Brexit has already dealt a brutal blow to one of the most cosmopolitan of UK workforces, and its human cost is blindingly obvious to anyone actually working in healthcareby Rachel Clarke / August 28, 2018 / Leave a comment
The health service already has a staff shortage—and Brexit is already making it worse. Photo: PA/Prospect composite The morning after the Brexit referendum, I met my Italian consultant on the steps of our hospital. Her face twisted a little and her eyes dropped to the floor. When I rushed to embrace her, she started to cry. It would be easy to dismiss this as emotional melodrama. After all, what had changed in her NHS contract? We had saved lives together, lost patients together, run cardiac arrests, sought to comfort grieving families—and surely could continue to do so. So why start weeping as though the world had ended? Well, as of that morning, while one of us remained fully entitled to be a doctor in the NHS, the other feared being stripped of her right to live and work here. Worse, she was left feeling fundamentally unwelcome and unwanted by the country she now called home. As if to prove her distress was not unfounded, the next day another colleague, a Polish optometrist, was subjected to a racist diatribe while working at a Saturday morning NHS clinic. “Why don’t you f*** off back to where you belong?” began the abuse from a patient’s skin-head relative, as children in the waiting room looked on. Later, we would learn that a nationwide spike in hate crime was reported after the referendum, with the police documenting a 57 per cent increase in its immediate aftermath. “Project Fear”? As we lurch towards March 29th next year—the date when the UK is set to leave the EU—the debate surrounding Brexit has never been more shrill or ugly. Nor, some might argue, less connected to reality. Last week, for example, Nigel Farage announced his “return” to UK politics by claiming that the EU’s chief negotiator, Michel Barnier, “would like the IRA to become active again,” while accusing the former French foreign minister of “almost encouraging Republican terrorism.” All this while accusing others, NHS doctors included, of cynically deploying “Project Fear”; of scaremongering the public into unfounded panic over Brexit. It’s not about scaremongering In general, as a doctor, I am all in favour of sober and dispassionate appraisal of risk. Indeed, the principle of informed consent, so central to medicine, hinges on a doctor sharing with their patients accurate, evidence-based information about the pros and cons of a potential medical intervention. Anyone who has followed the recent spate of deaths from measles across Europe, for example, will know precisely how dangerous scaremongering from unscrupulous doctors can be—such as the disgraced former NHS paediatrician, Andrew Wakefield, who preyed on parents’ emotions to deter them from giving their children the MMR vaccine. But the phrase “Project Fear” has become less a legitimate objection to scaremongering than an attempt to shut down debate and silence dissenting voices. What no deal means Take the NHS. There are widespread—and legitimate—concerns about how all forms of Brexit, particularly its ‘no-deal’ variant, might impact in the future upon patients. For example, the potential difficulties in importing drugs have been highlighted, as has the risk to patients with rare diseases of being excluded from vital European rare disease networks. More fundamentally, even if we are to believe that bodies such as the Royal Pharmaceutical Society, British Medical Association and Royal College of Nurses have all been infiltrated by Brexit saboteurs, accusations of “Project Fear” conveniently ignore the impact of Brexit now on the NHS; the damage already done. In a chronically understaffed NHS—we are currently short of 40,000 nurses and 10,000 doctors—any discourse around immigration that nudges immigrant staff back to their country of origin risks exacerbating the staffing crisis. Project Fact, not Fear There is clear evidence—Project Fact, not Fear—that Brexit is already fuelling an NHS brain drain, with 4000 staff from the European Union leaving the Nursing and Midwifery Council (NMC) register in 2017-18, a rise of 28 per cent on the year before. At the same time, the number of EU nurses and midwives coming to work in the UK has fallen to its lowest level. Just 805 of them joined the NMC register in 2017-18, a mere 13 per cent of the 6,382 who came over the year before. Brexit, in short, has already dealt a brutal blow to one of the most cosmopolitan of UK workforces, and its human cost is blindingly obvious to anyone actually working in healthcare. Closing beds Last year, my palliative care ward was forced to close a third of its beds. We simply couldn’t find the nurses to keep them open after some of our very best, most dedicated EU nurses had returned, reluctantly, to Portugal, Spain and Italy. Those closed beds translate into dying ill patients trapped at home, sometimes in desperate need of inpatient care, yet unable to receive it. Those closed beds are the consequence of xenophobic, anti-immigrant campaigning before and after the referendum. Our NHS has already been weakened by Brexit—and we haven’t even left yet.