The workforce after Brexit

November 6, 2018

A new report looking at the workforce after Brexit has been published, revealing stark figures for the future of health and social care.

Commissioned by the Cavendish Coalition, the report reveals that the NHS could be short of 51,000 nurses – enough to staff 45 hospitals – by the end of the Brexit transition period, while vacancy rates in social care continue to grow.

Brexit and the Health and Social Care Workforce in the UK – by the National Institute of Economic and Social Research (NIESR) – also highlights the increasingly crucial role EEA nationals are playing in UK social care services.

The NIESR report forecasts a potential shortfall of around 5,000 to 10,000 nurses in the NHS in England by 2021. That is on top of existing vacancies, which stood at 41,722 (11.8% of all positions) at the end of June, the latest period for which NHS Improvement figures are available.

To put these figures into context, the small-to-medium sized Royal Surrey County Hospital NHS Foundation Trust employed 1,141 nurses in June.

Meanwhile, between 2011 and 2016, the number of EEA nationals employed in social care grew by 68%, or 30,600 people. There were 42,000 registered nurses working in adult social care in England in 2017, with almost a third of registered nurses (32.4%) estimated to have left their role within the past 12 months, meaning a vacancy rate of 12.3%, equivalent to around 5,000 vacancies at any given time.

While it is anticipated there will be provision for doctors and nurses coming to the UK after Brexit, if the government follows the guidance of this autumn’s Migration Advisory Committee report, as it has indicated it will, there could be particularly significant implications for social care's workforce after Brexit. The sector relies on lower-paid colleagues who would be effectively cut off by a salary threshold of £30,000 and with no special allowance like that recommended for seasonal agricultural workers.

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 around 9% of doctors were from inside the EEA.

The Cavendish Coalition is warning that the future immigration system must enable the health and social care system to continue to attract the brightest and best from the EU and the rest of the world if the health and social care workforce after Brexit is to be appropriately staffed.

Danny Mortimer, Co-convenor of the Coalition and Chief Executive of NHS Employers, said, 'These startling figures should be taken extremely seriously by those negotiating our departure from the EU.

'...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 EU.

'In parallel we need to ensure the development of the future immigration system is responsive and agile, with as little red tape as possible, and that it uses public service value as a key factor in assessing skill levels and setting entry requirements rather than just salary.

'This will help tackle the often misleading assumption that the salary paid to a migrant worker is the prime indication of the value of their work to the health and wealth of the UK.'

Dr Heather Rolfe, Associate Research Director at NIESR, said, 'Our research findings highlight the fact that migrants are an essential part of the health and social care workforce, often found in shortage in specialties and localities where it is hard to recruit.

'Measures designed to increase recruitment from within the UK like ‘return to work’ schemes have potential to help fill gaps left by falling migration to the UK. However, they will take some time to take effect and are very unlikely to produce sufficient numbers to make up for a shrinking EU workforce.'

Early evidence is not promising. In the 12 months since the referendum, before the UK has formally left the bloc, the number of EEA nurse joiners to the NHS in England fell by 17.6% while the number of leavers rose by 15.3%.

Among the recommendations in the report are:

  • Any future immigration system needs to be uncomplicated to operate. It should also be transparent and cost effective for applicants, and responsive to the changing health needs of the population. At present, many social care and health jobs do not fulfil the requirements for the minimum skills or salary levels of the current non-EEA immigration system. If a future immigration system is to be modelled on the current non-EEA system, it will need to acknowledge the value and contribution of the health and social care workforce and adjust skill and salary levels accordingly 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. International recruitment should form part of a costed workforce strategy. 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 Government should introduce measures to monitor and address the decline in the number of applications to medical schools.

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