An evaluation of the impact of the threat of Brexit on employment, recruitment and retention of EU migrant workers within the NHS

Inhalt

Chapter 1: Introduction
1.1 Background Study
1.2 Research Question
1.3 Research Aims and Objectives
1.4 Rationale
1.5 Research Limitations
1.6 Research Roadmap

Chapter 2: Literature Review
2.1 The Status Negotiations on Future Mobility of EU Citizens
2.2 Prospect of International Migration Post-2020
2.3 Implications of uncertainty over future immigration system
2.4 The Current Scenario of EU Workforce in the Health and Social Care Sector

Chapter 3: Research Methods
3.1 Research Purpose
3.2 Research Approach
3.3 Research Strategy
3.4 Generalisability
3.5 Data Collection
3.6 Time Horizons
3.7 Limitations

Chapter 4: Findings and Analysis
4.1 Composition of Health Care Workforce in the UK
4.2 Analysis of the Findings for Doctors and Dentists
4.3 Analysis of the Findings for Nurses
4.4 Impact of EU Referendum on NHS
4.5 Summary of Findings

Chapter 5: Conclusion and Recommendation
5.1 Conclusion
5.2 Recommendations
5.3 Future Research Opportunity

References

Chapter 1: Introduction

1.1 Background Study

It is a widely known fact that the NHS is an ailing organisation and despite ongoing efforts from the government, it has serious lack of facilities, skills and resources to meet the increasing demand of the aging population of the UK. The 2016 referendum in the UK has added another layer of uncertainty and complexity to the health and social care workforce which is already a key struggling area for the NHS. According to Nuffield Trust (2017), there will be long term impact on the people receiving care and treatment at NHS of any deal that is being concluded between the UK and the EU. The number of people aged over 65 has increased to 18% of the total population in 2016 which was about 14% in 1976 and during the same time, the number of total population in the UK increased by about 10 million. Therefore, it is natural to estimate that the pressure on the NHS gradually increased where the number of finished consultations was about 21 million in 2012 which was only about 6 million in 1970 (Hawe and Cockcroft, 2013). This increased level of service was possible to provide due to the increase in the number of health and social care staff. The importance of the staffs become even more significant when it is known that the number of available hospital beds decreased to about 2.9 in 2012 which was about 9 in 1975 (Hawe and Cockcroft, 2013). According to the Office of National Statistics (ONS), despite an increase in the overall number of nurses between 1975 to 2012, the number of nurses per 100,000 people actually decreased from 784 to 739. With 25% of the population expected to be over 65 by 2046, it is only likely that the pressure on the health care service workers will only increase. However, with NHS struggling with funding issues and the overall net negative level of international migration to the UK, the staffing problem is going to exacerbate as NHS will find it difficult to hire young and energetic staff to meet the increasing demands.

While the above scenario indicates a demand-side issue, the increasing rate of aging population is a common problem in the western world due to strict birth control mechanisms. Therefore, the UK is facing an imminent supply-side issue in relation to the recruitment and retention of the staff for the NHS which is crucial to its survival and to its capability to serve public. The main problem is that with Brexit reducing the number of migration to the UK, there is a significant lack of planning to fulfil the demands by the domestic workforce (RCN, 2018). The national strategy for training and recruitment in the UK is not simply ready to start hiring local people and to train them for NHS as the UK has a long term system of hiring skilled staff from the EU and the EEA. With the uncertainty of future facilities to keep hiring from the EU27 countries once the Brexit is confirmed, the flow of available workforce will be impacted as well as the level of experience that the migrant workforce brings will also be missing. According to a survey by the Shelford Group (2018), over 40% of the NHS employers and service providers have mentioned that they will be negatively impacted by the restricted migration from the EU and only 35% of the employers mentioned that they have an active plan of recruiting staff locally or from out of the EU (Dolton et al., 2018). In fact, a large number of respondents were anxious about the rights of the current EU workforce in the ne future and if these people suddenly leave the job due to Brexit, there is a serious shortage of skilled workers in the health and social care sector and NHS is going to feel the burden. Therefore, it is very important to assess the impact on the NHS’s ability to employ, recruit and retain staff from the EU. Within the scope of this study, the level of EU migrant workers in the NHS will be assessed along with their impact in running the services. However, the issues related to the NHS and Brexit are multifaceted and not all of them will be assessed through this study due to certain limitations.

1.2 Research Question

With regards to the above background, the following research questions have been set by the author.

- How has the threat of Brexit affected the NHS?
- How the uncertainty of Brexit impacted EU nationals within the NHS?
- How the threat of Brexit has impacted possible EU nationals looking to work within the NHS?

1.3 Research Aims and Objectives

The main aim of this research is to assess the NHS’s capability to retain its EU staff across the service as well as the organisation’s ability to keep its current EU and EEA workforce. NHS is a significant employer of staff, such as doctors, nurses and carers from out of the UK due to availability of highly educated and trained workforce readily available. However, with Brexit, the scenario has changed where there is a stark uncertainty around the future of the nationals from the European soils. It is very important for the NHS, which has many other problems, to resolve the staffing issues and be prepared to keep running normally to meet the demands from the service users in a reliable way. In this regard, this study will aim to meet the following objectives.

- To investigate the position of EU migrants in the NHS workforce and the uncertainty in related to the immigration policies through the literature review.
- To analyse the composition of healthcare workforce in the UK with specific information on doctors, dentists and nurses in terms of European workforce
- To assess the issues in relation to recruitment and retention of EU staff and make recommendations in the post-Brexit scenario

1.4 Rationale

The rationale for conducting this study is to highlight one of the most impending issues facing the NHS which is already crippled with many other problems. NHS already has a shortage of doctors, nurses and other staff and if it increases due to Brexit where the organisation will not be able to retain its current EU workforce or recruit new staff from within the EU, this is going to pose significant problem for the organisations (Dolton et al., 2018). The demand on various NHS services are increasing gradually and it has been a big challenge for NHS to meet such demand properly to ensure a safe and reliable environment for all and in this regard, the EU employees help significantly in running the NHS services. The main benefit of recruiting EU staff is that there is a large workforce that is properly educated and trained and readily available to recruit by NHS services due to easier recruitment process where people from the EU can move freely within the UK and seek employment without any regulatory requirements (Dolton et al., 2018). To hire employees from out of the EU, NHS needs to follow various rules and regulations of the Home Office as well as meet the salary thresholds to issue work permits which often takes time. However, when it comes to the EU, the process is much straightforward and quicker. Over the years, many NHS services have recruited from within the EU significantly as it is cost effective as well. With the EU referendum where the ‘Leave’ vote has won by a small margin, the entire scenario changes and poses a significant issue for the NHS in terms of its large EU workforce. There is a big uncertainty if NHS will be able to retain these people or whether the EU workforce would want to be in the UK given the increases level of regulations to apply for UK work rights. This will also impact the future recruitment of staff from the EU. Therefore, this study gives an opportunity to assess various issues in relation to employment, recruitment and retention of staff from the EU and compare data pre and post Brexit to measure the impact on the NHS and its future.

1.5 Research Limitations

This study will look in to the NHS’s ability to recruit and retain its EU workforce in the context of Brexit. However, it would be an interesting proposition to assess where the NHS could survive without the EU workforce only by recruiting domestically and from out of the EU and EEA. This is another vast area and will be difficult to cover within the scope of this report. Moreover, this is a secondary study where data from various sources have been accumulated to assess the research question. It presents another limitation of the study where a primary study could shed more light on how the NHS services are currently doing and what could be the impact in the post Brexit time. However, cross sectional nature of the study meant that the author could not look in to those areas. But, it presents a future research opportunity in a wider context.

1.6 Research Roadmap

This chapter has highlighted the background of the study as well as discussed the research questions, aims and objectives. This chapter has been followed by a literature review to discuss the issues in relation to migration and the status of EU migrant within the NHS workforce. The next chapter was the research methods that has analysed the tools and techniques used in the finding and analysing data. The fourth chapter was the research findings and analysis followed by the last chapter that has concluded the report along with recommendations.

Chapter 2: Literature Review

This chapter has analysed the literature in terms of the current studies which have been taken place on the after math of EU referendum to highlight the issues of recruitment and retention of European migrants working at NHS.

2.1 The Status Negotiations on Future Mobility of EU Citizens

After the referendum results, the UK and the EU officials came to an agreement on 8th of December 2017 to ensure an orderly withdrawal for the EU. After this initial agreement was approved by the EU Council, the officials from the EU and the UK started the actual negotiation on the terms and condition of the withdrawal considering the greater socio-economic and political impacts. The negotiation started with three key issues which were the border issues of the Northern Ireland, the rights of the citizens of UK and EU living across the borders and the financial settlements of the withdrawal (Baird and McKenna, 2019). As this study is related to the employment, recruitment and retention of EU employees working at NHS, the main focus will be on the immigration related matters. The initial agreement between the EU and the UK agreed to protect the universal rights of the citizens under the EU law until the UK leave the EU on March 2019 (House of Commons, 2018). However, this date has been changed and the new deadline is set for October 2019. Therefore, the initially agreed 21 months transition period has already been extended and it can further be extended for a longer delay to Brexit. However, the initial agreement between the UK and EU includes that the people who would move to each other’s directions during the transition period will have the same rights and status as those who have moved before Brexit (House of Commons, 2018).

At present, there is very little information on how the UK will design its immigration system in the post Brexit era and that will determine if people from the EU will be able to travel freely and where the UK based employers will be able to access one of the main supply source of skilled workforce (Dolton et al., 2018). A report by the Home Office has confirmed that the government has not yet provided any direction about the future of immigration in the post Brexit time and it is still waiting for such instruction to start developing strategies and arrange logistics (Home Officce, 2017). While the Home Office is currently concerned with only reducing the number of immigrants, it also needs to come up with strategies to attract talents to the UK. However, the UK government has commissioned the Migration Advisory Committee by recognising its special partnership with the EU with a view to conduct cost benefit analysis and assess the immigration scenario as well as match it with the objectives of the UK to remain as the choice of place for people from the EU. In September 2018, the Migration Advisory Committee published its report and it will be one of the considering factors by the UK government to decide the future immigration policies that will guide the UK based employers to decide their employment, recruitment and retention strategies, especially in regards to EU based employees (Home Officce, 2017). Although the movement of workforce is a key issue an institution like NHS, it is in fact linked to other issues such as future access to the EU market.

Kara and Lenoel (2018) have described Brexit as the great British trade off in the review of exit options for the UK and determined that the full access to the EU market is a key factor that will decide the freedom of movement of labour by the UK government. This is going to be a compromise and it needs to be seen whether the UK government or the EU makes the compromise since the fate of millions of EU nationals in the UK is related. Therefore, the burden is not only on the UK fully (Kara and Lenoel, 2018). At present, the UK government is maintaining its stance of staying out of the custom union and possibly hold a strict view of the freedom of movement of the EU citizens to the UK and vice versa. As the negotiations are still open and future immigration stance of the UK government is unknown, the employers such as NHS and other who are dependent on the EU workforce in many ways cannot predict the future trends and make strategies to fulfil their needs. Most of the Brexit negotiations have been around trade deals and the withdrawal payment where little attention has been given to free movement of labour (Porters and Forte, 2017). From this, it can be implied that with a trade deal, the issue of the free movement will also be solved. Although immigration was a key driver of the EU referendum results, this has in fact taken a back seat with other pressing issues in hand (Porters and Forte, 2017). However, the UK can only end free movement by totally giving up its access to the EU single market and become a third party country which the politicians might be reluctant to do.

2.2 Prospect of International Migration Post-2020

Post Brexit, it is already known that they need to be certain compromises by all parties, however; the extent of such compromise is still unclear. However, it is more or less evident that the current state of free movement of people will end unless the Brexit is cancelled altogether. There have been various scenarios that have been discussed and these has been analysed in the context of health and social care workforce. Fahy et al., (2017) and Porters (2018) have distinguished between the terms of soft, hard or failed Brexit as have been commonly discussed and the implication on free movement of labour (see figure 1). However, it is still not possible to create a clear scenario of immigration and free movement that is loaded with uncertainty and will prevent the potential employers from taking any proactive actions. It is fairly easy to comment that nobody yet has a concrete idea of the situation in the next few years. Whatever strategy is taken, it needs to consider the EU nationals and the UK nationals living across the borders and setting a timeline for immigration policy changes to make it convenient for everything during the transition period (Porters, 2016).

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Figure 1: Brexit Scenario (Fahy et al., 2017 and Porters, 2018)

Since the referendum results, two terms that have been constantly published and discussed are hard Brexit and soft Brexit. Not a single have passed without the politicians or media mentioning these terms and they seem to be overused. However, these are important terms which ma define the future of UK-EU relationship and settle the debated going around the immigration and rights of the EU workers. In this regard, Dolton et al., (2018) have analysed the feasibility of various immigration policies as can be seen from table 2. However, there are three main possibilities as the free movement of people will be attached to the trade deal and these have already been discussed by Porters (2018) as can be seen from figure 1.

2.3 Implications of uncertainty over future immigration system

The following figure 2 created by Dolton et al., (2018) shows various events that have taken place since the EU referendum vote and highlights the uncertainty for the citizen of European Union to either stay or leaves the UK. This has significantly implication for thousands of employers who have employed EU nationals in key position and which can be difficult to fulfil in the short term.

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Figure 2: Timeline of Brexit and protection of rights of EU citizens (Dolton et al., 2018)

According to Dolton et al., (2017), uncertainty is one over the main issue as the UK is still formally in the EU and there are no concrete decisions that have been made. So the EU workforce currently working in the UK does not know about their future and this increases pressure. Moreover, the seemingly strict and complex immigration system that the Home Office has created also creates a burden on the EU nationals which is making them think about other options. The following figure 3 contains an analysis of the current immigration system in the UK as summarised by Dolton et al., (2018).

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