NHS could lose thousands of staff under Brexit migration shake-up

Home secretary Priti Patel has committed to introducing an Australian points based immigration system for the UK after Brexit, while the government has asked the Migration Advisory Committee to consider the evidence for salary thresholds and at what level they could be set.

According to NHS Digital data, examined by HSJ, there are 60,611 NHS staff, by headcount, from the EU and the rest of the world who are not currently on the shortage occupation list and earn less than £36,700.

This salary cap was suggested by centre-right think tank The Centre for Social Justice, which published a report in August on the future of immigration. In that report, it proposed the wage cap for skilled workers, both EEA and non-EEA.

The report also said the Home Office should consider a list of occupations that are “strategically important or in high demand, for instance NHS workers”.

The data also revealed there are 29,000 non-EU staff who are not on the shortage occupation list and earn less than £30,000, which is the salary currently required to receive a tier 2 visa, the category of visa for skilled overseas workers wanting to work in the UK. There are exemptions that allow staff to work below the cap if they are new entrants but they will need pay rises within three years.

According to the data, there were 116,000 staff in total from the EU/EEA and the rest of the world combined who earned less than £36,700.

Of this, over 47,000 were nurses and health visitors, with more than 1,600 community services nurses.

However, EU citizens currently living in the UK can apply for a settled status, which grants them the right to live and work in the UK. It is unclear how many EU citizens currently working in the NHS has already been granted settled status.

Physiotherapists at risk

Earlier this year, the Migration Advisory Committee recommended all medical roles should be added to the shortage occupation list and nurses should remain on it after a “significant” number of stakeholders reported difficulties in recruitment.

Other changes made included adding paramedics, medical radiographers and certain allied health professionals, such as psychologists and occupational therapists.

Physiotherapists are the largest group of allied health professionals who are both not on the shortage occupation list and have the highest number of EU and non-EU workers earning less than £36,700.

The data revealed there were more than 1,200 physiotherapists working in the NHS and earning less than £36,700 from the EU, and almost 600 from outside the EU.

Karen Middleton, chief executive of the Chartered Society of Physiotherapy, said: “We believe the government has two simple choices to ensure we can retain overseas physiotherapists, who form a crucial part of the workforce.

“They can either increase NHS salaries so they meet minimum visa requirements or recognise health and care as a special case and link the salary minimum for settlement to Agenda for Change.”

Clarity is needed

Danny Mortimer, chief executive of NHS Employers, said: “There are thousands of lower-paid staff who come from outside the UK on whom the NHS relies, such as care workers, as well as others performing vital services to the public but who are earning well below £36,700 a year, such as nurses.

“Lower paid colleagues, from the EU and elsewhere, would be cut off by a salary threshold as high as this and it seems short-sighted to suggest this increase, especially with no special allowance such as the one recommended for seasonal agricultural workers.”

Mr Mortimer warned increasing the salary threshold further would close the doors to “vital overseas colleagues”.

“The National Institute of Economic and Social Research predicted in 2018 that the NHS in England could be short of an additional 5,000-10,000 nurses by the end of the Brexit transition period in 2021. On top of the current vacancies, that is more than 51,000 nurses,” he said.

“We would call on the MAC to take this into account when establishing an appropriate level at which to set the salary threshold as part of the future immigration system,” Mr Mortimer added.

The head of policy and public affairs at NHS Providers, Ferelith Gaze, said any new immigration system must support the NHS and social care in recruiting and retaining the staff it needs.

“The criteria will need to recognise that low paid does not mean low skilled, and it will be several years before domestic supply increases enough to help close the sizeable workforce gap,” she said.

Ms Gaze also called for more detail around the rights of EU citizens in securing European temporary leave to remain.

“Without that clarity, those considering applying to work in the NHS or social care may be put off from making the commitment to move to the UK. We cannot afford to delay or disincentivise staff from joining the health and care sectors,” she said.

A Home Office spokesman said: “The government has not proposed or endorsed a minimum salary threshold of £36,700. We have asked independent experts at the Migration Advisory Committee to look at the issue of salary thresholds and we will consider all the evidence before finalising them.

“People from the EU and overseas are an integral part of our national health service and our new immigration system will allow us to take back control and prioritise the people who will add significant value to our country.”

Article amended at 14:25 on 10 October to reflect EU citizens can apply for settled or pre settled status that gives them the right to stay and work in the UK permanently after Brexit.