The NHS workforce: challenges post-Brexit

Neal Suchak, policy advisor at the Recruitment & Employment Confederation, analyses the workforce challenges facing the NHS post-Brexit

The problems facing the NHS never seem to go away. A lack of funding, cancelled operations, the annual ‘winter crisis’ and questions about the viability of delivering a true seven-day service are ever-present. But arguably the most significant issue underpinning these challenges is the skills and recruitment crisis. It has now been almost two years since the UK voted to leave the European Union, and we need to consider the serious implications for the NHS and the wider social care workforce. So what does Brexit mean for them?

Brexit means less money
Even if the Brexit referendum had not happened, the NHS would still have faced increasing demand, predominantly due to a growing and ageing population. The Office for Budget Responsibility (OBR) recently projected that NHS spending would need to increase by 5.3 per cent of national income over the next 50 years in order to meet demand for its services.

However, leaving the European Union may mean less money for public services in general, and with the lower economic growth and continued poor productivity predicted with Brexit, this will mean less money for medicines, new health technologies and investment in staff. There is also a risk that the UK could become a lower priority market when it comes to the launch of new drugs, meaning the UK could fall behind European competitors, with patients not getting access to the latest treatments and trials.

Brexit means fewer staff
The NHS and the wider social care sector faces the triple challenge of retaining the skilled staff it already has, filling immediate vacancies and attracting sufficient numbers to fill projected vacancies.

The NHS has never been able to produce enough doctors and nurses from within the UK. The health and care sector has had to rely upon the skills of European staff for decades. The latest Office for National Statistics data show that approximately 200,000 EU27 nationals work in the wider health and care sectors—about five per cent of the total workforce. The percentage in London and the South East is considerably higher. A UK in a Changing Europe report found that around 28,000 doctors are non-UK nationals, around a quarter of the total. NHS England alone depends on around 11,000 doctors from the EU, which amount to about 10 per cent of all doctors, with a further 20,000 nurses and around 100,000 social care staff coming from EU countries.

Prior to the 2017 election, the government promised to ‘make it a priority’ during the Brexit negotiations to ensure that ‘staff from EU countries can carry on making their vital contribution to our health and care system’. However, the Joint Report by the European Commission published in December shows Article 50 talks only provided protection for staff already in jobs, and not those who might be employed in future. Unless NHS and other healthcare workers are given a special category, they could be caught up in wider measures designed to limit immigration.

The uncertainty posed by Brexit is already starting to affect staffing levels. According to a 2017 British Medical Association (BMA) survey of EEA doctors working in the UK, 45 per cent said they were considering leaving the UK, with 18 per cent having already made plans to leave. The Royal College of Nursing (RCN) reported a 92 per cent drop in registrations of nurses from the EU27 in England in March 2017, and attributed this, at least in part, to the failure of the government to provide EU nationals with any security about their future.

Brexit means we need to plan now
The UK simply needs to train more staff of its own, and work harder to retain and re-train the staff that it has. However, self-sufficiency from training UK healthcare staff could take ‘somewhere in the region of 10 or 12 years’ according to Ian Cumming, the chief executive of Health Education England, quoted in the Health Committee’s 2017 report into Brexit and health and social care.

There are some positive and encouraging signs. The NHS is about to celebrate its 70th birthday this summer, and to coincide with this, a major consultation has been undertaken to look into its workforce strategy – the first in over 20 years. In addition, Theresa May is planning to invest billions of extra pounds a year into health spending as part of a ‘birthday present’. This is expected to lead to up to £4 billion extra annually for the health service over the next 10 years and a special NHS tax is ‘still on the table’.

In addition, the NHS has already invited bids for a £100 million contract to recruit overseas doctors into general practice. Many of these measures are a real step in the right direction to ensure that the NHS and wider social care system is sustainable in the long-term. However, we still need to address the immediate problems.

Brexit means we need agency staff
No matter how good the NHS’s workforce planning is, there will always be gaps in rotas. The REC’s monthly Report on Jobs consistently shows that nursing, medical and care employees are the most in-demand type of short-term staff.

Agency staff have provided a vital life-line to the NHS for decades and continue to provide the NHS with the extra support that it needs in times of increased demand, and are vital in ensuring patient safety. The REC’s research with the National Institute of Economic and Social Research (NIESR) found that agency staff have skills on a par with substantive staff, often with many years’ experience working in the NHS. It is essential that these staff are recognised for their professionalism and contribution, are treated fairly, are valued and are made to feel part of the NHS family.

Recruiters are experts in workforce planning, and those working in the health sector see first-hand on a daily basis the shortages that the NHS has to contend with. Recruiters are perfectly placed to identify where problems lie, and are able to offer immediate solutions. Many recruiters specialise in particular areas such as the mental health sector, radiography or dentistry, and their knowledge of these sectors can be used by workforce policy makers.

Without an adequate supply of highly skilled and trained doctors and nurses, the NHS simply couldn’t operate. It is therefore essential that the NHS invests properly in recruiting the next generation of workers, as well as retaining the staff that it already has.

The need for agency staff is not going to go away, particularly in light of heightened demand from patients, and so the NHS must ensure that it seeks to create a working environment that is favourable to all staff, regardless of how they choose to work. Creating an environment in which all staff are paid appropriately for the work they do, are made to feel valued, and receive the training, flexibility and support they need, will be crucial in producing a workforce that is healthy, happy and able to deliver the best possible outcomes for patients.