Under the lens: staffing and Brexit

06 July 2018

From staff attrition and visa issues to lack of funding and an ageing population – these are some of the issues affecting the service that dedicated healthcare professionals can provide. So what’s going on? Award-winning health journalist Danny Buckland reports.

Global Staff

Community practitioners are often referred to as the glue that binds healthcare services. From cradle to grave, as CPs you are a crucial element of an efficient and effective health system. But the adhesive properties of CPs are being dissolved by an acidic flow of harmful measures.

Consider some of the vital signs. The funds for local authorities who were given responsibility for a raft of public health functions from 2013 in England – were slashed by £85m last year (The King’s Fund, 2013). The falling number of health visitors across the whole of the UK is rarely out of the news (in March, one headline for Northern Ireland read ‘HV shortage causing baby review backlog’, in April it was reported that HV vacancies in Scotland have increased by more than 50% in the past year); and the school-nursing workforce in England has shrunk from a high of 3026 in January 2010 to 2314 in February this year (NHS Workforce Statistics, 2018).


The global need

The funding pressures on public health and the NHS in England at large are compounded by the turmoil of exiting Europe, which is causing staff migration just when the workforce is needed most. NHS England employs 62,000 staff from EU countries (more than double that report a non-British nationality) (UK Parliament, 2018). Around 200,000 EU nationals work in the wider social-care sectors in the UK (Hervey and McCloskey, 2018). Yet their future is shrouded by the fog of Brexit rhetoric despite promises that they are a priority in the negotiations.

The NMC reported that the number of EU nurses and midwives leaving the register had risen by 29% to 3962 between April 2017 and March 2018 and, over the same period, only 805 EU nurses and midwives joined the register compared with 6382 the year before – a drop of 87% (NMC, 2018).

Estimates from leaked government documents also point to a potential longer-term shortfall of around a further 20,000 nurses by 2025-26 in England alone, while projections from the Nuffield Trust suggest a lack of as many as 70,000 social-care workers in England by the same date (Dayan, 2018a).

‘Brexit is part of the perfect storm, and the NMC figures demonstrate the plummeting number of nurses prepared to come to the UK, and this will hit the care sector way more than the registered nurse workforce,’ says Dr Crystal Oldman CBE, chief executive of the Queen’s Nursing Institute (QNI).

We have traditionally gone internationally for help – the Windrush generation is the perfect example – but Brexit and visa issues mean we will also have to start looking at home.’

The concerns echo around all corners of healthcare. Saffron Cordery, deputy chief executive of NHS Providers, the trade association for acute, ambulance, community and mental health services, says: ‘The uncertainty will be with us for a fair while before it eases, and there is no clear sense when visa issues will be sorted out.’

Sarah Cook, Unite’s health lead for the London and Eastern region, which represents more than 16,000 health workers, says: ‘Brexit particularly impacts in London because there is a transient population and a lot of migrant workers. The reality is that they are going home or they are not bothering to come now, and we don’t have the numbers to replace them. People underestimate the numbers of workers in the NHS who are saying they are not sure they want to stay.’ Northern Ireland of course also looks to be hit particularly hard, given that it’s the only UK health service that shares a border with an EU member state – it means a unique set of problems for staff, patients, funding, initiatives and service delivery (Dayan, 2018b).  


Living longer

Dr Oldman also points to the rising demands of an ageing population and the need to establish better end-of-life care, but says workforce planning has not kept pace with changing times.

The stress fractures appear and widen by the day, nurse responsibilities are down-banded and caseloads given extra freight, she says, leading to workforce stress and thinly delivered care. This goes for wider healthcare, too. Sarah sees regular evidence of down-banding, staffing pressures and debilitating stress.

Dr Anna Charles, senior policy adviser at The King’s Fund, says: ‘As we have more people living longer with more complex conditions, and we want those people to be able to live at home with their conditions, the role and importance of community services becomes greater, as do the demands on those services.

‘But the sector is facing financial challenges, with budgets often reducing or static despite a rising level of demand in terms of the volume and complexity. We can see some worrying trends in the workforce. If you look at the number of qualified district nurses now compared with 2000, they dropped by around 50% just in England.’


Retaining interest

George Coxon, until recently the UK chair of the Mental Health Nurses Association, says: ‘We have to recognise that there are major workforce pressures on recruiting and retaining staff across all health and social care. There also needs to be wider understanding that the attrition rates are massive and a sizeable proportion of nurses, across all disciplines, are looking forward to their retirement,’ he says.

‘Many of the new recruits who are supposed to replace them do not stay once qualified so we have lots of challenges on our hands.’

He also believes that NHS red tape and complex working practices are hampering staff performance.

‘I talk to a lot of mental health nurses and they feel they have been well trained and have expertise, but they are restricted because of new imperatives or systems in place and the mechanisms are not in place for them to do what they do best. We have skilled people becoming more and more frustrated that they are not allowed to practise their expertise.’

Colenzo Jarrett-Thorpe, Unite’s national officer for health, adds: ‘There are less resources so it is harder for community practitioners to do their job to the standard they would like to. Less resources, less staff, less time is a heady cocktail that takes a toll. Caring for other people’s welfare is their priority so this is deeply frustrating.’


Finding the funds

Whether it’s for ill health or prevention, funding is of course a major issue across the board.  

‘Every area of health and social care is being starved and strangled because of a lack of high-level investment,’ says George. ‘The political argument is that we have a huge budget deficit so cannot afford to invest more, but there has to be a priority given to the needs of vulnerable people and a lot of those are people with mental health issues.’

George says that mental health accounts for 12% of the NHS expenditure but amounts to nearer 22% of the UK’s health burden. ‘When everyone is fighting for diminished resources, mental health nursing loses out.’

Colenzo adds: ‘At health visitor level, there is a danger of people slipping through the net. We know the five mandated visits are not always done, so problems can escalate for children and families. The whole point of a health visitor being there in those initial stages is to nip issues in the bud so they don’t become bigger problems going forward.’

Research by the Labour party (which has pledged an additional £25m for health visiting) showed that the number of health visitors fell by 20% in two years to December 2017, resulting in 12% of babies missing out on a new birth check and 17% missing their six- to eight-week review (Labour, 2018). 

Colenzo says that the ‘massive budget cuts’ to public health over the last five years ‘ultimately increases the pressures on health professionals who have to deal with long-term health issues’.

‘If you can deal with it in the community there will be less demand on acute services but, at the moment, those services are more threatened than supported,’ he says.

‘You cannot keep cutting and cutting,’ says Sarah.

‘If we don't do something soon, the NHS will become so fragmented that it won’t be able to come back. However, if there is a will to put in better funding then things can change and improve. It is still a strong institution and there is a lot of faith in it.’

The inspirational efforts of healthcare staff regularly illuminate austerity and adversity. Dr Oldman says:

‘There is a lot of cause for hope. There are examples of local areas working differently to join up care along with a shift in mindset to systems based around collaboration rather than competition.

‘The thing that shouldn’t be underestimated, though, is that it is very challenging both in terms of the current financial context and within the NHS current legal framework.’

£2000 Infographic

Picture Credit | Mark Ward



IFS. (2018) Cost pressures on the NHS will only grow: it needs a long term funding solution, and that is likely to mean substantial tax rises. See: https://www.ifs.org.uk/publications/12998 (accessed 13 June 2018).

The King’s Fund. (2013) Big cuts planned to public health budgets. See: https://www.kingsfund.org.uk/press/press-releases/big-cuts-planned-public-health-budgets (accessed 12 June 2018).

NHS Workforce Statistics. (2018) NHS Workforce Statistics, February 2018 Staff Group, Area and Level - Excel tables. See: https://digital.nhs.uk/data-and-information/publications/statistical/nhs-workforce-statistics/nhs-workforce-statistics---february-2018 (accessed 13 June 2018).

UK Parliament. (2018) NHS staff from overseas: statistics See: https://researchbriefings.parliament.uk/ResearchBriefing/Summary/CBP-7783 (accessed 19 June 2018).

Hervey T, McCloskey S. (2018) The impact of Brexit on NHS staff. See: http://ukandeu.ac.uk/the-impact-of-brexit-on-nhs-staff/ (accessed 19 June 2018).

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