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Brexit: The only thing that hasn’t changed is people need support from the sector

Andrew McCracken from National Voices, the leading coalition of 160 health and care charities, looks at the potential impact and ramifications of the UK’s Brexit decision on the sector.

It’s unprecedented, it’s blurry, and it’s fast-moving. Many are struggling to comprehend the implications of Brexit. 

What has now been set in train will, soon or eventually, have its effects on UK research, innovation and knowledge sharing, international co-operation on public health and health protection, human rights, health inequalities, social cohesion, and funding for charities and civil society. 

The list could go on, but there are two immediate and inter-dependent issues that are emerging as pivotal to the future of our health and care services: as the UK negotiates its exit from the EU, can we maintain economic stability and retain the ability to recruit overseas staff? 

The economy 

The Vote Leave campaign argued that membership of the EU was costing the UK £350m a week, a significant sum of money that could be better spent on public services, such as the NHS. Even more specifically, the Leave Camp pledged to invest an additional ‘£100m per week’ in the NHS, over and above the additional funding announced in the last Spending Review. 

At the same time, the Treasury warned that a vote to leave the EU would lead to the UK being ‘permanently poorer’.  NHS England chief executive Simon Stevens backed this up: “It would be very dangerous if at precisely the moment the NHS is going to need extra funding actually the economy goes into a tailspin and that funding is not there.” 

Britain’s economic future arguably hinges on our ability to retain access to the European single market. The price for retaining that access, according to Donald Tusk, president of the European Council, is the free movement of EU citizens. 

Freedom of movement 

For many, immigration became the key issue of the campaign, and the free movement of labour has a significant impact on health and care services. 

Staff shortages in the health and care sector are well documented. Earlier this year the House of Commons Public Accounts Committee warned that the frontline in England may be as many as 50,000 short of staff. The story is the same in social care, where there is an estimated vacancy rate of 5.4%, rising to 7.7% in domiciliary care services.

Many providers have looked overseas to plug the staffing gap. According to the NHS Confederation, 10% of doctors in the UK are from another EU country. The proportion of registered nurses and midwives from the EU is lower, at approximately 5%, but that figure represents a sharp increase at a time when the numbers of British-trained nurses has fallen. 

Regardless of your views on the referendum, it is clear that the NHS is currently heavily reliant on EU citizens to fill vacancies in the workforce. 

Have our cake and eat it? 

A majority of the electorate voted to leave the EU, and for many that was on the grounds of immigration. If the new government holds the Vote Leave line on restricting freedom of movement, it will have potentially bad effects on recruiting staff and – critically – retaining the existing EU workforce. 

Insisting on restrictions on the free movement of people may make it difficult, or impossible, for the UK to retain access to the single market. And if we don’t have that access it could harm the economy, with  a proportionate impact on health and care funding. 

So now the central issue is whether we can have our cake and eat it in the Brexit negotiations. 

The only thing that hasn’t changed 

It will take some time to digest the full implications of this historic vote and its political aftermath. A lot is uncertain, and some things will unfold slowly. At National Voices, as a coalition of health and care charities, we are preparing to defend the things that we hold dear, both in domestic policy and in the mandate for negotiations to redefine our relationship with Europe and the rest of the world. 

Pretty much the only thing that hasn’t changed since the referendum is that people and communities still need the support offered by health and care services, charities and community groups. Now is a time for us to provide the stability that many in society need.

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