Comment

26.09.18

Brexit-proofing the workforce

Source: NHE Sept/Oct 2018

As Brexit looms, radical change is needed to deliver on immigration policy, writes Danny Mortimer, chief executive of NHS Employers.

As Brexit preparations are moving into their final stages, we have looked at what social care and health needs from a future migration system to deliver both workers and certainty. The clock is ticking and there is a lot to do.

The NHS in England employs people from 202 different countries, making up 6% of our workforce. In social care alone, there are 175,000 people from outside the UK working in frontline direct care worker roles.

Nobody working in the sector thinks overseas recruitment is a cure-all to our workforce gaps and problems – but it is necessary. When done well, overseas recruitment can be a positive experience for individuals, employers and patients.

Engagement around our employment offer must also continue with our local community – and be visible in schools, colleges, and with those in or out of work. National recruitment campaigns help, but we all recognise it needs to be coupled with sustained local activity.

Over two years ago, we and our colleagues in the Cavendish Coalition stated that the UK’s departure from the EU provided an opportunity to reset our approach to migration. If we accept recruiting from outside the UK is necessary and desirable, there are some principles upon which we think this should be designed. These are:

  • To support a plan to grow and develop our domestic supply of health and social care staff;
  • For the sector to continue to recruit quality and skilled staff from abroad when domestic supply is not available, and being agile and responsive to changes in demand;
  • It needs to recognise the value and contribution of the health and social care sector to the UK population, with public service used as a primary factor to determine contribution and value, not just salary and academic skill level;
  • To enable the sector to attract high-calibre professionals into clinical practice, research, education and infrastructure, for example in digital and technology;
  • Finally, it should provide opportunities for overseas nationals to learn and gain knowledge in the UK health system to support the improvement of health and healthcare systems abroad.

The principles we’ve outlined above are not radical. But to deliver on these does require a radical change to the way in which present immigration policy and systems run in the future.

There are two key dates which we need to keep in mind, as they drive the timetable for change. If we secure a deal with the EU and move into the implementation phase from April 2019, we are working based on free movement of people continuing until December 2020. That probably gives enough time to work through and roll out new arrangements for the stage of ‘life after free movement of people.’

If we leave the EU in March 2019 with no deal – and if that means there is no transition or implementation phase – then work now needs to start on what the interim arrangements will be for employers from April 2019.

The points-based system implemented over a decade ago has become rigid and restrictive. Some of the ‘tiers’ are closed for entry. The demand placed on the Tier 2 route earlier this year brought the whole system to a grinding halt and eventually led to the temporary removal of doctors and nurses from the immigration cap.

Looking longer-term, and most concerning of all, there is no obvious long-term entry route for non-registered care workers into social care. However, there is dedication and commitment from across health, social care and wider business to find a way through the tricky politics to deliver change that works for everyone.

We do still have the opportunity to reset our approach to migration, immigration policy and the systems which underpin it – but we need to move quickly.

 

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