Kate Ling, senior policy manager at the NHS Confederation’s European Office in Brussels, reacts to the EU referendum results and comments on its implications for the NHS workforce.
My mobile phone buzzed at an unearthly hour on Friday 24 June and my bleary eyes scanned the text from a (Belgian) friend that read: ‘OMG! Brexit!’ Now, over a week later, there is no sign of the political turmoil dying down, but there has been time to absorb the news and draw some sensible conclusions about what all this means for employers and employees in the NHS.
We are still a full member of the EU
The NHS European Office has been inundated with calls and emails from people and organisations wanting to know what impact the result will have on them. The most important message I can give is (as Corporal Jones would say): ‘Don’t panic!’ The UK is still a full member of the EU. Negotiations on our exit package will not begin until the UK government officially informs the EU that they wish to withdraw, under Article 50 of the Lisbon Treaty. For a minimum of two years after this, all current EU legislation will continue to apply.
I know how worried many people are at the moment, with anecdotal evidence of EU staff uncertain about their future and NHS employers concerned they will have trouble recruiting to fill much-needed vacancies. The biggest danger in the short term is that the prospect of Brexit could discourage EU citizens from coming to the UK due to fears of being unwelcome and / or concerns around pensions and employment rights. There is also speculation about the impact of a less favourable exchange rate, making the UK a less attractive destination for healthcare workers to live and work. We can all play a part in dispelling some of these fears by joining the #LoveOurEUStaff social media campaign, spearheaded by NHS Employers – we need to use every means at our disposal to spread the message that we welcome the great contribution that EU citizens make to our workforce.
So what might happen next?
After the initial two-year period is up, as the director of the European Office, Elisabetta Zanon, said in her blog last week everything will depend on the outcome of the negotiations between the EU and the UK government about their future relationship. The critical factor is whether or not the UK continues to have access to the single market, entailing freedom of movement for EU citizens to live and work in the UK and vice-versa, and requiring buy-in to EU employment and other legislation – the so-called ‘Norwegian option’. Under this scenario, virtually nothing would change for employers and staff.
At the other extreme, a total exit from the single market would leave the UK completely free to determine its own policies on employment issues such as immigration, professional regulation, employment law and health and safety laws.
Let’s look at some of the most important areas for NHS employers and employees:
Education, training and workforce planning
Currently, students from other EU countries can come to the UK and pursue medical training on the same basis as British students, and without having to obtain Tier 4 visas that apply to non-EEA overseas students. British students can study in other EU countries and increasing numbers of British young people are pursuing medical degrees (often taught in English) at European universities. European rules on mutual recognition of qualifications mean that medical graduates from some EU countries can apply for Foundation Year 1 places as trainee doctors. Some of the Shape of Training proposals on reforming future medical training could, if implemented, affect (and probably increase) the number of future European applicants.
Under a Norwegian-style agreement, current workforce planning assumptions on numbers of training places and on trainee mobility will (broadly speaking) continue. Depending on what successor arrangements were put in place, a more radical option could significantly alter inward and outward flows and might encourage greater mobility between English-speaking non-EEA countries, rather than between the UK and European countries. It would be up to the UK government to decide what restrictions would best meet its perceived workforce needs.
Recruitment and retention
Under the EU’s freedom of movement rules, EU workers can work in the UK on the same basis as British citizens. This won’t change for the next couple of years, nor after that if the UK retains access to the single market. Even if we don’t, it is unlikely that a future government would make it difficult for the NHS to recruit and retain the staff it needs. Britain could unilaterally decide to relax entry restrictions for certain groups of workers in shortage occupations and make it easy for them to stay, in the same way as Australia uses a points system to actively encourage entry by healthcare workers. The NHS Confederation and NHS Employers will actively push for a thorough review of the migration system so that employers can recruit and retain European staff with confidence.
Such a review would need to consider arrangements for transferability of pensions and employment rights, to ensure that staff from EU countries would not lose out.
Current EU legislation on professional qualifications fast-tracks EU citizens holding a qualification from an EU country as a doctor, general care nurse, midwife, dentist or pharmacist by automatically recognising their qualification, though they still have to satisfy regulators’ other requirements in order to practise. While not without its problems, automatic recognition certainly facilitates mobility by cutting through unnecessary red tape. Of course it also works the other way and allows British health professionals to live and work more easily in other European countries. The EU also has a secure online patient safety alert system, whereby regulators can warn each other about rogue professionals who, having been struck off or had their practice restricted in one member state, seek to move across borders and practise elsewhere.
If the principle of freedom of movement were to be restricted in future as a result of leaving the EU, without negotiating access to the single market, then it is possible that EU professionals could be treated in the same way as overseas nationals for the purposes of professional registration, and regulators might lose access to the EU-wide information exchange system. However, a future government could make legislative changes and/or agreements to ameliorate this situation. Existing EEA-qualified registrants will remain on the register as now.
Employment legislation and the Working Time Directive
The WTD has become iconic, symbolising everything perceived in certain quarters to be ‘wrong’ with EU employment laws: over-detailed, bureaucratic and meddlesome. We in the NHS EU office have taken every opportunity since our inception to argue the case with the European Commission for a more flexible approach to employment legislation, which preserves the principles of health and safety and workers’ rights while allowing the details to be decided at national level. This flexible and pragmatic approach fits well with the European Commission’s current review of its legislation to see where unnecessarily bureaucratic rules can be simplified.
We expect the issue of working time and of wider work-life balance issues such as maternity, parental and carers’ leave to be back on the EU’s agenda next year. We will be using every channel at our disposal to influence changes to the law in the interest of the NHS, as all these rules will still apply in future (as they do to Norway) if the UK continues to have access to the single market. Of course if we don’t, then the UK can make whatever employment laws it likes, but the contractual terms and conditions enshrined in (eg) doctors’ contracts and Agenda for Change will continue to apply until renegotiated.
We will back you to the hilt
Over the coming weeks and months, politicians will need to walk the delicate tightrope of managing public expectations about migration control without damaging Britain’s ability to attract and retain talented people who can support our economy. We will be working with NHS Employers and a broad coalition of stakeholders to ensure that negotiators are fully aware of the implications of proposed policies for the NHS and its workforce - promoting an effective case for sustainable services for patients underpinned by a secure future for staff.
For more on the implications of the EU referendum on the NHS, see the NHS European Office’s web page.