The National Health Service, UK's largest single employer, has been in the centre of the debate since the announcement of the Brexit referendum. Its workforce benefited from the free movement of people laws within the European Union but now staffing levels from the continent are changing their trends.
1. How many EU staff are in the NHS?
1 out of 20 workers in NHS England come from other countries of the European Union.
At the end of 2017 there were 62,301 EU non-British EU nationals working in the English health service, according to data from NHS Digital. This represents 5.6% of NHS staff in England.
This number has changed a little since the Brexit referendum. It increased from the 58,702 EU workers that were in the National Health System in June 2016, but the whole system has grown. Although it shows an increase of 3,500 workers, they represented 5.5% of the staff with a known nationality at that moment, so there has just been a 0.1 percentage point increase.
2. So EU workers aren't really leaving, are they?
Well, it is not that simple.
The percentages above are calculated in relation to the total staff with a known nationality, a proportion which has increased over time. But the increase of EU workers has been smaller than the one of other foreign workers.
To analyse it in more detail, it is useful to see the trends of joiners and leavers of the NHS.
During the calendar year 2017, 12,120 EU nationals joined the health system and 10,353 left. They represented 8.1% of joiners and 8% of leavers.
The share of EU workers joining the NHS increased until 2016, the year of the referendum, when the proportion started to fell. The proportion of leavers during the last five years rose.
3. Are there more EU workers in any staff positions?
Yes, the proportion of non-British European Union workers varies from a fifth to a fiftieth in different groups.
EU staff represent less than 2.5% among managers and ambulance staff and its supporters but more than 10% of the more experienced doctors like registrars (10.2%) and speciality doctors (13%) and nearly one out of five staff grades (19.5%).
From the five categories with more workers, two have a higher proportion of nationals from the continent than the NHS mean. They represent 6.9% of nurses and health visitors and 9.7% of Hospital and Community Health Services doctors.
4. Is all England in the same situation?
No, the share of foreign workers, especially of EU workers, is bigger in London and the south east of England.
That is why the report Brexit and the NHS says that “these are the areas most vulnerable to skills shortages should future immigration rules become more restrictive”.
In the three London health education regions, EU staff make up more than 11% of the workforce. In the other four regions in the South East, the proportion of workers from the continent is also higher than the national average.
5. Are trends the same for all EU nationals?
No, the patterns of joiners and leavers differed among different European countries.
Let's focus on the nationalities with more workers in the health system. The number of Spanish and Portuguese professionals joining the NHS went up until the year of the referendum, when the arrivals decreased. In contrast, joiners from Poland and Ireland increased.
One explanation for such divergence may relate to nurses. This collective account for nearly two of every three Spanish NHS workers (61%) and half of the Portuguese (50%), but only 35% of the Irish and 16% of the Polish.
Nurses and health visitors where the group experimenting a higher increase in EU workers share up to the Brexit referendum. They went up to represent almost one out of five nurses in England (17%). But they were also one of the staff groups who suffered the biggest drop afterwards.
6. Why is it important to pay attention to the nurses' case?
The Royal College of Nursing (RCN) estimated in a report that there were 40,000 nurses missing already in England alone last year. Uncertainty after Brexit referendum can just be one more factor added to this situation.
Applications to study nursing and midwifery courses at English universities have dropped by 10% between 2018 and 2017, according to Universities and Colleges Admissions Service (UCAS). The decrease was of 20% the year before, following the abolition of bursaries in 2017.
The fall in EU joiners can also be related to the new language requirements introduced by the Nursing and Midwifery Council (NMC) in January 2016.
7. How we got to this situation?
"The UK has never trained enough doctors for its own needs", said Tamara Hervey and Sarah McCloskey in a recent report. That is why the system needs workers from abroad, but “restrictive rules on recruiting non-EU nationals are already causing problems for the NHS, and extending these to EU nationals will aggravate the situation”, they add.
“Funding is clearly an issue, but I would suggest that the root cause of unfilled vacancies is the low morale within the existing workforce”, pointed Niall Dickson.
Dickson, chief executive of the NHS Confederation, which represents organisations across the healthcare sector, said “Brexit, the new doctors’ contracts, and unsafe staffing on wards leading to compromised patient care have created despair for staff in the NHS. Staff are leaving the system and the government is not doing enough to attract new talent by improving morale”.
8. What will happen in the future?
There is a lot of uncertainty around the Brexit negotiations.
Health Secretary Jeremy Hunt has said he wants EU nationals to continue in the system because they "do a brilliant job", but he also he believes “this country should be training all the doctors and nurses that we need”. This wouldn't be quick and would constraints from the public finances, say from the think tank The UK in a Changing Europe.
Last December joint report of the Brexit negotiators state that EU citizens will retain the same rights to live and work here as they enjoyed prior to the withdrawal.
For the head of the NHS European Office, Elisabetta Zanon, “from an NHS perspective it will be crucial that this promise is maintained when decisions on the new immigration system are taken”. Because “a malfunctioning immigration policy may lead to a malfunctioning health system”, say Menon and Bevington in Brexit and the NHS report.
Data for this report has been analysed from various downloads from NHS Digital workforce statistics and its supplementary information.
Images are shared under a Creative Commons license. Front image from U.S. Navy photo by Mass Communication Specialist 2nd Class Chad A. Bascom.
