What impact will Brexit have on the health and social care workforce?

Helen McKenna

What’s the issue?

Although the delivery of health and care is primarily a matter for member states, leaving the European Union could have a significant impact on health and social care.

What’s behind this?

The UK’s departure from the EU could affect a number of issues including cross-border patient entitlements; the regulation and supply of medicines and devices; scientific and medical research; procurement and competition rules; and cross-border co-operation on public health issues. While all these issues are important, the most significant may be the potential impact on the health and social care workforces.

Approximately 60,000 of the 1.2 million NHS workforce* are from other EU countries, including more than 10,000 doctors and more than 20,000 nurses and health visitors. In adult social care, 90,000 of the 1.3 million workers employed by local authority and independent sector employers come from elsewhere in the EU.

The current policy of free movement remains unchanged until the UK concludes the terms of its exit from the EU. Following the announcement of the referendum result, health and social care leaders sought to reassure EU staff that they remain welcome and valued.

Despite this, there is evidence that Brexit is having an impact. The number of EU nationals registering as nurses in the UK has fallen by 96 per cent since the referendum, with just 46 EU nurses registering with the Nursery and Midwifery Council in April 2017. There has also been a fall in the number of EU nationals taking jobs in the social care sector.

It is widely acknowledged that the NHS and the social care sector are struggling to recruit and retain permanent staff. In 2015, there was a shortfall of around 47,000 full-time equivalents between the number of staff that NHS providers said they needed and the number in post, with particular gaps in nursing, midwifery and health**. The adult social care sector has an estimated vacancy rate of 6.8 per cent, rising to 11.4 per cent in domiciliary care. High turnover is also an issue, with an overall turnover rate of 27.3 per cent (equating to around 339,000 workers) leaving their role each year.

The government is taking action to strengthen the workforce. Jeremy Hunt recently announced plans to create a new nursing degree apprenticeship, as well as to train up to 1,500 more doctors every year, resulting in ‘more home-grown doctors’ with the aim of making the NHS ‘self-sufficient in doctors’ by the end of the next parliament. However, it will take a number of years for these extra staff to filter through to the front line.

The King’s Fund view

The UK’s decision to leave the EU could impact on a number of important issues in relation to health and social care, all of which will need to be resolved during exit negotiations. Given the financial and operational challenges facing services and the existing pressures on both workforces, the NHS and social care system can ill afford an exodus of staff. We therefore welcome assurances given by the Secretary of State for Health that securing the rights of EU nationals working in the NHS will be a top priority in the Brexit negotiations. In our view, EU nationals currently working in health and social care should be guaranteed a right to stay, while post-Brexit immigration rules should also allow NHS and social care providers to continue to recruit from EU countries if they are unable to fill vacancies with resident workers.

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*These figures exclude those working in primary care or other contracted-out services

**These figures were calculated using the estimated shortfall in each staff group according to contributions to the NHS Pay Review Body by Health Education England and the Office of Manpower Economics compared to the estimated number of staff in post in the NHS in March 2015