With concerns over staffing, NHS funding and abusive behaviour from patients towards doctors and nurses, the full impact of Brexit on UK healthcare is already turbulent, despite it not yet being clear exactly what will happen with the right to free movement within the EU. Although there is still a great deal of negotiating to do before the UK completely pulls out of Brussels, healthcare professionals are understandably worried about what Brexit will mean for them.
The NHS Chief Executive Simon Stevens has stressed how valued the 130,000 EU health professionals are and that no one should be considering leaving the UK or avoid traveling to the UK to train/work as a knee-jerk reaction to Brexit. In addition, Bruce Keogh, the NMH England’s Medical Director, has sought to publicly reassure EU staff working in the health service that their roles are safe.
To offer some insight into the potential implications Brexit will have on the UK and EU health professionals, we have helpfully separated them into categories:
Financial Impact
Despite Brexit campaigners' promise that the £350 million per week currently sent to Brussels would instead be pumped into the NHS, the reality is that the NHS could face cuts when the UK pulls out of the EU. The Economist Intelligence Unit (EIU) has already monitored a lull in investment since the referendum was first called and, is predicting a 2017 recession. With a recession could come cuts to public services such as the NHS, and the EIU is estimating that healthcare spending per head will be roughly £135 lower in 2020 than if the UK had voted to remain in the EU. Not only could this limit the level of care that patients have access to, but it could also lead to redundancies for existing NHS staff.
Despite these predictions from the EIU, some politicians uphold their belief that Brexit will have a positive financial impact on the NHS. The biggest talking point revolves around the right to free movement; if migration from within the EU is slowed, there will be less of a strain on healthcare services. Although a recession could result in NHS cuts, the impact could be offset by the reduced numbers of EU immigrants using the healthcare service. However, in its vicious circle, fewer EU migrants means fewer skilled healthcare workers from within Europe.
Impact on Skills, Human Resources and indefinite leave to remain
If the right to free movement is lost, we would see a serious shortage of skilled doctors and nurses in the NHS. Currently, around 10% of physicians in the UK have been trained in another EU country and 4% of registered nurses are EU immigrants. That's a total of 55,000 NHS staff members who were born in EU countries.
Vote Leave seemed firm that post Brexit any new immigration system would have no consequences for EU citizens already lawfully resident in the UK. On its web site it maintained that such EU citizens “would automatically be granted indefinite leave to remain in the UK and will be treated no less favourably than they are at present.” It is unknown whether skilled doctors and nurses from EU countries will be forced to leave the UK post-Brexit. It seems that no firm position will be forthcoming from the UK government until the position of UK citizens resident in the EU has been negoitatied/clarified. Many lawyers take the view that the Vote Leave is optimistic in its assertions and the legal position is uncertain. At present after 5 years of continuous residency, visa holders can apply for permanent right to remain. It is important however to have the documentation to prove this and if this is a route EU nurses or doctors wish to go down they should ensure they have documents to prove residence such as tenancy agreements, freehold title to property, P60s, contracts of employment etc. There is a worry that restrictions on the right to free movement could prevent skilled healthcare workers migrating to the UK in future, which may cause a staffing crisis down the line. There is also a concern that EU-born staff will pre-emptively leave the UK due to the uncertainty on migration restrictions during the first couple of years of the Brexit vote.
It is thought that the impact of this staff shortage could hit the nursing profession hardest. If a proportion of those 55,000 leave the NHS this could well result in a system already under significant pressure being tipped into crisis. Statistics also show that numbers of new EU immigrant nurses have increased very rapidly over recent years at the same time as the number of British citizens training to be nurses has dropped.