29th August 2019

Image: Brexit. An Uncertain Unhealthy Future?Skills for Health’s recent research on Leadership and Management which was launched at the Houses of Parliament, highlighted some of the skills issues which are challenging organisations across the public sector1. Some of these challenges manifest themselves in internal issues which require internal consideration (communications, vision, strategy, recognition) but these are often conditioned and influenced by those external drivers of change which exert pressure on the workplace and the workforce.

In the survey which underpinned Skills for Health’s research, respondents cited the key external drivers which they feel will require attention and action over the coming years in order for organisations to continue to deliver excellent public services. These research findings have been echoed in a range of interviews, focus groups and scenario planning workshops conducted with public sector experts over the last 3 years.

In isolating the health sector participants in this body of qualitative and quantitative research, the external issue exercising most concern is Brexit and its actual and perceived impact across all aspects of health service delivery. This includes the availability of medicines, collaborative medical research, reciprocal healthcare arrangements, protection of public health, regulatory imperatives, funding and clinical trials.

One subject of great concern which is already being significantly impacted, is the healthcare workforce – the implications for which will only become clearer when a ‘deal’ or ‘no deal’ decision is made. However, whatever the decision, it would appear that from 31st October, the sector will encounter rough(er) waters in terms of a squeezed labour supply chain, staffing levels and service provision.

In July of this year, the NHS Confederation issued a letter to the Prime Minister which stated that ‘the biggest single challenge facing the health and care sector is now workforce – the NHS has more than 100,000 vacancies.’ These vacancies are running at over 10% of the whole workforce and following Brexit (in any of its forms) a significant minority of the workforce will be EU nationals, concerned about their continued status in the UK.

There are over 63,000 EU nationals working in the NHS, which represents 5.6% of all NHS staff. Overall, 12.7% (one in every eight)[2] of NHS staff’s nationality[3] is self-reported as not British and draws from 200 different nationalities[4]. An estimated 10% of doctors, 7% of nurses and 5.6% of scientific therapeutic and technical staff in NHS England are EU nationals. One-third of these EU nationals are concentrated in London and the South East NHS trusts[5]. The recorded trends are showing a worrying decline in some numbers; Overall, EU nationals have decreased as a percentage of staff joining the NHS from 11% in 2015/2016 down to 7.9% in 2017/2018. This is most evident for nurses with the percentage dropping from 19% to 7.9% over the same period. Moreover, 13% of nurses leaving the NHS were EU nationals, a 4% increase from 2015[6].

Whilst some of this attrition is being addressed through increased training of UK nationals and an upsurge in non-EU nurses joining the Nursing and Midwifery Council’s register, this can, in no way hope to fill all the gaps that will appear. Although any Brexit agreement will allow all migrants currently working in the UK to apply for "settled status", this will be complicated by the debate which rages about the details of a new skills-based immigration system to begin in 2021. This proposes an earnings threshold for all migrants – the level at which this threshold will be set is still being discussed. The £30,00 figure currently being indicated would preclude some migrant workers from taking up key posts in the NHS.

All-in-all, across staff at all levels within the NHS, Brexit poses a real headache for workforce planners. Organisations are already confronting uncertainty and confusion which is bound to be exacerbated as we head to (and beyond) 31st October. The Cavendish Coalition[7] (of which Skills for Health is a member), last month urged employers to do all they can to support their EU staff. It is vital that this happens alongside forward-thinking workforce planning which will support the health sector to apply evidence-based resilience approaches in response to whatever Brexit eventually throws up.

Start considering how you will address these workforce challenges today and contact our workforce development and consultancy team for effective planning solutions, driven by evidence based research.



[1] Sills for Health

[2] The percentages here exclude staff whose nationality is unknown

[3] As nationality is self-reported the value entered by an individual may reflect their cultural heritage rather than their country of birth. As such, these figures should be treated with a significant degree of caution. Therefore these figures do not necessarily equate to migrants from other countries, and such data is not captured elsewhere in the workforce systems.

[4] Baker, C. (2018) NHS staff from overseas: statistics. Commons Briefing papers CBP-7783. Available at: https://researchbriefings.parliament.uk/ResearchBriefing/Summary/CBP-7783

[5] Baker, C. (2018) NHS staff from overseas: statistics. Commons Briefing papers CBP-7783. Available at: https://researchbriefings.parliament.uk/ResearchBriefing/Summary/CBP-7783

[6] Baker, C. (2018) NHS staff from overseas: statistics. Commons Briefing papers CBP-7783. Available at: https://researchbriefings.parliament.uk/ResearchBriefing/Summary/CBP-7783

[7] The Cavendish Coalition is a group of health and social care organisations united in their commitment to provide the best care to communities, patients and residents.