Brexit Britain: the state we're in

11 April 2019

Maddie Grounds of the Immigration Advice Service predicts the NHS facing staff and funding shortages whatever the outcome of Brexit negotiations.

Brexit is officially at crisis point. Work sectors across the UK wait in apprehension over what the future will actually look like once we leave the EU – assuming we do – and how they possibly go about preparing.

One sector that continues to express fears over the uncertainty of its future is healthcare, already crumbling because of staff and funding shortages. The current policy of freedom of movement means that nearly 62,000 of the NHS’s workforce and an estimated 104,000 of the UK’s social care sector are currently from other EU countries (NHS Digital, 2018; Skills for Care, 2018). With the government’s white paper confirming plans for the end of free movement, the NHS risks catastrophic consequences for patients, the health workforce and services, especially while the possibility of a no-deal looms in the air. Deal or no deal, here’s what we do know community practitioners (CPs) can expect, assuming we still leave the EU*.

The implications of Brexit

Migration from the European Economic Area (EEA) plays a fundamental role in aiding our health service that is already struggling to fill vacancies and skills gaps. Across the NHS, there is currently a shortage of more than 100,000 staff – one in 11 posts (Triggle, 2018). Exacerbating these shortages was the leave vote, which has seen an 87% reduction in EU nationals registering with the NMC between 2017 and 2018 (Confederation of British Industry, 2018). The uncertainties surrounding rights to work in the UK have already led many potential EU health workers to turn to alternative employment options across Europe.

With a diminishing healthcare workforce seeming inevitable, CPs will face challenges in tackling problems across the healthcare sector. Health visitors, school nurses and community nursery nurses are vital in providing integrated person-centred care with families and children. However, ensuring that this care is to the best standard may be subverted by recruitment challenges, a stretched workforce and subsequent inadequate healthcare provision. Yet recruiting young people to fill these positions is becoming increasingly difficult, especially after the loss of bursaries for nurse education at university level.

Additionally, research collaboration with the EU will be jeopardised after we revoke our membership, resulting in the loss of European research talent and funding sources. Between 2007 and 2013, the UK received €8.8bn for research and development (The Royal Society, 2015). To tackle these cutbacks, the 2018 NHS funding settlement scheme pledges to increase NHS funding of £20.5bn per year by the end of five years. However, a no-deal could mean that the price of goods and services such as drugs and treatments would massively increase.

With public health legislation such as nutrition, food safety and alcohol established by EU legislation, Brexit will also require the UK government to create new public health policy. The government has expressed its intention to maintain the ‘do no harm’ duty of the Lisbon Treaty, which requires the government to consider a ‘high level of human health’ when making policy.

Immigration plan

The government’s white paper, published in December 2018, laid out a new skills-based immigration system which will treat EEA migrants the same as non-EEA migrants. Despite scrapping the 20,700 cap on tier 2 work visas, the minimum income requirement remains at £30,000, a threshold that will exclude many CPs.

What’s more, the Home Office announced this January that the health surcharge to accompany a five-year tier 2 visa application has doubled from £1000 to £2000. This ensures that migrants are medically covered throughout their stay and will be treated the same way as UK citizens. According to the UK Government, the Immigration Health Surcharge has brought in over £600m to the economy so far, with an additional £220m expected to be directed at the NHS, once we leave the EU - assuming we still do (Home Office, 2018).

Yet the issue underpinning the health surcharge is that it does not serve to benefit the actual healthcare positions that recruiters seek to fill with talent from the EU and beyond. Despite the chancellor, Philip Hammond, acknowledging the ‘very high numbers of foreign workers keeping our NHS going’, the hostile immigration plans to restrict movement and increase visa prices shows that any appreciation for migrant talent is missing in practice.

Preparing for Brexit

Healthcare professionals can expect staff shortages and funding cuts to affect the quality of care and standards of available resources. While the UK government has finally started preparing the health sector for a no-deal, including stockpiling medicines and reviewing supply chains, organisations such as the BMA have argued this is simply ‘too little, too late’ (BMA, 2018).

CPs need to engage with other staff to explore new ways of working to achieve the highest standard of patient care in their practices. If you are an EU migrant looking to continue employment in the UK, it is vital that you apply for the EU Settlement Scheme to ensure your right to work after Brexit (see EU settlement scheme, below).

EU settlement scheme

One step towards securing the rights of EU nationals currently working in the UK, including the 165,000 working in health and social care, is the EU Settlement Scheme. With or without a deal, the scheme will mean:

  • EU citizens who by 31 December 2020 have lived in the UK for five years will be eligible for ‘settled status’, allowing them to reside in the UK indefinitely.
  • EU citizens who arrive by 31 December 2020, but have not yet lived in the UK for five years to be eligible for ‘pre-settled status’, are permitted to stay in the UK until they have reached the five-year threshold. They can then apply for settled status.
  • For healthcare workers already in the UK, this is certainly positive progress in securing residency rights. However, concerns remain over the future migration of EEA citizens needed to maintain the healthcare sector’s operational capacity. Employers are now planning to invest by filling in a sponsor licence application – a licence which allows employers to hire from overseas – to ensure that they can continue to recruit after Brexit.

It is difficult to predict the changes that the government will implement to secure a deal. Whether the healthcare sector can maintain its EU workforce, continue access to EU research and create effective public health legislation depends on political events. However, with already crippling workforce and funding issues permeating the NHS, CPs can expect to face recruitment and staffing challenges regardless of the result.

Maddie Grounds is a correspondent for the Immigration Advice Service.

*Information correct at time of press.


The Immigration Advice Service is a team of specialist immigration lawyers. Get details of the EU settlement scheme and sponsor licence applications at iasservices.org.uk

Time to reflect

How can you and your practice prepare for Brexit? What are you most worried about? Share any insights and join the conversation at @CommPrac using #BrexitBritain

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