When Theresa May triggers Article 50 next week, the official negotiations for Britain's departure from the EU will have begun. Held in the balance are the lives of both UK nationals living abroad and several million EU citizens who live and work within the UK. Approximately 60,000 of these EU nationals work within the National Health Service and nearly 100,000 work within social care - a large number of which could leave the UK if negotiations relating to freedom of movement break down.
Following the Brexit vote, the number of EU nurses coming to the UK has fallen by 90%, while at the same time there has been a 68% increase in EU nurses leaving the health service - that's around 2,700 nurses in 2016 according to information provided through Freedom of Information requests. The Royal College of Nursing has stated that Theresa May's failure to guarantee the rights of EU citizens is partly to blame for these worrying statistics which seem to indicate that we can no longer rely upon Europe for much of our NHS workforce.
The high numbers of EU nurses leaving the health service is particularly worrying considering that this year, 96% of British hospitals have experienced nursing shortages according to the Telegraph, while last year NHS Improvement identified a national shortage of approximately 15,000 nurses, blaming a significant reduction in the number of nurses from outside the EU joining the health service. Shortages result in unsafe conditions for patients and additional stress upon an already demoralised workforce.
At the same time as foreign intakes of nurses are dropping, nursing degree applications within Britain have fallen by around a fifth, largely due to the government's removal of bursaries, which have been replaced by student loans. The removal of bursaries for nurses, midwives and allied health professionals makes what is already an unattractive option for potential undergraduates even less worth their consideration. Pay under the Agenda for Change contract has been frozen at a 1% increase each year since 2010, which according to the GMB union represents an actual pay loss of £22,702 from midwives and £18,360 from staff nurses between 2010 and 2020. Horror stories of hospital corridors littered with patients are hardly an incentive to join the profession.
Although last year, Jeremy Hunt promised to end the NHS's 'reliance' upon workers from overseas, it seems as though by 2020 we will be more reliant upon what is a dwindling pool of foreign staff than ever before. At a time when homegrown nurses are needed to plug the gaps in overseas recruitment, therefore, a 20% reduction in new recruits has the potential to bring the health service to its knees.
We will not find out the extent of the damage until the 2017 intake of trainee nurses graduates, in 2020. Yet there are several steps that the government could immediately take to avert what appears to be an impending drought of nursing staff. The first is to place the job security of NHS and care workers at the forefront of EU talks, and to do so vocally via the press so that EU nationals feel more secure. Alternatively, May could guarantee some form of UK visa for all NHS and social care workers. She has made a conscious decision not to do this, and in doing so offer the EU any kind of leverage during the next two years of negotiations.
The other option is to, as Hunt fairly pointed out, focus on a recruitment drive at home to replace some of the gaps in the workforce with British graduates and school-leavers. Unfortunately, his government's decision to remove nursing bursaries and to continue to freeze NHS pay has made this solution currently (and perhaps unnecessarily) unworkable. An unlikely U-turn on the nursing bursary would show level-headed competence from the government at a time when the future of the National Health Service is in jeopardy. It would ideally be coupled with a "new deal" for NHS and care workers including a long-overdue pay increase in line with the cost of living and a generous benefits package to attract young people to the profession.
If the government continues to ignore the scale of the problem, however, the NHS workforce will face a perfect storm of conditions by 2020. The reduction in NHS workers from abroad, coupled with the departure of EU workers and a dramatic reduction in British students taking up nursing and midwifery, may result in many more scenes of disastrous conditions in hospitals, with more patients being put at risk waiting on hospital corridors.