Lintern's Risk Register: The NHS faces a workforce Brexodus

A poor Brexit will deliver a workforce apocalypse

The prime minister is preparing to send her letter to the EU triggering Britain’s plunge into the uncharted waters of Brexit. It’s expected Theresa May’s historic missive will be sent any day now.

As the country prepares for two years or more of uncertainty and negotiations over the future relationship with the EU, one issue will weigh heavily on NHS managers – the fate of staff from the EU working in the service. They will want to hear details of what Britain’s immigration policy post-Brexit will look like as soon as possible so they can understand what it means for ensuring they have sufficient staff on wards.

Be under no illusion: if one considers the nursing shortage post-Francis inquiry as a crisis, then the potential fallout of a poor Brexit deal and harsh immigration rules could deliver a workforce apocalypse.

The government has already introduced tougher immigration rules, making it harder for the NHS to recruit foreign staff. Nursing has been added to the shortage occupation list because of concerns trusts won’t be able to source enough staff under normal visa rules. The Royal College of Nursing and the British Medical Association warned last week the planned immigration skills charge of up to £1,000 a year for a visa, which comes into effect in April, could drain millions of pounds from the NHS.

Increasingly, the bureaucratic system of recruiting overseas staff is costly and longwinded, and hampered by regulatory processes. Some of this can’t be avoided and is important, such as language testing. But following last June’s referendum result, the hurdles need to be lowered when they can, not made higher.

The real threat is not the rules and processes but the tone that is struck by British politicians, media and the public. Are we welcoming staff from overseas or projecting something more sinister? Following the referendum, some trusts reported an increase in racism towards staff. Health minister Lord O’Shaughnessy has recently said there has been a decline in EU nurses joining the NMC’s register since July 2016.

A poll carried out by Channel 4’s Dispatches suggested two-fifths of EU citizens working in the NHS were considering leaving the NHS in the next five years. The survey also found that 70 per cent of EU NHS staff thought the referendum made the UK a less appealing place to work and 66 per cent were worried about their career.

In apparently indisputable evidence, in the months since the referendum, figures from NHS Digital show that almost 5,500 EU staff left their posts in England, an increase of more than 25 per cent on the same period in 2015.

There are also economic pressures to go elsewhere. The decline of the pound means overseas staff earnings, which might often be sent home or saved into bank accounts in their origin country, buys a lot less than it did just a year ago.

With ever increasing patient demand, pay restraint and an NHS constantly squeezing them to work harder, some staff might conclude the easier option is to just go home or better yet travel to other countries where they perceive to be more welcome.

The description of a “perfect storm” doesn’t adequately capture these dangers coming together to create the protentional for a ‘Brexodus’ of EU staff heading home. The NHS won’t be able to replace them easily.

And this isn’t just about EU staff. The tone we strike as a country will be reflected in recruitment from elsewhere in the world, where it has always been that much harder to recruit compared to the benefits that free movement offered by the EU made possible. Should the EU pipeline become constricted the NHS will not be able to cope.

Health secretary Jeremy Hunt is doing his best to try to show the government is committed to the thousands of EU staff working in the NHS. At the chief nurses summit in Birmingham this week, he said: “EU nurses, all 22,000 of you, you are valued and are needed and we want you to stay in the NHS.”

But Mr Hunt is not a standing member of the cabinet Brexit committee (though I’m sure they invite him now and again) and whatever the Department of Health says, I am told senior civil servants are seriously concerned over the risks Brexit poses to the NHS workforce but are struggling to get their voice heard in Whitehall.

The decision of the Lords to back down over demands for EU workers to be given protection in the Article 50 legislation in Parliament was a mistake – but nowhere near as colossal as that when the government failed to offer such protection straight off the bat.

Brexit will be a long game with many twists and turns, but if the government is relying on EU staff to wait and see how it plays out, they are taking a very big gamble.