With the Brexit deadline of 29th March fast approaching and almost half of the UK’s GPs planning to retire in next five years, the NHS is officially facing a workforce crisis.
In the UK there is one doctor for every 356 people, compared with one for every 277 people on average across comparable European countries. It is estimated that the NHS workforce shortfall could rise to over 350,000 by 2030.
Currently, the NHS employs the lowest number of doctors and nurses per head of population in Europe. Brexit, regardless of what form it takes, is likely to compound this already acute situation by reducing the workforce further. When presented with the various Brexit scenarios the NHS finds itself between a rock and a hard place. A no-deal outcome represents unchartered territory with all the attendant risks and uncertainties in the short to medium term. Conversely, there is now more uncertainty over Theresa May’s much maligned withdrawal agreement which could end freedom of movement and membership of the single market and customs union, exposing the health and social care sector to further recruitment and retention threats.
The NHS heavily relies on the contribution made by staff from abroad and Brexit uncertainty surrounding immigration regulations for EU nationals adds further challenges to a health service already struggling to fill vacancies. Nursing is facing a particular crisis, with 51,000 additional staff needed by 2021 – the equivalent of full nursing teams for 45 hospitals.
The eagerly anticipated Long Term Plan published earlier this year offered limited reassurance to the workforce threat, and the 136-page document only mentions Brexit twice. It did promise a workforce strategy, set to be published in 2019, but for the time being there is little clarity on what lies ahead. Acknowledging the major pressures on NHS staffing, the Plan points to the need for the health service to address the way staff work in order to meet changing patient demands. The Plan also contains a commitment from NHS England to work with the Government to ensure any post-Brexit migration system provides necessary certainty for health and social care employers, particularly for roles where shortages exist.
To combat the workforce issues amplified by Brexit uncertainty, the Government published an immigration White Paper for a new skills-based immigration system to begin in 2021; treating EEA migrants in the same way as non-EEA migrants. Whilst acknowledging England’s reliance on migrants in the social care workforce, the paper proposes that workers would only be permitted residence for a limited time over a transitional period, with no guarantee of how long this could be.
Putting Brexit aside, the health service faces a number of profound challenges. The number of NHS staff leaving due to workplace bullying and a poor work-life balance has almost trebled in the past seven years. Meanwhile Britain’s most senior medical staff have called upon the Government to urgently address the ‘harmful’ pensions tax which is currently leading to increasing levels of early retirement. But who or what is to blame? Labour place blame on the Government for their systematic mismanagement of the NHS while experts highlight “an incoherent approach to workforce policy at a national level, poor workforce planning, restrictive immigration policies and inadequate funding for training places”.
2018 marked 70 years of the NHS but this ‘national treasure’ faces an uncertain future. A workforce implementation plan must offer practical solutions to staffing challenges while bearing the flexibility to handle different potential Brexit outcomes. This will ensure the NHS’s 71st birthday and beyond are occasions where we can continue to celebrate the achievements of the health service and its staff.
Measurement and evaluation