Dr Mike Galsworthy: Brexit’s chilling effect on European staff at the NHS

For a short while after the Brexit vote, their numbers in our NHS continued to grow. Then decline set in. They are leaving. A House of Commons library report in February this year highlighted that after years of growing numbers, the proportion of EU nurses in the health service hit a peak of 7.5% in September 2016 then began the decline, down to 7.1% a year later. With European doctors, the peak of 9.9% was hit in March 2017, before declining to 9.6% in September 2017.

Alarm bells were first rung across the mainstream media in June 2017, when news broke that nurse applications from other EU countries had dropped by 96%. Brexit was clearly in everyone’s minds, but another factor made it more complicated: An English language test (the IELTS) had been made mandatory for incoming EU nursing staff to the NHS just one month after Brexit.

When the language test, difficult even for natives, was imposed on non-EEA nursing staff in previous years, it was associated with a substantial decline in new recruits. So what was to blame for the declining European nurse applications? Brexit of the IELTS?

Some Brexiteers attempted to put all the blame for the fallen numbers on the language test. Nice try, but there were two clear flaws with the theory.

Firstly, it was dismissed by those actually dealing with the problem first-hand. The Royal College of Nurses (RCN) diplomatically said the IELTS was ‘not the primary reason’ for the sudden fall. Secondly, there was further clear evidence for the impact of Brexit on nurses already in the UK. Those EU nurses did not have to do the IELTS and yet their leaving rates had shot up by 67%, according to Nursing and Midwifery Council (NMC) data. This spike was not seen in the UK or non-EU nurses in the NHS. There was something specific to non-Brit EU nurses that suddenly made the UK a less attractive place of work for them: Brexit.

There were still those who argued the case. Last November, a piece appeared on the Brexit Central website making the claim that although the numbers of EU nurses may have fallen, those for European doctors and the wider NHS workforce had actually increased since Brexit. Again, nice try; but the data was old and flawed.

The House of Commons Library addressed this specific issue several months later in an authoritative 20-page analysis entitled NHS staff from overseas: statistics. They noted that notional increases in EU staff numbers were confounded by the fact that there were fewer ‘unknown nationalities’ before, as more of those unknowns already present had been coded into nationalities over that time.

More importantly, the analysis made clear that EU staff were at their lowest joining rate since 2013/2014, and highest leaving rate on record. As to the issue of overall NHS staff numbers – it was true that there was a slight increase in the proportion of non-British EU staff – this was attributable to the non-clinical support staff.

All the front-line staff – the doctors and nurses – were declining. And it is the front-line workforce which is the area where critical help is needed. With 40,000 nursing vacancies, every single new nurse counts.

And this is where EU nurses are particularly valuable. Between September 2013 and September 2016 the numbers on the UK nursing register increased by 19,046. The total increase in EU nurses (or, more precisely, those from the European Economic Area) during that time period was 20,768.

Yes, that’s more than 100% of the increase. So new EU nurses had plugged a fall and then added all the growth. That is a vital concept. As numbers of UK-trained and non-EU nurses were treading water, the UK was relying on the European influx to deal with its nursing numbers deficit. The fact that EU nurses are now leaving means that total numbers are dropping and the deficit is becoming larger.

An NMC report from earlier this year showed this pattern clearly. From March 2017 to March 2018, the number of nurses and midwives from the UK increased the register by 1,321.

The number from outside the EEA increased the register by a further 1,093. However, the number from EEA countries decreased by 2,909 – wiping out all gains and making the total a net decrease. The NMC noted that the current number on the register was 4,266 lower than the all-time peak in March 2016.

Brexit has also harmed recruitment of EU doctors into the NHS. And hostile press coverage hasn’t helped. A Daily Mail front page three months after the referendum screamed: ‘Patients at risk from EU doctors’, claiming Brexit could help close a ‘loophole’ allowing European doctors to ‘work in the UK without basic safety checks’.

This, and similar attacks, prompted health secretaty Jeremy Hunt, in October 2016, to promise to ‘end NHS reliance on overseas doctors after Britain leaves EU’.

This was clearly questionable in tone and pragmatics, as training doctors takes from seven to ten years. Yet Theresa May endorsed this rhetoric, saying foreign doctors would be allowed to stay ‘until further numbers [of home-grown doctors] are trained’. This prompted a backlash from critics pointing out the perverse logic of the prime minister’s position, including a viral tweet from Nicola Sturgeon: ‘The arrogance of this from the UK government is breathtaking… like they’re somehow doing these doctors a favour by ‘allowing’ them to save lives here.’

The government’s hostile stance towards foreign doctors – that they were only a temporary stopgap who could then go home – was then complicated by an NHS initiative last summer to spend £100 million on recruiting foreign GPs into the NHS.

It was followed, in December, by a message from Hunt urging European NHS doctors and nurses not to quit Britain over Brexit. The move was branded ‘too little, too late’.

The farce was worse for non-EU doctors who had been offered jobs only to find that they could not take them up, because the ‘Tier 2’ visa cap had already been hit by the recruitment of non-European staff for roles such as nursing (in an effort to compensate for the decline in applications from the EU). So the Home Office was turning away doctors that the Department of Health was desperate to hire.

It was only last month that the government finally blinked in its game of chicken with common sense and announced that doctors and nurses would be removed from the Tier 2 visa scheme. In what has been a depressing story on NHS staffing since June 2016, it was an all too rare injection of common sense.