Brexit: a step into the unknown

Comment & Opinion

Joan Pons Laplana, RGN, Telehealth FLO Clinical Lead NHS Arden & Greater East Midlands Commissioning Support Unit.

Proud Nurse, NHS Change Day Hubbie and Care Maker

Britain has voted  to leave the European Union by a narrow majority

Brexit has won, but let’s not forget that nearly as many people voted to remain in. The question now is how to pull together and move forward?

In my opinion the Brexit vote was also a revolt against a political system that is not working. Brexit is a reaction against the continuous globalisation that is clearly failing to benefit anyone, particularly the working class. Across Europe, recent years have been marked by extreme austerity to solve a crisis that the majority of us did not create, but are  suffering its consequences of.

For me, the EU Referendum has been the start of a silent revolution. We had had enough.

But let’s go back to what most matter to us:

The future of our beloved NHS

The health service is currently in a financial crisis; nine in 10 hospitals are overspent as a result of years of funding squeezes. We should not forget that this is a Government choice and at the moment, the Conservatives are still in charge.

So much of what’s good or bad for the NHS comes back to money and funding – it pays for the staff, the buildings, the medicine, the machines and everything else. 

The UK spends a smaller proportion of its GDP on health care than countries such as Portugal, France, Spain or the Netherlands. It has consistently spent less of a share of its GDP on health than either the EU average or that of the member countries of the Organization for Economic Cooperation and Development (OECD).

Allow me to showcase how much our NHS is starved not only of cash but also resources:

  • Current health expenditure in the UK was 8.46 per cent of GDP in 2013. This compares to 16.43 per cent in the USA, 11.12 per cent in the Netherlands, 10.98 per cent in Germany, 10.95 per cent in France, 10.40 per cent in Denmark, 10.16 per cent in Canada and 8.77 per cent in Italy.
  • Current expenditure per capita (using the purchasing power parity) for the UK was $3,235 in 2013. This can be compared to $8,713 in the USA, $5,131 in the Netherlands, $4,819 in Germany, $4,553 in Denmark, $4,351 in Canada, $4,124 in France and $3,077 in Italy.  
  • The UK had 2.8 physicians per 1,000 people in 2013, compared to 4.1 in Germany, 3.9 in Italy, 3.8 in Spain, 3.4 in Australia, 3.3 in France, 2.8 in New Zealand and 2.6 in Canada.
  • The UK had 2.8 hospital beds per 1,000 people in 2013, compared to 8.3 in Germany, 6.3 in France, 3.1 in Denmark, 3.0 in Spain and 2.8 in New Zealand.

Despite all that, in comparison with the healthcare systems of ten other countries (Australia, Canada, France, Germany, Netherlands, New Zealand, Norway, Sweden, Switzerland and USA), in 2014 the NHS was found to be the most impressive overall by the Commonwealth Fund.  It was rated as the best system in terms of efficiency, effective care, safe care, coordinated care, patient-centred care and cost-related problems. It was also ranked second for equity.

Let’s remind to ourselves that the Brexit side have pledged to redirect £5.2 billion of Britain’s annual spending on the EU to the NHS. Our job now is to make accountable of their promise and make sure that they inject the much needed cash to our National Health Service.

Today is the day we need to restart the fight to save our NHS. The distraction is now over and challenges are now clearer.

But let’s make one thing clear, migration is not the cause of the NHS problems and struggles. Austerity is and that has been a government choice.

And let’s not forget that we have a publicly-funded healthcare system; it is paid for by taxpayers. About 78 per cent of working age EU immigrants in the UK are in work (a higher proportion than among UK nationals), so most are paying tax and contributing to the NHS. In theory, the NHS will be able to cope better with higher immigrant numbers. Migrants to the UK are also more likely to be young and fit so less likely to need the NHS.

What’s more, 130,000 EU citizens work in our health and care service. It’s a fact that you are more likely to find yourself cared for by a migrant than to find one queuing for benefits.

One question continues to monopolise my thoughts: What will happen to all European health workers such as myself, now?

55,000 out of the 1.2 million staff in the English NHS are citizens of other EU countries according to the English Health Service’s Electronic Staff Record. This includes doctors, nurse,  professionals such as paramedics and pharmacists, support workers providing care and administrative staff.

Nobody will deport any EU Citizen back to their countries. The UK economy and especially the health system will collapse if so. Migrants, including myself are here to stay. We are part of the backbone of this country and we will continue to be in near future.

A second question comes to my mind. What will happen to future recruitment?

It’s a well-known fact that currently we have a massive recruitment crisis. Thousands of NHS nursing and doctor posts lie vacant. At present more than two-thirds of trusts and health boards in the UK are actively trying to recruit from abroad as they struggle to cope with a shortage of qualified staff.

In nursing and midwifery, EU immigrants make up a small proportion, but their numbers have been increasing at a historically rapid rate in in recent years as the number of nurses trained in Britain has dropped; in future recruitment oversees will increase whether we are in or out the EU as Plans to scrap student bursaries and charge nurses and other health staff for their degrees in England could backfire.

At present All EU Member States agree to the free movement of workers and to the underpinning legislation on mutual recognition of training and qualifications.  One of the benefits that the European Union has brought to Nursing is that all the Nursing studies across Europe are very similar. That will not change after UK will leave EU.

It’s a simple equation of offer versus demand. We are in desperate need of qualified Nurses and the best place to recruit them will still be in EU countries like Spain or Portugal where the Numbers of qualify Nurses exceeds their countries demands.

It will be foolish to change it.

Let’s put a stop all the scaremongering. Let’s extend a hand to the losing side. There are no winners or losers. We have a uncertain road ahead. Change can be very daunting but often leads to better things. Let’s be positive.

But one think is for sure without change there will be no butterflies. It’s time to learn to fly together.