By cATHARINE BERWICK AND MATTHEW WALKER, PA healthcare expertS
In the two months since the Brexit vote some of the initial risks to healthcare and the NHS have receded. With the Secretary of State continuing in his role and an early election unlikely, the political instability that could have put at risk the delivery of the Five Year Forward View and Sustainability and Transformation Plans has not materialised.
However, looking to the medium to long term there are still concerns about the potential impact on the workforce. The NHS already faces challenges in getting enough people with the right skill sets in to the right roles. These shortages are having a direct impact on patient care and hampering the ability of the system to transform itself and Brexit now means addressing these workforce issues will become even more urgent.
With 130,000 or around 10% of the health and social care workforce coming from EU countries, there is a significant risk that restrictions on immigration will create further staffing shortages. In 2010, the then Home Secretary Theresa May, put forward immigration restrictions on non-EU migrants, amid concerns from her cabinet colleagues that it would damage the economy and NHS recruitment. In that case, the subsequent shortfall in NHS staff was picked up by migration from the EEA, an option which Brexit could now rule out. However, while these risks are real, any future points based system is unlikely to exclude skilled healthcare professionals from working in the UK or impose a long term block on EU migrants joining the NHS. The problem is more likely to arise from restrictions on lower skilled staff.
Alongside these challenges, the biggest risk of Brexit continues to be an economic slowdown. NHS finances are already under pressure and recruiting more staff to make up shortfalls if there are further cuts to funding would be unaffordable.
All this means that there are a number of actions that the NHS must take to prevent the existing workforce challenges becoming a crisis.
- Reassure the EU workforce: In the short term it is essential that healthcare leaders at all levels of the NHS provide clear reassurance to EU staff that nothing will change in the foreseeable future and that their work is highly valued. The NHS is a community that relies on team work and a “them and us” culture cannot be allowed to develop. Managers also need to take action to counteract the negative impact of the increase in hate crimes, some of which has targeted NHS facilities with large numbers of EU workers. This message of reassurance is necessary but not sufficient and should be accompanied by practical plans to guarantee NHS workers long term working visas.
- Develop plans for junior workers: The NHS is heavily reliant on junior healthcare staff (Bands 1-4) and support staff such as porters, cleaners and kitchen staff. Many of these jobs are outsourced meaning that the NHS is likely to have less control and a less clear view of the risk in their supply chain. These roles are vital to the safe and smooth running of the NHS but they are likely to prove difficult to prioritise in a points based immigration system. The NHS must act now, potentially using Health Education England, to build workforce resilience plans in collaboration with its suppliers.
- Manage any changes to the European Working Time Regulation (EWTR): Although this regulation has been incorporated into UK law, it could be scrapped through the proposed “national interest” test process of deciding which EU laws to keep and which to remove. This would complicate existing discussions on junior doctor and consultant contracts but might help to resolve some of the issues. The combination of the EWTR and New Deal has led to complicated and potentially unsustainable rosters for junior doctors and returning to a single set of rules would help hospitals plan more sensibly. It also offers the potential to resolve the long running issues that some surgical educationalists have had with the EWTR.
All these factors make it all the more essential that the NHS uses the Brexit timeline as an opportunity to inject some urgency into workforce changes that have been long discussed but not implemented. These include changes to the skill mix, investment in developing a culture of learning and improvement and greater use of technology to support the clinical and managerial workforce. Making progress in these areas would both mitigate Brexit risks and drive real improvements in the effectiveness of the NHS workforce.