Labour Research March 2019


Health unions warn over Brexit

With time rapidly running out for prime minister Theresa May to get Parliamentary backing for a withdrawal agreement and avoid a no-deal Brexit, Labour Research asks health unions about the impact on the NHS of the UK’s departure from the EU.

With the UK scheduled to leave the European Union (EU) at the end of this month, health unions continue to say they are deeply concerned about the impact of a no-deal or hard Brexit. Several warn that whatever form Brexit takes, it will be harmful, if not catastrophic, for the NHS.

A number of unions representing NHS workers, including the GMB and Unite general, UNISON public services and midwives’ RCM unions, campaigned to remain in the EU in the run-up to the June 2016 referendum. 

The GMB and RCM, together with the non-TUC affiliated doctors’ BMA and nurses’ RCN unions, are also calling for a “people’s vote” for a final say on how or whether the UK leaves the EU. 

Brexit impact on NHS stafing

The government recently set out its NHS Long Term Plan to improve the quality of patient care. Although unions representing health professionals welcomed some aspects of the plan, they say it is hopelessly under-funded and fails to address what the GMB describes as “the gaping 100,000 staffing black hole” which is “the single biggest crisis facing our health service”.

NHS staffing ‘black hole’

Quarterly figures published in November 2018 by NHS Improvement, which is responsible for overseeing organisations providing NHS-funded care, show there were 102,821 whole-time equivalent (WTE) vacancies across the NHS at the end of September 2018. This is a vacancy rate of 8.7%.

Around 63,000 NHS staff in England are EU nationals, making up 5.6% of all staff, according to an October 2018 parliamentary research briefing. The RCM midwives’ union says they are “part of the fabric” of the NHS, caring for 60,000 people in every 36-hour period.

The RCN nurses’ union points to 40,000 nurse vacancies in England, with cancer centres struggling to recruit specialist cancer nurses, a loss of 5,000 mental health nurses since 2010 and district nurse numbers falling almost 50% over the same period. 

In January 2019, the union highlighted figures showing the number of EU nurses and midwives registered to work in the UK fell by 2,385 between September 2017 and September 2018. 

EU doctors currently make up around 10% of the NHS medical workforce. At the end of September 2018 there were already over 9,000 WTE doctor vacancies in the NHS.

Of course, Brexit is not the only reason for this crisis. “The NHS staffing crisis pre-dates Brexit and is mostly due to cuts, reorganisation, poor pay, bursary cuts and lack of workforce planning,” Unite national officer for health Jackie Williams told Labour Research. 

“There are many reasons why people leave the NHS, not just Brexit. Brexit is one issue among many.”

However, unions say Brexit is certainly not helping and has been having an impact since the referendum. Last year, UNISON head of health Sara Gorton described a “European exodus” of nurses and midwives, with Brexit making many European nationals feel “decidedly unwelcome”. 

The RCM has also reported a massive drop in EU midwives coming to the UK since the referendum, and fears worse to come post-Brexit. 

RCM spokesperson Stuart Bonar says the reasons for the current 3,500 shortfall of midwives across the NHS include a long-term failure to recruit since the 2001 baby boom — there are now 80,000 more births per year than in 2001.

There is also an ageing workforce, with one in three midwives in their 50s and 60s, while workloads and pressure are driving some midwives out of the service. Meanwhile, stagnating pay means they, like other NHS staff, do not feel valued and are under financial pressure. 

But, says Bonar, Brexit is undoubtedly also a factor. “There used to be a net inflow of midwives from other EU countries, but since the referendum there has been a net outflow,” he told Labour Research. 

“There are now less than 50 coming onto the register each year while the number leaving is around 230. There used to be around 200 registering every year, so Brexit is already having an impact.”

He says whatever form Brexit takes, it will worsen the situation by introducing bureaucratic hurdles and making it more difficult for midwives from other EU countries to come and work in the UK. 

The government has moved to provide some assurances and, in the event of a no-deal Brexit, EU nationals already living in the UK will have 18 months to register for settled status. “On the face of it that’s really positive” Bonar says. “But the problem is that if there is no deal, new arrivals from the EU will no longer have the automatic right to live and work in the UK. 

“EU nationals already here will have to prove their immigration status to employers and landlords. If they haven’t applied for settled status, how will they do that? Employers and landlords may also be reluctant to take on EU nationals — it will be less bureaucratic to employ or rent to UK nationals.”

A survey last year by the BMA doctors’ union of over 1,500 EU doctors working in the UK found that less than a quarter (22%) have faith in the prime minister’s commitment to protect their rights in the event of a no-deal Brexit. Over a third (35%) are considering moving abroad following Brexit, and almost four in 10 (37%) are not aware of the government’s “settled status” scheme for EU nationals. 

Unions also say the government’s proposals for new, post-Brexit immigration rules, set out in a December 2018 White Paper, will add to an environment in which EU nationals just don’t feel welcome. They say they will create more barriers and bureaucracy to deter people from coming to the UK. 

The RCM says it would be better to allow those able to register as midwives to live and work in the UK rather than imposing arbitrary financial hurdles. The union says it wants to see a more “open-door approach”.

Supply of medicines, radioisotopes and equipment

Union concerns over the impact of Brexit on the NHS are not confined to staff shortages. 

Unite’s #Voteitdown campaign film called on MPs to reject May’s Brexit deal — which they did in January in a historic 432 to 202 defeat for May — and for members and workers across the UK to unite for a better deal. 

It highlights fears about counterfeit medicines and the risk to services including radiotherapy. The Unite GHP pharmacists’ section warns that under May’s deal: “We would not be able to access the European databases which protect the British public against counterfeit medicines entering the supply chain.” 

An NHS radiographer and Unite member is also quoted as saying the NHS could be starved of radioactive materials — crucial for X-rays and cancer treatment — and that failing to guarantee safe access to this material could mean many people do not receive the care they need. In some cases, this could be fatal.

Richard Evans, chief executive officer of the SoR radiographers’ union, told Labour Research that although he is confident measures are being put into place to ensure the supply of medicines and radioisotopes, “there is still a massive risk that Brexit could be disastrous in both the short and long term”.

“I’m more reassured that contingency plans are in preparation and that radioisotopes are not being overlooked,” he said. “But bringing them in by air rather than road is less secure. Airports close down far more often than ferries or the channel tunnel, and are inherently more risky.”

He also said the NHS is no different from any other industry in terms of relying on imported machinery and parts. If equipment like CT scanners break down, “you get hours’ rather than days’ notice. Any delay will have an impact on health care.”

Professional standards

Unions representing health professionals have also outlined concerns about qualifications set at European level. 

“The EU-wide system creates a floor for the standards it sets for midwives below which the UK cannot drop,” Stuart Bonar explains. 

“The RCM would oppose and campaign against any attempts to weaken the standards, but the government may be tempted to do this to deal with the shortfall in the number of midwives.” 

The BMA says that currently, doctors who qualify in one member state can have those qualifications quickly recognised in another. But after Brexit they are likely to face additional barriers to recognition. 

Other impacts

It also points out that the UK’s membership of the European Medicines Agency means patients have timely access to new medicines and medical devices. Post Brexit, it says, the UK’s medicines regulator will have to follow the rules on medicines but will have no power to shape them. 

As an EU member, the UK works closely with partners to monitor and share information on disease outbreaks and response planning. But if the UK is excluded from the European Centre for Disease and Control (ECDC) it will no longer be able to influence ECDC decisions. 

The union is also worried that the loss of EU health-related research funding programmes after Brexit would limit the UK’s ability to translate research into medicines and medical devices into products to bring to the market. 

And it says care on both sides of the border between Northern Ireland and the Republic of Ireland will be at risk if healthcare professionals are not able to travel freely to provide care to patients. 

Meanwhile, UNISON and the RCM have outlined fears that Brexit could open up the NHS to further privatisation through future trade deals. 

“The UK is not in a strong place and the government will be desperate to sign new trade deals,” says Bonar. “Opening up the NHS to big US healthcare providers could be the price it would have to pay to get Trump’s signature on a trade deal.” 

Health unions demand action

As Labour Research went to press, unions were calling for action to address these concerns, ranging from calling for a public vote, to calling for a general election and supporting Labour leader Jeremy Corbyn’s alternative Brexit plan (see box above).

Unite’s Jackie Williams told Labour Research: “Given the difficulties that the NHS is facing in a no-deal Brexit with staffing shortages and access to medicines being problematic, it is time to immediately stop wasting resources on outsourcing our NHS and focus on ensuring that there are no detrimental effects on the level of care to patients and those working within the NHS.”

According to the BMA, only by remaining a member of the EU can Britain be guaranteed to continue to have access to the same benefits. “The only thing that is certain is how disastrous leaving the EU will be for the NHS, its workforce, its patients and the health of the country as a whole — and that no type of Brexit can ever offer the same benefits we currently have,” said BMA council chair Dr Chaand Nagpaul, speaking in December 2018. 

RCM general secretary Gill Walton warned in January that “every single type of Brexit” will hurt the economy and mean less money for the NHS to train and recruit staff, build and maintain hospitals, and care for patients. She criticised the “£350 million lie on the side of that bus” — Unite’s #Voteitdown campaign also makes clear there will be no “Brexit bonanza” — and renewed her union’s call for a public vote. 

The RCN called for an extension of Article 50 beyond 29 March to allow time for a nationwide vote on the final Brexit deal, and highlighted five priorities to ensure Brexit will not harm nursing and healthcare services. 

These include: 

• having a strategy that includes social rights for EU nursing staff and allows for future migration; 

• preserving regulations governing staff and medicines, including a continuation of EU education standards which set minimum training hours for student nurses; 

• addressing public health collaboratively, particularly on communicable diseases and antimicrobial resistance; 

• applying employment rights set at EU level to nursing staff in the UK; and 

• maintaining the opportunities for collaboration across Europe on research and between nursing organisations. 

Labour-affiliated unions have backed calls for a general election. For example, GMB general secretary Tim Roache said: “It’s now time for a general election, which must be an election not just on Brexit but how we fix a broken system that led people to cast a Leave vote in the first place.” 

And UNISON general secretary Dave Prentis posted: “UNISON has been clear from the outset: the best, swiftest and longest-lasting solution for public services, and those who provide them, is a general election.”

After meeting Theresa May with other union leaders, he said the UK could not leave the EU without a deal and that there was not enough time to resolve the ongoing political turmoil. He also called for an extension of Article 50.

Last month, Unite endorsed Corbyn’s alternative plan, set out in a letter to the prime minister. He told party members it was “an approach that can bring all people of goodwill together”. 

Labour’s alternative plan

In a letter to prime minister Theresa May last month, Labour leader Jeremy Corbyn set out Labour’s alternative plan to “move us beyond divisions over Brexit and lay the ground for the transformation of our country that only Labour can deliver”. 

He called for:

• a permanent and comprehensive UK-wide customs union and an agreement for the UK to have a say on future EU trade deals. This would deliver frictionless trade and avoid a hard border on the island of Ireland;

• close alignment with the single market, underpinned by shared institutions and obligations and with clear arrangements for dispute resolutions;

• dynamic alignment on rights and protections so that UK standards keep pace with evolving standards across Europe as a minimum, allowing the UK to lead the way; 

• clear commitments on participation in EU agencies and funding programmes, including areas such as environment, education and industrial regulation; and 

• unambiguous agreements on the detail of future security arrangements. 

The six tests Labour has previously laid down for the deal to meet before securing its backing in Parliament are:

• ensure a strong and collaborative future relationship with the EU;

• deliver the “exact same benefits” as we currently have as members of the Single Market and Customs Union;

• ensure the fair management of migration in the interests of the economy and communities;

• defend rights and protections and prevent a race to the bottom;

• protect national security and our capacity to tackle cross-border crime; and 

• deliver for all regions and nations of the UK.

The proposals would address some of the unions’ concerns about the impact of Brexit on the NHS. But campaigns calling for a public vote said they fell short of the “six tests” Labour said any deal must meet before securing its backing in Parliament.