Brexit fears trigger exodus of crucial EU health and social care workforce – The Guardian
The warning comes a year after the UK voted to leave the EU – and as the number of non-British EU nationals in the health and social care workforce has grown exponentially in the past eight years. In 2016, 209,000 people working in the sector in the UK were EU nationals, up from 121,000 in 2009 – a rise of 72% – according to figures from the Office for National Statistics (ONS).
But since the 2016 EU referendum, there are tentative signs that when it comes to public sector workers, the UK has lost some of its appeal as a place to live and work. More recent ONS figures show that the number of non-British EU nationals who said they worked in the UK public sector fell by 27,000 between January and March 2017. And anecdotal evidence suggests that the decline in immigration from public sector workers from the other 27 EU countries is due to uncertainty about the future, combined with a fall in the value of the pound since last June.
The loss is already keenly felt by public services blighted by staff shortages and increasingly reliant on EU migrant labour to fill vacancies: in the last three years alone, the number of EU nationals working in the UK’s social care system soared by more than 40%, in response to a parliamentary question earlier this year. Despite this, according to the Royal College of Nurses, England alone has a shortage of 40,000 nurses and 3,500 midwives.
Martin Green, chief executive of Care England, which represents almost 4,000 providers of social care, says the problem of EU nationals now leaving is “quite significant”. “One of the things we are seeing is that people are making decisions [to leave] when they are thinking about the next phase [of their career], or have been here two years,” he says. “The other problem is that they are not being replaced.”
EU nationals make up 7% of the adult social care workforce (90,000) in England, with the highest proportion in London (13%), the south east (10%) and the east of England (8%), according to figures published by Skills for Care. They are most prevalent in care worker roles (7%) and as registered nurses in nursing homes (13%), with 5% in social work.
A record number of EU nationals are also working in hospital and community health services (61,934), up from 57,604 12 months ago, according to NHS Digital figures for March 2017. This includes 10,668 doctors, 22,232 nurses and health visitors, 1,384 midwives, and 7,383 scientific, therapeutic and technical staff.
Danny Mortimer is chief executive of NHS Employers and one of the co-convenors of the Cavendish Coalition, an umbrella group of health and social care organisations set up following the EU referendum. It seeks to ensure that all EU nationals currently working in UK health and social care services can remain in the UK after Brexit. He says that the number of junior doctors applying to come from Europe appears to be unaffected, but recruitment of EU nurses, on which the NHS relies, is “drying up”.
‘For the first time in recent history, far more nurses and midwives are leaving the profession in the UK than joining.’ Photograph: Alamy Stock Photo
“Some of that is because employers don’t feel able to go and recruit, because they can’t answer the questions about leave to remain; some of it is that there aren’t as many people wanting to come because of Brexit [and] because of the value of sterling; and some of it is people not wanting to come because the economies in their own countries are picking up,” he says.
Staffing pressures were writ large earlier this week when it emerged that for the first time in recent history, far more nurses and midwives are leaving the profession in the UK than joining, according to new figures from the Nursing and Midwifery Council. The numbers of EU registrants leaving has also increased, from 1,173 in 2012/2013 to 3,081 in 2016/2017, and Brexit was one of the top three reasons this latter category cited for leaving, according to a survey by the council.
At the same time, the number of EU nurses registering to work in the UK has plummeted by 96%. Tough new language tests introduced by the government to help restrict immigration won’t have helped matters, but it is unlikely that these are the primary cause for the decline, says Anne-Marie Rafferty, professor of nursing policy at the Florence Nightingale Faculty of Nursing and Midwifery, King’s College London. “Markets, including Labour markets, are very sensitive to signals from government,” she says, “and I suspect that part of that drop is also to do with the uncertainties which surround the rights to remain – and under what conditions these rights would be granted for EU nurses.”
The dependence on EU recruitment because of a lack of homegrown nurses could result in real difficulties, says Anita Charlesworth, director of research and economics at the Health Foundation charity. “If the flow of people registering with the NMC is slowing very dramatically – which is what we’ve found – then obviously we are potentially facing a significant issue if the numbers of nurses working in our NHS, who then choose to go back to their source EU country, continues to rise.”
But data from NHS Digital, which collates data across the health service, shows that despite this massive drop in official registrations with the nursing regulator and the increase in EU nurses leaving, there are actually more EU staff working in the NHS. Nursing numbers, it says, rose from 21,030 to 22,232 between March 2016 and March 2017 – as well as midwives, from 1,331 to 1,384 over the same period. While 9,419 EU workers left the NHS since March 2016, 13,480 have joined.
The apparent contradiction could be explained by the fact that while more EU nationals are leaving nursing and fewer people are registering, those who remain are increasingly switching from agency work to direct employment with NHS organisations. In other words, hospitals are employing more EU staff as they attempt to cut their agency and locum staff bill. “I can’t prove that because the data on agencies is very limited, but we do know that spend from nursing on agencies has fallen significantly over the last year and the NHS has been trying to shift nurses from agencies to its own books,” says Charlesworth.
Either way, public sector unions are increasingly alarmed at the potential for more EU staff to leave. A “huge crisis” looms if more do depart, says Rehana Azam, GMB national secretary for public services. “If you look at health and social care we need more people, not less – and we certainly can’t do it with fewer people if people start leaving – and they are.”
The general secretary of the Trades Union Congress, Frances O’Grady, says there is no sign that an impact assessment has been conducted, let alone a much-needed post-Brexit workforce strategy to tackle the recruitment and retention crisis in health and social care. And she says that last week’s proposals by the government to allow all EU nationals living in the UK to apply for “settled status” post-Brexit will only serve to create more anxiety and uncertainty – at least in the short-term.
‘The number of EU nurses registering to work in the UK has plummeted by 96%.’ Photograph: Dimitris Legakis/Athena Pictures
“Now the government is beginning to set out some of the limits of what it’s prepared to offer – at least in this first round of talks,” says O’Grady. “What is being thrown into the air is exactly what the cut-off date will be, whether there will be an income threshold for bringing your family … all sorts of questions without answers are being added to the list.”
The reasons why British workers are not filling care jobs – low pay, the zero-hours culture that plagues the adult social care sector – also need to be addressed, says O’Grady.
“Regardless of their passport, no one should be working for a rubbish wage – and nobody should be at the end of the phone waiting to see if they get a call to say whether they’re going to earn a wage that day.”
Nadra Ahmed, chair of the National Care Association – which represents small and medium-sized care providers and is a co-convenor of the Cavendish Coalition – warns that nursing homes will close if the future of EU nationals isn’t clarified soon. She says Brexit has only served to deepen a pre-existing staffing crisis in social care as a number of EU nationals elect to return to their country of origin.
“Until we know what’s going to happen, it’s hard to say whether people will see us as a destination for work. [The Brexit white paper] will settle some nerves, but I’m not sure it will settle all nerves. It needs to be resolved quite quickly because otherwise we will see nursing homes closing. We’ve already got nursing homes de-registering, because they don’t have enough qualified nurses to meet their legislative requirements.”
‘The referendum result just didn’t make sense’
If Dr Sebastian Kalwij (main picture, top) were young, free and single, he doubts he would still be working as a GP in England. For Kalwij, the result of the EU referendum last year provoked upset, disappointment and a sense of betrayal.
“I felt disbelief,” says the Dutch national who first arrived in the UK in 1994. “It didn’t make sense – it still doesn’t make any sense.”
Like many of his European friends, Kalwij says his first reaction last June was a desire to leave. “I felt I’m good enough to help the NHS and prevent it from sinking but otherwise I’m not allowed to stay?”
Reality then kicked in for Kalwij, who is married to a Swiss national, with whom he has two children born in the UK. “We’ve got a house and the kids go to school and their identity is with London and England and not so much with Holland and Switzerland. It’s not fair to uproot them and go somewhere else where they have to start over again.”
One thing he has had to deal with in his surgeries is patients concerned that their local GP might be forced to leave because of his nationality. “A lot of patients ask me about it.”
It was working with doctors from all around the world that most appealed to Kalwij when he first arrived as a junior doctor 23 years ago. “It felt a bit like united Europe and we just got on very well,” he says.
He decided to stay after qualifying as a GP because 20 years ago there was plenty of work due to the shortage of doctors; now, there is still a shortage of doctors, he quips.
Given the short flight to Holland, Kalwij said he had never felt like an immigrant – until now. “There is a bit of a nasty undertone,” says Kalwij. “I just think Brexit is a massive mistake.”