The NHS could be hit by a shortage of more than 40,000 nurses by 2026 after the UK leaves the European Union, according to leaked documents showing workforce modelling by the Department of Health.
It has prompted serious concern among ministers and officials at Richmond House as the UK heads into Brexit negotiations with the EU, according to Health Service Journal. Such a fall in the number of nurses and midwives would leave the NHS “unsafe”, the Royal College of Nursing has also warned.
“If demand goes up again, we are in a very challenged position”
The modelling, carried out by Department of Health civil servants, forecasts a worst case scenario for the UK where all EU and non-EU inflows of nurses and midwives cease after changes to immigration rules.
The modelling shows a decline in nurses from 2019, when the UK is expected to exit the EU and the government could choose to introduce immigration restrictions (see graph).
If all EU and non-EU inflows stopped, this would create a shortage of nurses in the health and care sector of between 26,000 and 42,000 by 2025-26, compared to the forecast base case supply.
While this is considered unlikely to happen, any impact on workforce supply from Brexit and increased demand on services could place considerable pressure on the NHS and be a risk to patient safety. Research has frequently shown patient safety is linked to the number of nurses caring for patients.
“EU nationals who work in the NHS make a valuable contribution and this will be taken into account during Brexit negotiations”
Department of Health
The leaked documents, seen by Health Service Journal, said: “The analysis indicates that there is a severe risk of undersupply if immigration rules change and international inflows stop.”
They predict that, if migration of nurses from the EU stopped, the estimated supply of qualified nurses and midwives would fall by 14,000-22,000 whole-time equivalents by 2025-26.
Even the base case supply of nursing staff to the health service over coming years will barely meet the lower estimated level of demand. If demand even marginally increases, the supply of nurses, regardless of the effects of the Brexit deal, will fail to keep pace.
The estimated “upper demand level” for nurses reaches a peak of 419,000 WTE nurses by 2025-26 but the base supply will only be marginally above 400,000.
If rising patient demand is “unconstrained”, then the gap could be even worse with a potential shortage of 36,000 WTE nurses, assuming the base case supply of nurses from other sources is achieved.
“It’s time for an ‘NHS guarantee’ for these workers ensuring their rights”
A source close to the work said: “Even the best case scenarios are pretty stark… if demand goes up again, we are in a very challenged position.
“All of the approaches to mitigate this are sensible, but even if the model on the Brexit position is realised then this could have serious consequences for the nursing workforce,” they warned.
“If the downside scenario plays out, the gap could be 40,000-plus. London would be exposed to this issue to a far greater extent,” they said.
“But everyone is finally recognising we don’t have enough [nurses]; it’s a more honest narrative about the nursing workforce now,” the source told Health Service Journal.
The modelling, presented to ministers last month, is understood to be one reason why NHS England emphasised increasing the number of NHS nurses by 2020 in its Next Steps for the Five Year Forward View plan last week.
According to Health Service Journal, health minister Philip Dunne has set up a new committee at the DH to lead a policy response to workforce issues. All the national NHS arm’s length bodies are represented on the committee, including NHS England and Health Education England.
It is expected the group will look at nursing supply, retention and training, as well as issues affecting other staff groups. Brexit will be discussed but decisions will be made at cabinet and secretary of state level as negotiations with the EU progress.
“This is a large problem that is coming at us quickly and we need to move fast”
One DH source said workforce was the biggest problem for the NHS related to Brexit and ministers accepted that more needs to be done to maintain a sufficient staff supply.
Janet Davies, chief executive and general secretary of the RCN, said the NHS would be unsafe if the number of registered nurses fell by the levels estimated by the modelling.
She said: “It would be unsafe. Decisions would have to be made about what would we be able to provide. You wouldn’t want to keep running an unsafe service that was so short of nurses.”
She said the modelling estimates were worrying but not a surprise, adding: “We warned of this years ago and we were told we were scaremongering.
“This is a large problem that is coming at us quickly and we need to move fast,” she said. ”What we are not seeing is any real action.”
Janet Davies 25 June 2015 roundtable
A DH spokeswoman said: “As you would expect, the department and others are focused on workforce planning to ensure the NHS has the staff it needs to continue to provide good care.
“The secretary of state has always made clear that EU nationals who work in the NHS make a valuable contribution and this will be taken into account during Brexit negotiations,” she said.
Health Education England plans to publish a workforce plan later this month. Its chief executive Professor Ian Cumming said he “supported a system that allows us continued access to the widest possible pool of healthcare professionals to ensure we meet the needs of the NHS and patients”.
Opposition parties used the leak to repeat calls for a guarantee to stay in the UK for NHS nurses from other EU countries.
“It is difficult to see how the NHS can continue to function safely with a hard Brexit”
Labour health spokesman Jonathan Ashworth said: “The government’s intentions for the NHS after Brexit are almost unknown so far.
“When parliament returns the secretary of state must update the House [of Commons] on his response to this independent civil service analysis and finally outline his plans for the NHS staffing and Brexit,” he said.
“It’s time for an ‘NHS guarantee’ for these workers ensuring their rights – offering these workers who care for our sick and elderly the certainty that they deserve,” said Mr Ashworth.
Liberal Democrat Health spokesman Norman Lamb said: “It is difficult to see how the NHS can continue to function safely with a hard Brexit.
“That is why I have called for an ‘NHS passport’ for all EU citizens who work in the NHS, guaranteeing their right to remain,” he added.
Whole/Full-time equivalent nurse/midwife supply and demand estimates for health and care
Brexit nurse supply modelling graph