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Thursday, 26 January 2017

NHS Dorset, Clinical Commissioning Group Consultation Document- and the Implications of BREXIT in relation to Recruitment and the National Health Service

"We have difficulties staffing some services because there are national and local shortages of some medical staff with key specialist skills and it is difficult to recruit to some posts. This includes GPs, mental health nurses, consultants working in accident and emergency and paramedics. We also face the prospect that quite a lot of our staff are coming up to retirement age in the next few years. We are now trying to recruit staff from other countries such as Portugal, Spain, Italy, Ireland and the Philippines". NHS Dorset Clinical Commissioning Group Consultation Document, page 8.

No mention of the implications of Brexit for the NHS and the free movement of labour.

Plight of EU nationals seeking UK residency to be investigated, The Guardian

"May’s government has yet to provide EU nationals with any assurance that they will be allowed to stay in the UK after Britain’s withdrawal from the EU. The prime minister has said it will be an issue to be negotiated after article 50 is triggered. In recent months the Guardian has learned that employers have been seeking guarantees of right to remain from EU nationals. Other EU nationals, such as Hawkins, have sought permanent residency because of fears for their future status".

What is the percentage of foreign nationals working throughout the NHS?

"While the longer term consequences of UK withdrawal from the European Union cannot yet be foreseen, all EU trained nurses and midwives on our register can be reassured that there is no immediate impact and that the vital role they play in providing high quality care to patients in the UK is highly valued, Nursing and Midwifery Council Annual Report (pdf)

Staff crisis grows as foreign nurses abandon the NHS, The Times, 27. 1.2017 - "European nurses are giving up on the NHS, with the number arriving to work in Britain down more than 90 per cent since the Brexit vote. A total of 101 EU nurses registered last month, down from 1,304 in July, according to figures from the Nursing and Midwifery Council (NMC). More European nurses are also leaving, prompting fears that Britain may be seeing the start of an exodus of the staff who have kept hospitals running in recent years. Hospitals are already struggling to find enough qualified nurses, with tens of thousands of vacancies and many wards dangerously understaffed. Hospitals turned to the EU after a damning report into the Mid Staffordshire scandal four years ago warned against cutting staff to save money. Recruiting missions were dispatched to Spain, Grece and other countries to increase the numbers of their citizens working in the NHS."

Figures show extent of NHS reliance on foreign nationals - Thinktank warns stricter immigration rules could hit service after stats show 11% of all staff and 26% of doctors are non-British

NHS intensive care 'at its limits' because of staff shortages, The Guardian, Units are so overwhelmed that life-saving operations are having to be delayed, warn senior doctors

EU immigration and NHS staff

The full-time equivalent GP workforce dropped by almost 100 doctors over the past year, official data show, in a blow to government plans to recruit and retain an extra 5,000 GPs by 2020 - GP Online - "GP leaders said the figures showed that the crisis in general practice was 'getting worse, not better'. The GPC warned that government 'scapegoating' of GPs over the wider NHS crisis would undermine efforts to attract more doctors into the profession, and warned that pledges to increase GP funding must be implemented faster.T here were 34,495 full-time equivalent (FTE) GPs in September 2016, down 96 from 34,592 a year earlier - a drop of 0.3%".

Thousands of doctors trained in Europe 'may quit UK after Brexit', The Guardian -BMA warns of impending ‘disaster’ as its research shows 40% of doctors who qualified in EEA may leave because they feel less welcome

Dorset Healthcare Recruitment Campaign

Dorset Healthcare has launched £90,000 London advertising campaign to attract staff- after spending £12million on agencies, Bridport News

Nurses star in London advertising campaign for Dorset HealthCare, ViewNews

Fears for Bridport Community Hospital's future as beds closed due to staff shortage, June 2016, Bridport News

Six Monthly Review of Inpatient Nurse Staffing Establishment:Ensuring Safe StaffingPart 1 Board Meeting 28 September 2016, DorsetHealthCare, NHS, pdf  - Excerpts follow:

3.1.7 The Trust is engaged with Dorset CCG as they develop other models of service delivery through their Clinical Services Review. This will lead to increased flexible working and changes in acuity and dependency of patients....

3.3 Recruitment and Retention

3.3.1 The Trust recognises the existing recruitment challenges: • National shortages of newly registered health professionals • The large number of small sites from which the Trust provide services, across a wide geographical area (much of it rural) • Attracting staff to work with the over 65 age group in both physical and mental health services is difficult, but particularly so in mental health services

3.3.2 Similar to other Trusts, DHC continues to be impacted upon by the national lack of available mental health and general nurses particularly at band 5. Proactive workforce analysis, rigorous recruitment and maximising opportunities for commitment to and use of new roles is in progress to continually support the Trust to meet ongoing clinical demands and staffing requirements.

3.3.3 In order to attract sufficient numbers of staff to meet service needs, more innovative and unique approaches to recruitment are already being considered by the Trust. Work has progressed and a Recruitment and Retention Project Group Is considering the collective approach required. A variety of recruitment strategies have been undertaken including, local open days, stands at national and regional recruitment events, targeted advertising and developing, delivering and evaluating a generic recruitment marketing campaign to raise the profile of the Trust as an employer and to highlight the range of opportunities available. Recent events have led to approximately 200 interested job seekers which we are making contact with and sending regular updates to.

Additionally: • A process has been commenced to look at international recruitment for nursing and medical staff. A number of agencies have been invited to provide information on how they could support a recruitment campaign overseas in European as well as further afield countries. This is only in the very initial stages, more updates will be provided in due course. •

3.3.6 Most of the Community Hospitals have Registered General Nurse vacancies with Swanage, Bridport and Wareham Hospitals reporting the highest vacancy factor at 33.03%, 32.5% and 28.05% respectively

3.3.7 The wards are constantly monitored for staffing fill rates and in the event that staffing falls below an acceptable, safe level and sufficient bank /agency nurses cannot be found decisions are taken to mitigate patient harm. This includes taking decision to reduce bed numbers or close the ward to further admissions. This has occurred within the past six months in Bridport Hospital and Swanage Hospitals with bed numbers being temporarily reduced to ensure patient receive the right care. As mentioned earlier where the staffing resources are not available a ward will be closed with beds relocated to other areas – this has occurred at Weymouth Hospital - Chalbury ward with the relocation of the beds to St Brelades and Herm Wards at Alderney Hospital.

GP crisis, Dr Michael Mosley, BBC Radio 4 (iPlayer) - "Doctors in Northern Ireland say the service is at breaking point and are threatening to end their contracts with the NHS. They're blaming it on a shortage of GPs, particularly in rural areas, and claim the Government has failed to train and recruit new staff quickly enough".

Ambulance service struggling to handle demand, Sky News

Large number of hospitals cancelling cancer ops - Royal College of Surgeons, Sky News

Sky TV News reported today (26 January) that Bridport Hospital is desperate for nursing staff. BBC News on 27 January  featured GP surgery closures and doctor shortages..

Brexit and Health (pdf) Letter from Commons Select Committee, Health Committee, to Secretary of State -"Leaving the European Union will have major consequences for a wide range of health and social care issues, from our future licensing and access to medicines to the health and social care workforce...

On the basis of the evidence and advice that we have received so far, there are six areas in particular which the Committee feels will be vital for health and social care: 1. The UK’s health and social care workforce – both those that are here now, and those that we will need in the future; 2. Reciprocal health care coverage and cross-border healthcare; 3. Medicines, medical devices, clinical trials and wider health research; 4. Public health, including environmental protections and communicable diseases; 5. Resources, including EU agencies, funding programmes, networks and health in overseas aid; and, 6. Market functioning and trade agreements".

Inventory of areas for consideration by the Department of Health in Brexit negotiations

Key considerations

Further detail 1. The UK’s health and social care workforce

Staff from European Economic Area (EEA) in NHS and adult social care (right to remain for existing staff, future flows of staff into UK, rights of workers and their families as EU citizens while working/living in UK)

Current entitlements, which extend to both health and social care staff and their families (if EU citizens) include non-discrimination on nationality for entry, residence, access to employment, housing, accumulation and transfer of pensions, social security, right to health care coverage in REU on retirement, right to access to health care when visiting in home country (e.g. childbirth), welfare; recognition of qualifications (subject to linguistic competencies); access of children to education; access of spouses and dependents to residence, employment and housing;

Professional competencies currently recognised through mutual recognition of qualifications and exchange of information through cross-border alert mechanisms

Employment rights affecting health and social care staff (the whole of the EU acquis on employment law)

Current entitlements are EU equality law (sex, race, disability, other grounds); EU health and safety at work law (including maternity leave rights); EU employment law on restructuring e.g. transfer of undertakings

Brexit and Health: Jeremy Hunt replies to Chair of Health Committee - see page 8 for Jeremy Hunt's reply of 13 January 2017 to Dr Sarah Wollaston MP Member of Parliament for Totnes, Houses of Commons, Westminster London, SW1A 0AA

"Thank you for your letter of 14 December 2016. As you would expect, we are doing the comprehensive preparatory work necessary ahead of triggering Article 50 and the impending negotiations. We will play our part in securing the best possible outcome from exiting the EU, dealing positively with its consequences, while continuing to focus attention on improving the health and care system and the challenges it faces. In terms of how our work is organised, at official level our work is coordinated by a small team within the Global and Public Health Directorate. A number of relevant policy teams in other directorates then lead on considering the implications and opportunities of exiting the EU for their respective areas (for example the workforce policy team lead on the health and social care workforce elements you raised). It is not possible to establish a full-time equivalent figure because many of these staff are undertaking the work as part of their wider responsibilities. A wide network of our stakeholders are also involved in the work by various means, including regular meetings with Ministers, officials and special advisers. The most focused preparations are naturally in those areas where leaving the EU will have the greatest effect, including those identified in your letter and those included in the Department’s written evidence to this inquiry. As you rightly point out in your letter, many of the issues your committee has identified are not bound by departmental responsibilities.  We are working closely with the Department for Exiting the European Union (DExEU) and other departments to coordinate the multiple complex strands of work involved in preparing to leave the EU. We will also be closely involved as the negotiations progress. I hope this goes some way to answering your questions and I look forward to a fuller discussion with you and your Committee in person later this month".   JEREMY HUNT

Submission from Stephen Rogers (BRE0001)

"My wishes for the NHS after Brexit are (1) that all current employees of the NHS should have continuing residency in the UK assured and (2) everything contained in the NHS Reinstatement Bill".

September 2016

From a study of the above correspondence and exchanges it would seem that, for practical purposes, any comments or evidence on these matters might usefully be addressed to Dr Sarah Wollaston MP Member of Parliament for Totnes, Houses of Commons, Westminster London, SW1A 0AA

Examples of written evidence to date:

Written evidence from Healthcare Distribution Associations' Council (HDA UK) (BRE0092)

"In line with many other business sectors, we are concerned about the impact of Brexit on the ability of employers to source appropriately qualified staff. The healthcare sector, from research scientists in pharmaceutical companies, to pharmacists in hospitals and the community, benefit from skilled workers from the EU.

We would not like to see Brexit negotiations ending the advantages of the appropriate freedom of workers to come to the UK. It is also highly important that the UK maintains the parity of qualifications for healthcare professionals that ensures that British regulated healthcare standards are sufficiently aligned with the EU’s equivalents, enabling European health professionals to practise in UK pharmacies, hospitals and GP surgeries, with whom our businesses have long-standing business partnerships and relationships".


See also - Simon Stevens (Wikipedia)

Reform Strategies For The English NHS, Health Affairs, May 2004

Costing the NHS, BBC

£146 per patient is not enough: it’s time for GPs to charge fees, Prit Buttar, The Telegraph

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