Over the years, many experts have stated that nursing in the UK is in crisis and nurses are struggling owing to the increasing number of older and sicker patients, staff shortages and budget cuts that have affected working conditions (Beech et al, 2019). With the rise of the COVID-19 pandemic, unprecedented levels of pressure were placed on an already strained nursing workforce. Hospital admissions of patients with life-threatening illness reached new highs, leading to a drastic increase in patient acuity levels that affected everyone working in the NHS. This prompted the Government to deliver a warning that the NHS was at risk of being overwhelmed (Department of Health and Social Care (DHSC), 2021a).
The Royal College of Nursing (RCN) warned that leaving the European Union (EU) would possibly exacerbate the NHS staffing crisis (RCN, 2019), posing a danger to patient care. And a review published in The Lancet argued that all forms of Brexit would negatively affect the NHS (Fahy et al, 2017). A year after the 2016 referendum, figures from the Nursing and Midwifery Council (NMC), showed that the number of European Economic Area (EEA) nurses joining the register, had dropped from around 10 000 to around 1000 (NMC, 2017). Furthermore, in 2019, nearly 5000 EEA-trained nurses and midwives had left the NHS, over a period of 2 years, with 51% of those who responded to the NMC survey claiming that Brexit was the contributing factor (NMC, 2019).
‘The burden of the COVID-19 pandemic has exhausted nursing staff. Even if only a small percentage quits, that would still hugely impact all healthcare services and it will potentially take decades for the NHS to recover’
The Government has specified that it wants to attract migrants who will contribute to the UK's society and economy, even though this is already happening. A report from the Migration Advisory Committee found that, as most existent migrants in the UK are young and healthy, they give more than they take and are essential contributors to the health service (Migration Advisory Committee, 2018).
At the same time, the NHS relies on foreign workers, the majority being from the EU (Baker, 2020), and when these leave, talent and skills beneficial to the NHS are lost. With Brexit making the UK a less attractive destination option for migrant health professionals, combined with the weaker value of the pound and the economic rise of certain EU countries, existing EU workers in the UK could seek better paid employment elsewhere. Taking into consideration that a recent report by The Health Foundation indicated that 15% of the UK's nursing workforce trained outside the UK, this could potentially lead to a significant depletion of the NHS workforce (Buchan et al, 2020).
To tackle the staff shortages, the Government responded with The NHS Long Term Plan, which proposed to recruit an extra 50 000 nurses over a period of 5 years (NHS England/NHS Improvement, 2019). Reassuringly, recent published figures indicated that there were 14 813 more nurses in the NHS in England than in the previous year (DHSC, 2020). However, at the same time, there were 36 655 full-time nursing posts registered as unfilled (NHS Digital, 2020).
The Government frequently says that it is optimistic that the target of 50 000 more nurses will be achieved, aided by international recruitment campaigns. Yet changes in the immigration laws, such as the points-based system, undoubtedly will have an impact on the recruitment of health professionals, from the EU and elsewhere. However, alarmingly, there are concerns that 50 000 more nurses will not be sufficient to meet the rising demand (The Health Foundation, 2020), and it is predicted that, if the Government's plan fails, the NHS could be short of 70 000 nurses by 2024 (Beech et al, 2019). With the outbreak of the COVID-19 pandemic, that number will almost certainly rise.
While working in the NHS during the pandemic, many nurses and other health professionals have reported symptoms suggestive of post-traumatic stress disorder and exhaustion. This is likely due to the increase in the number of critically ill patients, bringing to light the significant nursing staff shortages. And many have raised concerns about patient and staff safety (Ford, 2021).
To counter this, the UK Government created an initiative called the Bringing Back Staff scheme, which aimed to boost staff levels by getting recently retired nurses and other health professionals back to practice. However, it could be argued that this was somewhat ineffective, as only approximately 1000 nurses, out of a possible 73 000, returned to the NHS during the COVID-19 pandemic (NHS England, 2020). In addition, the NMC expedited the, usually lengthy, registration process of 2000 overseas nurses (NMC, 2021).
The outlook for healthcare in the UK is already visibly uncertain post-Brexit and COVID-19, and, despite Government reassurances, the potential consequences of these two major events are likely to affect patient care and cause increased costs. The burden of the COVID-19 pandemic has exhausted nursing staff, not just in the UK but worldwide, and many are ready to leave the profession. Even if only a small percentage of the current nursing workforce quits, that would still hugely impact all healthcare services and it will potentially take decades for the NHS to recover.
Therefore, moving forward, the UK Government needs to address and enhance nurse recruitment by paying fair wages to stop staff walking out of their jobs. Measures, such as denying nurses a pay rise, at which some MPs even cheered (Sharman, 2017); the voluntary returns scheme where EU citizens are offered up to £3000 to leave the UK (Home Office, 2021); and, more recently, the proposal of a 1% pay rise to some NHS staff (DHSC, 2021b) are unhelpful in preventing what could be an even greater staffing crisis.
Staff retention and effective recruitment are, therefore, the big challenge that the NHS currently faces, and until both are improved and resourced, the growing bill spent on nursing agencies and overseas recruitment campaigns will continue to rise. The UK Government needs to take urgent action to ensure an integrating and cohesive society that continues to welcome migrants post-Brexit and to acknowledge the contribution they make to UK society. Hopefully, this will encourage more EU health professionals to come to the UK and help retain the ones who are already here.