Across NHS trusts there is currently a shortage of almost 100,000 staff (representing 9 per cent of posts), severely affecting some key groups of essential staff, including nurses, many types of doctors, allied health professionals and care staff. Vacancies in adult social care are rising, currently totalling 122,000, with around 9 per cent of care worker roles unfilled. International recruitment is a key factor in addressing these vacancies. Brexit and immigration policy will have an impact on the ability of the NHS and social care providers to successfully fill these vacancies.

The policy of freedom of movement and mutual recognition of professional qualifications within the European Union means that many health and social care professionals currently working in the United Kingdom have come from other EU countries. This includes nearly 65,000 (5.5 per cent) of the 1.2 million workforce of the NHS in England and an estimated 115,000 (around 9 per cent) of the 1.3 million workers in England’s adult social care sector. The proportion of EU workers in both the NHS and the social care sector has grown over time, suggesting that both sectors have become increasingly reliant on EU migrants.

The UK has a greater proportion of doctors who qualified abroad than any other European country, except Ireland and Norway. Latest General Medical Council (GMC) data shows that the number of doctors from the EEA joining the medical register is now holding steady (but still down 40 per cent on 2014). A combination of relaxed visa restrictions and active recruitment by trusts means that the number of non-EEA doctors joining the register doubled between 2014 and 2017. However, some specialties not currently on the Home Office’s shortage occupation list are still facing difficulties, for example, child and adolescent psychiatry.

The situation in nursing is similar, in 2018/19 only 968 nurses and midwives from the EEA joined the Nursing and Midwifery Council’s (NMC) register, a decrease of 91 per cent since 2015/16. This fall has only been partially mitigated by more non-EEA nurses joining the register – their numbers increased by 126 per cent in 2018/19, with 6,157 non-EEA registrants joining during the year. As with GMC registrants the likely causes of these trends are relaxed visa restrictions, nursing being added to the shortage occupation list in 2015 and active recruitment from outside the EEA by trusts.

However, even with both EEA and non-EEA registrants taken into account, these figures are considerably below the peak of around 16,000 international nurses on the NMC register in 2001/02. Although there are other contributing factors, including the introduction of new English language requirements in 2016, Brexit has had a significant impact.

In the longer term, the potential economic impact that Brexit may continue to create could act as a powerful disincentive for health and care staff to work in the NHS and social care. For example, a fall in the value of the pound would mean the money staff earn in the UK is worth less in their home country.

One of the main priorities in the first phase of the negotiations between the United Kingdom and the European Union was clarifying the status of EU citizens currently living in the United Kingdom and of UK citizens living in other EU countries. Any EU citizen currently living in the United Kingdom, including the 165,000 EEA staff already working in health and social care are able to apply for the EU settlement scheme. They will need to apply by June 2021 (or December 2020 in in the event of no deal) in order to be able to stay in the United Kingdom.

The government published an immigration White Paper in December 2018 setting out proposals for a new skills-based immigration system to begin in 2021, which would treat EEA migrants in the same way as non-EEA migrants. It removes the limit on numbers of skilled workers but proposes an annual earnings threshold of £30,000, which is likely to have an impact on the ability to recruit certain health professionals to the NHS. The threshold generated fierce debate – in June 2019 the government commissioned the Migration Advisory Committee (MAC) to carry out an in-depth analysis of potential future salary thresholds. The MAC is due to report back by January 2020 with recommendations as to what level any future salary threshold should be set at.

The White Paper also acknowledges England’s reliance on migrants in the social care workforce. However, it proposes that for a transitional period such workers would only be allowed to work for a limited time, with no entitlement to bring dependants. Again, this is likely to impact the ability of the social care system to attract sufficient workers. In the event of a no-deal Brexit, for an interim period EU citizens would be able to enter the United Kingdom as they do now, but if they wish to stay longer than three months they would have to apply for permission under a new European Temporary Leave to Remain scheme. People who obtain this status would be entitled to live, work and study in the country for a further three years.

Separately the Prime Minister has announced that under new rules, international students will be entitled to the right to remain in the UK for two years after graduation. This will allow international graduates in medicine and nursing additional time to secure long-term employment. The previous rules only allowed four months.

Staff shortages across the NHS are a real challenge, for example, our calculations show that the NHS requires an additional 5,000 internationally recruited nurses per year to prevent current staffing shortages getting worse. Any post-Brexit migration policy which impedes this could have serious implications for future staffing of the NHS. The situation in social care is just as serious, with 90 per cent of staff in the sector qualifying for a permanent work visa under the reforms proposed in the immigration White Paper, as they earn less than the £30,000 per year threshold.

In short, the impact of Brexit on the health and care workforce will depend on future migration policy and the barriers or incentives to live in the UK and work in the NHS and social care that are put forward.