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Brexit could leave health and social care 51,000 nurses short

Future immigration system must be responsive and agile, and consider skills – not just salary

Louise Prime

Tuesday, 06 November 2018

The NHS could be short of 51,000 nurses by the end of the Brexit transition period, the authors of a new report for the Cavendish Commission have revealed. They warned that health and social care both rely heavily on staff from the European Economic Area (EEA) and elsewhere in the world, so for health and social care to be properly staffed after Brexit it is essential that the UK’s future immigration system will enable it to continue to attract ‘the brightest and the best’.

The Cavendish Commission, a coalition of 36 health and social care organisations, commissioned the National Institute of Economic and Social Research (NIESR) to produce Brexit and the Health and Social Care Workforce in the UK. The report forecasts a potential shortfall of about 5-10,000 nurses in the NHS in England by 2021 in addition to existing vacancies, which already stood at 41,722 (11.8% of all positions) at the end of June (the latest period for which NHS Improvement figures are available). It said this figure of 51,000 nurses is equivalent to the number of nurses needed to staff 45 hospitals, given that the small to medium-sized Royal Surrey County Hospital NHS Foundation Trust employed 1,141 nurses in June.

The NIESR pointed out that health and social care relies heavily on staff from the EEA and the rest of the world – in the UK, a little over 5% of the regulated nursing profession, 16% of dentists, 5% of allied health professionals and about 9% of doctors were from inside the EEA. It reported that the number of EEA nationals employed in social care grew by 68%, or 30,600 people, between 2011 and 2016. And in 2017 there were 42,000 registered nurses working in adult social care in England, with almost a third of registered nurses (32.4%) estimated to have left their role within the past 12 months – a vacancy rate of 12.3%, equivalent to about 5,000 vacancies at any given time.

The Commission noted that although it is expected that there will be provision for doctors and nurses coming to the UK after Brexit, “there could be significant implications for the social care workforce in particular” if the government follows the guidance of this autumn’s Migration Advisory Committee report (as it has indicated that it will) because salaries in this sector fall below the £30,000 threshold. Its recommendations include that:

  • Any future immigration system needs to be uncomplicated to operate; transparent and cost-effective for applicants; and responsive to the changing health needs of the population to minimise any further detrimental impact to workforce supply.
  • The UK and devolved governments must urgently review their workforce planning approaches across the health and social care sector. Occupations in health and social care should be acknowledged as being in shortage in a future immigration system.
  • The home office should guarantee that its settled status programme for EU nationals will be honoured in the event of a no-deal Brexit
  • All levels of government should work together to review career routes within social care.
  • Professional regulators should regularly review their processes for registering international professionals.
  • The UK and devolved governments should introduce measures to monitor and address the decline in the number of applications to medical schools.
Danny Mortimer, co-convenor of the coalition and chief executive of NHS Employers, urged Brexit negotiators to take the report ‘extremely seriously’. He said: “The health and social care sector is deeply reliant on talented colleagues from across Europe and the rest of the world so it is deeply disheartening to see these projected workforce gaps at a time of rising demand for services…

“The health and social care sector desperately wants to retain the EU nationals working in our services now and need the welcome process for registering for settled status to be honoured if no deal is agreed with the EU27. In parallel we need to ensure the development of the future immigration system is responsive and agile… setting entry requirements rather than just salary.”

The Nuffield Trust commented that the ‘extensive and credible’ report should trouble everyone who cares about the future of health and care in the UK. Its chief executive Nigel Edwards warned: “The government’s reported plan to stem all immigration of less qualified people after Brexit, and the repeated ducking of tough choices on social care, make this worst case scenario look worryingly plausible.”

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