earned – which is usually, the hard way.

This observation is prompted by prime minister Theresa May’s bathos ridden plea for the European Union to respect the UK’s government over Brexit.

Oh dear. Going Full Aretha on the EU is just not a good look for Mrs May. It has somehow escaped her government’s attention that the EU is a rules based organisation, which has been consistently and crystally clear that its four freedoms will not be breached to accommodate a member country that has chosen to leave. The government’s desire for selective participation in the EU single market is a political pick ‘n’ mix fantasy.

One week before the start of the Conservative Party conference, the likelihood of a “no deal” Brexit from the EU has risen sharply due to this week’s events. This will embolden the hard Brexit crowd of MPs, whose attempts at producing their own EU exit strategy were little short of embarrassing.

And the raised risk of a “no deal” Brexit in just six months’ time matters enormously to the NHS and the broader health and care system.

It’s the workforce, stupid

There is not only the impact on the existing NHS workforce, 12.5 per cent of which is non-British and 5.6 per cent of which is from the EU.

The metropolitan liberal elite have every right to be concerned about his, since one third of all EU nationals in the NHS work in London. Nursing and Midwifery Council data show a significant rise in the number of EU nurses and midwives leaving the register. Between April 2017 and March 2018, 3,962 people left – an increase of 29 per cent.

The NMC data also continues to find a dramatic drop in those joining the register from the EU. Over the same period, 805 EU nurses and midwives joined the register compared with 6,382 the year before – a drop of 87 per cent.

However, as this column has been pointing out pretty much from the start, the sector likely to see the biggest impact is the social care workforce.

Around 230,000 jobs in adult social care are held by people with a non-British nationality (90,000 EU; 140,000 non-EU). Seven per cent (95,000 jobs) had an EU nationality and 9 per cent (125,000 jobs) had a non-EU nationality.

Let them eat brioche

For all these staff, the prospect of a hard Brexit means further relative decline in the value of sterling against their home nation’s currency. It also means massive uncertainty about their future status, despite Mrs May’s warm words.

Our political narrative around immigration and immigrants has been led by a uniquely poor generation of politicians. We ought to be in no doubt that for many people who came to the UK for work now experience a hostile environment.

The NHS has a workforce crisis. Since we cannot instantly train the extra staff that we need, and there might be some minor governance issues around bringing in actors, we have one serious option, which is to import the staff we need from overseas.


It is impossible to quantify the economic damage a hard Brexit would cause, but the International Monetary Fund’s Christine Lagarde is former top EU lawyer and nobody’s idea of a fool. When Ms Lagarde warned this week that the consequences of a disorderly Brexit would be highly economically damaging, it behoves members of the reality based community to listen.

Currently, the NHS Commissioning Board is preparing a 10 year plan for the extra money Mrs May promised after being walked up to so doing by the Hunt-Stevens axis.

The court of public opinion seems to be ruling in favour of more public spending in a way unprecedented for over a decade.

But we do not know the source of this extra money.

And if there is a disorderly or “no deal” Brexit, as now seems more likely, the economic consequences could imperil the promised extra money for the NHS.

And we have not even hit 2018’s peak winter demand yet.

Of course we need to plan how to spend the extra money, if it arrives. But it is increasingly clear that we are going to need to plan for a “no deal” Brexit as well.

If there is no deal, there could be hundreds of millions pounds a year less for the NHS. Anyone up for sticking that on the side of a bus?