EITHEROf the potential risks and opportunities Brexit poses for the health service, the biggest was always going to be the issue of labor.
The longstanding failure to establish a proper workforce plan for the NHS (and social care) has allowed deep and persistent shortages to develop. These, in turn, created unsustainable high workloads for NHS staff and lengthened waiting times for patients.
Although exacerbated by Covid, these problems have been around for years. EU membership meant that it was relatively easy to make up for some of these shortfalls by importing staff from our neighbours. For nurses and midwives, this meant attracting just under 10,000 skilled employees in 2015-16.
The decline in arrivals after Brexit was immediate and sustained, even if there were other factors at play, a new language test to be able to practice in the UK. In 2021-22, fewer than 700 new nursing and midwifery staff came from the EU.
For those who want to reduce migration, this may seem like something of a victory. However, faced with an ongoing jobs crisis, the NHS has turned to countries outside the EU to fill vacancies. In 2015-16, just over 2,000 new nurses and midwives arrived in the UK from these countries. After Brexit, the number increased dramatically, reaching just under 23,000 by 2021-22.
Nurse vacancy rates remain stubbornly high As many are leaving the profession, but solely to seek employment, the number of people joining the NHS from outside the EU is showing a notable increase.
In 2021-22, of the new nurses arriving in the UK, 42% came from India and 25% from the Philippines. Both are countries with a history of exporting personnel. Third in the ranking, however, is Nigeria, a country on the “red list” of countries where the World Health Organization says active recruitment should not take place because that nation already suffers from staff shortages.
Other ‘red list’ countries are also finding that significant numbers of their healthcare staff are choosing to move to the UK to work in the NHS. While these staff play an important role in alleviating the shortage in the UK, this will come at a significant cost to already fragile healthcare systems in other countries.
In addition to the workforce, trade policy does matter for the NHS, given the volume of medicines and medical devices imported from abroad. Of course, the UK also exports medicines, although difficulties in exporting goods are more of a problem for UK plc than for the NHS directly.
Leaving Northern Ireland aside, it is not easy to disentangle the impact of Brexit from the global supply chain problems that followed covid, although it is unlikely that there will be many who would claim that Brexit has made it easier, given the unquestionable increase in bureaucracy worldwide. border. Before the UK left the EU, there were also concerns that the NHS could end up as part of the negotiations on any new trade deal, but as no such deal has been reached with the US ( where most concerns lie), this is still something for the future.
Beyond these specific health impacts, the impact of Brexit on the broader economy is likely to be most important at the moment. The UK economy is not doing well and we are facing another prolonged period of austerity, at the same time as a rise in inflation affecting the NHS just like every other part of the country.
Reliant on general taxation as it is, the deep strain on public finances means that even relatively sheltered public services like the NHS face a challenging financial outlook. Some have used this difficult context to raise questions about the sustainability of the NHS funding model, currently paid for by taxes and largely free at point of use.
Fundamentally, however, the question is how much we want to spend on health, not how this money is raised. Faced with a weak economy, any health financing system, whether through taxes, social security, or private spending, will be forced to answer the same tough questions about affordability.
Richard Murray is Chief Executive of The Kings Fund
