In the two months since the Brexit vote some of the initial risks to healthcare and the NHS have receded. With the Secretary of State continuing in his role and an early election unlikely, the political instability that could have put at risk the delivery of the Five Year Forward View and Sustainability and Transformation Plans has not materialised.
However, looking to the medium to long term there are still concerns about the potential impact on the workforce. The NHS already faces challenges in getting enough people with the right skill sets in to the right roles. These shortages are having a direct impact on patient care and hampering the ability of the system to transform itself and Brexit now means addressing these workforce issues will become even more urgent.
With 130,000 or around 10% of the health and social care workforce coming from EU countries, there is a significant risk that restrictions on immigration will create further staffing shortages. In 2010, the then Home Secretary Theresa May, put forward immigration restrictions on non-EU migrants, amid concerns from her cabinet colleagues that it would damage the economy and NHS recruitment. In that case, the subsequent shortfall in NHS staff was picked up by migration from the EEA, an option which Brexit could now rule out. However, while these risks are real, any future points based system is unlikely to exclude skilled healthcare professionals from working in the UK or impose a long term block on EU migrants joining the NHS. The problem is more likely to arise from restrictions on lower skilled staff.
Alongside these challenges, the biggest risk of Brexit continues to be an economic slowdown. NHS finances are already under pressure and recruiting more staff to make up shortfalls if there are further cuts to funding would be unaffordable.
All this means that there are a number of actions that the NHS must take to prevent the existing workforce challenges becoming a crisis.
All these factors make it all the more essential that the NHS uses the Brexit timeline as an opportunity to inject some urgency into workforce changes that have been long discussed but not implemented. These include changes to the skill mix, investment in developing a culture of learning and improvement and greater use of technology to support the clinical and managerial workforce. Making progress in these areas would both mitigate Brexit risks and drive real improvements in the effectiveness of the NHS workforce.