The NHS nurse shortfall may hit 51,000 by the time the UK has officially left the European Union, health chiefs have warned.
They said nurses from the European Economic Area (EEA) were being driven away due to uncertainty over their future rights in the wake of the Brexit vote.
“These startling figures should be taken extremely seriously”
The issue was being compounded by a decline in people studying nursing in England since the government scrapped bursaries for these students, they added.
The worrying predictions are set out in a new report published today called Brexit and the Health and Social Care Workforce in the UK.
The research was carried out by the National Institute of Economic and Social Research (NIESR) on behalf of the Cavendish Coalition, which is made up of 36 health and social care organisations.
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By examining the pattern of leavers and joiners of the NHS before and after the EU referendum in June 2016, NIESR estimated a potential loss of an additional 5,000 to 10,000 nurses by the end of the Brexit transition period in 2021.
Combined with existing vacancies rates, this could result in a black hole of 51,000 nurses in England alone, according to the report.
When approached by Nursing Times, the government highlighted it had introduced a new EU settlement scheme and had given health and social care workers who were worried about their future first priority to secure visas to stay in the UK.
The NIESR report noted that the NHS had become increasingly reliant on nurses from the EEA in the past several years.
Between 2010-11 and 2015-16, the proportion of nurse posts occupied by EEA nationals rose from 1.8% to 5% – more than any other health profession. However, the result of the EU vote curtailed this upward movement, the report noted.
In the year after the referendum, the number of EEA nurses joining the Nursing and Midwifery Council register fell 32% from 9,389 in 2015-16 to 6,382 in 2016-17. Over the same period, there was a 55% increase in EEA nurses leaving the register, from 1,981 to 3,081.
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NIESR said if the rising trend in EEA nurses seen before the vote had continued there would have been an additional 3,000 nurses from those countries working in the UK by the end of June 2017.
The study found that EEA nationals were more likely to work in health specialties and locations that struggled to recruit locally.
However, the report stated that “an increase in hostility towards migrants” along with “uncertainty about rights to future settlement in the UK” were pushing EEA nurses away.
It also highlighted the introduction of a new English language test in January 2016 for people wanting to join the NMC register as a possible impactor on EEA nurse numbers.
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In additon, the NIESR recognised the vital role that EEA nurses played in supporting the UK social care system.
In its recommendations, NIESR called for new immigration policies to be made “uncomplicated” and for the process to be kept “low cost” for nurse applicants. It said nurses should be classified as a “shortage occupation” and therefore not be included in any cap on visas.
“Our research findings highlight the fact that migrants are an essential part of the health and social care workforce”
However, it also made clear that Brexit was not the only issue that was affecting the nurse workforce problems.
It found that there had also been a 0.8% fall in the number of British nurses registered with the NMC since 2012. It highlighted that in 2016-17, 9,200 more UK nurses left the register than joined.
The report raised concerns over the impact of the removal of the nurse student bursary in England.
It found that while applications for nursing courses increased from 185,000 in 2010 to almost 224,000 in 2016, they fell drastically to 176,000 in 2017 – the first year students were required to take out a loan. The document said: “Considering the timing it seems obvious that this year-on-year decrease of more than 21% can be attributed to the [bursary] reform in the English NHS.”
At the same time, NIESR noted that the acceptance rate onto nursing courses had gone up from 12.2% in 2016 to 14.8% last year. The document warned: “While a more detailed analysis of this phenomenon is beyond the scope of our study, a continuation of these trends has potential implications for the quality of the workforce as the pool to choose applicants from is smaller.”
The report highlighted a need to bolster the domestic supply of the nurse workforce in the UK by establishing new routes into nursing and by enticing former nurses back into the profession. It warned that a “large cohort of nurses” would be retiring in the mid-2020s.
“We hope those from the EU will take up the early opportunity to secure their future in the UK”
Department of Health and Social Care
The report said: “Entry to registered nursing roles could be facilitated through opening up of routes from nursing support and social care roles. An apprentice route has been set up but this is both expensive and may not produce sufficient numbers to meet demand for registered nurses who can meet clinical needs.
“Employers need to attract back nurses who have left the profession through improving the attractiveness of working arrangements, including by offering flexible working. There is a large pool of nurses who work temporarily, for banks and agencies, who could be attracted back to permanent roles. This could include accommodating rotas according to their preferences for working hours.”
The report urged UK leaders to “urgently” review their workforce planning for health and social care to recognise the public, private and third care sectors as a “common system” ensuring supply was sufficient for all services.
Danny Mortimer, co-convenor of the Cavendish Coalition and chief executive of NHS Employers, said: “These startling figures should be taken extremely seriously by those negotiating our departure from the EU.
“The health and social care sector is deeply reliant on talented colleagues from across Europe and the rest of the world so it is deeply disheartening to see these projected workforce gaps at a time of rising demand for services,” he said.
He added: “We know we need to do more ourselves to strengthen staff retention and reduce turnover, but we are also reliant on decision-makers to ensure the UK remains an attractive prospect for our valued and talented colleagues from the EU and rest of the world.”
Mr Mortimer said assurances were needed that the EU settlement scheme would be honoured even if no Brexit deal was agreed.
Dr Heather Rolfe, associate research director at NIESR, said: “Our research findings highlight the fact that migrants are an essential part of the health and social care workforce, often found in shortage specialties and localities where it is hard to recruit.
“Measures designed to increase recruitment from within the UK like ‘return to work’ schemes have potential to help fill gaps left by falling migration to the UK. However, they will take some time to take effect and are very unlikely to produce sufficient numbers to make up for a shrinking EU workforce.”
The trial EU settlement scheme opens to health and social care workers on 29 November – four months before it is available to the general public. It will allow successful applicants to have unrestricted rights to remain in the UK.
A Department of Health and Social Care spokesman said: “We greatly value the contribution of nurses to the NHS and we hope those from the EU will take up the early opportunity to secure their future in the UK.
“There are 11,900 more nurses on our wards since 2010, 52,000 nurses currently in NHS training and we have made more funding available to increase university training places,” he said.
“Later this year, we will also set out plans to reform the adult social care system to make it sustainable for the future, including how better to attract and retain staff,” he added.
Chief nursing officer for England, Professor Jane Cummings, said: “I am encouraged to see the increase of almost 4,000 more nurses and midwives registered with the NMC this year, the highest number of nurses and midwives on the register before 2013 when data was first recorded this way.
“We still face significant challenges with vacancies but this rise in numbers is a welcome step in the right direction for our NHS workforce,” she said.