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EU nurse pipeline: Is it time to push the Brexit panic button?

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Since the summer there has been a growing hum about the potential impact that the Brexit result would have on the health service’s sizeable overseas workforce.

In the weeks following the historic vote on 23 June, overseas nurses said they were already starting to feel anxious about their immigration status and whether they remain welcome in the UK.

They also told Nursing Times that such concerns, along with potential economic factors, meant there was a risk the UK was now a less attractive place to work.

Meanwhile, unions spoke of healthcare workers who had been verbally abused since the result of the vote, and of those who feared they would no longer feel as accepted in the UK as before.

“There was bound to be some uncertainty”

However, this was all largely anecdotal stuff. There was bound to be some uncertainty and feelings of being unsettled among those EU nurses already in the country.

And the unions were just doing their job really by sticking up for their members and raising concerns about staff shortages.

Personally, I wondered if things might settle down once the initial impact of the vote had passed, especially if the government had then made some encouraging noises about EU nurses being allowed to stay in the UK or something similarly reassuring. Alas, I am still waiting for this reassurance.

“The reasons for the drop-off are not black and white”

However, this week the concerned hum and the anecdotes were found to be based on something seemingly more solid. We reported on the emergence of the first evidence that the Brexit vote is already disrupting the pipeline of European Union nurses that have been coming to the NHS in recent years.

Figures shared with Nursing Times showed the number of EU nurses admitted to the Nursing and Midwifery Council’s register crashed from 1,304 in July to only 100 joining in December.

Meanwhile, the number of EU nurses leaving the register every month has increased slightly over the same time, from 257 leaving in July, to 318 in December.

The combined effect has meant the total number of EU nurses registered with the NMC shrank towards the end of the year – from 38,992 in September to 38,661 by December.

“This is the first time in years that we have seen a drop-off,” Jackie Smith, the NMC’s chief executive and registrar, told Nursing Times.

Now, like with so many things, the reasons for the drop-off are not black and white. The regulator suggested it could be due to the UK’s decision to leave the EU, the introduction of new language testing rules over summer 2016, or a combination of both.

“English language testing is a factor… but then we’ve also got possibly Brexit as a factor,” Ms Smith told Nursing Times.

Without asking all the nurses why they chose not to come to the UK, I do not have the answer immediately. That would probably take a further data trawl of overseas nurses from outside the EU to see if there were also fewer of them – if there are, it looks like the language tests are the culprit, if not, the finger points at Brexit.

“Surrey and Kent had established that 9% of their nursing workforce came from EU countries other than the UK”

So what does all this mean, if anything? Coinciding by chance with our reporting of the NMC data on Wednesday, I was asked to appear on several local radio stations in the South East who had done a joint investigation.

The BBC radio stations for Sussex, Surrey and Kent had established that 9% of their nursing workforce came from EU countries other than the UK – compared to 5% nationally. They also had some examples of nurses describing their uncertainty over their future employment status, including one who was sure he would lose his right to work here and, therefore, his job.

The presenters wanted to know what would happen if all the EU nurses upped sticks and left, and so I tried to outline a few possible scenarios.

I noted that, prior to the mass targeting of EU nurses in recent years, we had a tradition of recruiting nurses from countries like the Philippines and India. Trusts could potentially try and target those countries more heavily in future. But let’s face it, many other countries are also hoping to attract them – the US and Australia, for example.

“Trusts told them they still planned to recruit from overseas in the next 12 months”

Could we just carry on targeting EU countries after Brexit, but with a bit more admin to do, such as visas?

Presumably yes, but back in July Ms Smith from the NMC said there would be a major impact of the regulator’s ability to process applications if it were required to apply its current approval procedures for nurses from the rest of the world to those coming from the EU.

“There would be an issue with the pipeline,” she said at the time, noting that at present 10 times more overseas nurses came to the UK from the EU than the rest of the world.

However, this point on paperwork ignores the basic issue of whether nurses from Europe will still want to come here. They may not.

The radio presenters also highlighted that most trusts told them they still planned to recruit from overseas in the next 12 months due to a lack of nurses coming through the system here in the UK.

They wanted to know why we had insufficient numbers of British nurses, so I tried to explain the “boom and bust” cycle of new nurses coming through the education system, which results from trying to predict how many staff will be needed in three years’ time, eg the length of a degree.

Of course, the current move from bursaries to loans may have an impact on this, but that’s a whole other discussion.

Likewise, there are the new nursing associates that may be used to fill registered nurse vacancies, but the role will take two years to train, the pilot sites have only just begun and there will only be 2,000 of them to begin with anyway – the RCN has estimated we have a nurse shortage of 20,000.

“What is really needed is some reassurance from ministers that valuable EU healthcare workers will be allowed to stay”

Returning to my point near the beginning, what is really needed is some reassurance from ministers that valuable EU healthcare workers will be allowed to stay – and others actively encouraged and welcomed to come here via some way of avoiding immigration red tape.

The chief nursing officer and the health secretary have both separately stated that EU staff working for the NHS should be valued and appreciated, which is certainly positive. But something more concrete is needed – probably from 10 Downing Street. That would at least go a bit of the way for now.

So, in conclusion, many uncertainties remain. However, the one certainty is that there has been a dramatic decline in the number of EU nurses coming to work in the UK since the summer.

This, I would suggest, should set some alarm bells ringing – even if we don’t need to panic just yet.

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