Brexit, population ageing and nursing shortages: A perfect storm?

Published: 20 Dec 2016

Rachel MarangozovRachel Marangozov, Senior Research Fellow

New analysis by the Institute for Employment Studies has found that Brexit and a growing population of over-85-year-olds could leave some NHS trusts in England more reliant on international nurses, from outside the EU, not less.

The research highlights that an already-squeezed NHS in England will face both increasing demand from the growing number of over-85s and a restricted supply of nurses from any post-Brexit disruption to the EU recruitment pipeline. Without a domestic nursing workforce to fill these gaps, the NHS will have to depend on nurses from countries like India and the Philippines to meet increasing demand for healthcare provision.

The NHS in England is already short of nurses and the current nursing workforce is ageing, with one in three nurses projected to reach retirement age in the next ten years. The increased demand for nurses, caused by the post-Francis emphasis on safe staffing, is only adding to this pressure. On top of this, the restricted supply of nurses due to constrained budgets has led to too few nurse training places being commissioned and fewer nursing posts.

This perfect storm has led to increasing dependence among some NHS trusts on nurses from the EU. Currently EU nurses make up 4.5 per cent of the total nursing workforce in England. This may not sound like a lot but this is up from just over one per cent in 2009, highlighting a growing reliance on EU nurses in recent years. This total workforce figure also masks geographical differences, with some trusts in London and the South East of England being more dependent on EU nurses than trusts in other parts of England. EU nurses make up around 15-20 per cent of all nurses in some trusts. However, future recruitment from the EU is likely to be more difficult post-Brexit.

To compound these challenges, the IES research finds that some of these same NHS trusts are also vulnerable to higher-than-average growth in the local number of over-85s who are most likely to make intensive use of healthcare resources. For example, Milton Keynes University Hospital NHS Foundation Trust, Burton Hospitals NHS Foundation Trust and Wrightington, Wigan and Leigh NHS Trust all face very rapid population growth amongst the over-85s and have above-average employment of EU nurses, leaving them particularly vulnerable to any nursing shortages following Brexit.

So what can be done to meet this future demand for nurses? The Department of Health has indicated that a ‘growing your own’ strategy leading to self-sufficiency in UK nurses is the preferred solution. However, given that applications to study nursing next year are down by 20 per cent and bursaries for student nurses are being cut, self-sufficiency any time soon may be more difficult to attain in a short timescale.

In the past, the UK nursing labour market has been characterised by cyclical patterns of nursing shortages and there are few indications that this is about to change. A lack of long-term workforce planning has previously meant that nursing supply and demand in the UK has rarely been in sync, and there have been periods when active international recruitment has become a ‘policy solution’ for the NHS in England. In fact, it was only this year that the government decided to keep nursing on the Shortage Occupation List to ease the most recent nursing shortage.

International recruitment has traditionally been attractive to policymakers because it presents a relatively quick and cheap response to workforce shortages. The international recruitment of nurses can still be a much quicker way of addressing workforce shortages than ‘growing our own’ (if ‘growing our own’ is based only on increasing supply through investment in training new staff). International recruitment also carries with it little financial risk to policymakers because the recruits are trained elsewhere and at someone else’s expense.

Historically, the option to recruit nurses freely from overseas has helped NHS trusts to mitigate the short-term consequences of domestic skill shortages, recruitment and retention difficulties. The uncertainty in the wider NHS that has been triggered by the vote for Brexit in June 2016 means that the future of this ‘mixed economy’ approach to resourcing and the ability of the NHS to act as a ‘magnet’ for nurses around the world, may now be in doubt. The solution lies in both the removal of uncertainty over the status of EU nurses currently and prospectively working in the NHS, and increasing the responsiveness of workforce planning and labour demand forecasting in the NHS both at national and at local levels.

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Any views expressed are those of the author and not necessarily those of the Institute as a whole.