GRI has joined forces with long-standing partners, HSJ Magazine, to create a whitepaper that delivers true visibility and insight on the impact of Brexit on current EU workforce numbers in the NHS.

This 12 page report contains the very latest statistics, facts and trends on the movement of EU professionals to and from the UK health service. Importantly, our analysis provides tangible, easy to implement advice on how to retain vital EU staff – as well as a forecast on where competition for talent is most likely. Includes interviews, views and opinions with current EU staff as well as:

Anita Charlesworth, director of research & economics at the Health Foundation

Danny Mortimer, chief executive of NHS Employers and chair of the Cavendish Coalition

John Drew, director of improvement and culture at Oxford University Hospitals Foundation Trust

Kevin Cheatle, director of workforce at Kingston Hospital Foundation Trust

Mark Dyan, policy analyst at the Nuffield Trust

Read on for an exclusive excerpt or request the full paper at


Grappling with the burning issue of brexit

In summer 2016, shortly after the referendum in which the nation voted by a slim majority to leave the European Union, Kelvin Cheatle began a new job. And as he took up the reins as director of workforce at Kingston Hospital Foundation Trust, the possible effects that national vote might have on NHS staffing was already weighing on his mind.

“It’s fair to say that I was immediately concerned about the impact of the referendum,” says Mr Cheatle. “And it’s fair to say it’s now been my number one issue for two years.”

The concern is understandable. EU recruitment had previously been a balm to the underlying workforce and vacancy issues in the health and social care sectors. But, post-referendum, the flow of staff from the EU into the UK has already changed.

Brexit is not the only reason. But it’s an important one and, whatever the specific future may hold on an issue which has wrought regular confusion for the past two years, it seems likely the NHS will need to mitigate the workforce impact of the UK’s exit from the EU.

We’ve put together this supplement to support you in doing just that. Through conversations with analysts, it presents a comprehensive overview of the impact Brexit has already had on the NHS workforce.

But it also features views from EU staff and NHS leaders, who give insight into how the service might reduce any continuing effect. We hope you find it helpful and thought provoking.

Claire Read, HSJ

Change. In 1948 it was seismic with the creation of the NHS. In 2000, just a whimper with Y2K. How will Britain’s exit from the EU ultimately be judged?

The day after the vote GRI created a taskforce, to better inform our NHS and private healthcare clients on what next. As independent workforce management experts helping organisations control agency worker spend, we provide visibility of temporary hiring activity. This allows us to deliver pertinent and personalised support to clients in their retention and recruitment efforts.

For example, we have been able to create an accurate picture of exactly which EU countries workers are from, per job category or location. A level of detail invaluable in helping clients understand the likely push and pull factors of UK settled status, versus the attractiveness of home countries or other EU nations.

Typically this management information has shown UK/EU nurse percentage splits of 85.6 per cent vs 14.4 per cent – with nurses from Romania, Ireland, Poland, Italy and Hungary usually the most represented, accounting for twice as many nurses than all the other EU countries combined. Understanding your EU diversity is a helpful starting point. For example, statistics of the Office for National Statistics provide some comfort that Romanian citizens have been the least likely cohort of EU workers to leave the UK since the referendum.

GRI commissioned this white paper as a useful extension of this type of insight, to provide clear facts, new perspectives and specific recommendations to guide healthcare leaders through the post-Brexit landscape.

Andrew Preston, chief executive, GRI


The complicated story so far

Fears of a mass exodus of European NHS staff following the referendum may have proved unfounded, but there is little doubt that there has been an impact on the numbers of EU staff – particularly in nursing

HSJ - Brexit.png

The now-infamous Vote Leave bus, which suggested leaving the EU would mean £350m a week could go to the health service instead, is the most memorable way in which the NHS featured in the referendum campaign on whether Britain should stay in the EU.

But arguably the biggest impact of Brexit thus far on the health service has been a workforce one. “Since the vote to leave, we’ve already seen a direct impact of the flow of staff from the EU,” reports Anita Charlesworth, director of research and economics at the Health Foundation.

Nursing figures give particular cause for concern. Nursing and Midwifery Council statistics show that, in March 2014, there were 20,916 nurses and midwives on the NMC register whose initial registration was in a European Economic Area country. By March 2017, that had climbed to 38,024 nurses and midwives, constituting 5.5 per cent of all registrants.

But by the following year there had been an 8 per cent slump. The numbers of EEA nurses and midwives joining the NMC register for the first time also shows significant atrophy. There were just 805 new EEA registrants over April 2017 to April 2018. In 2013-14, that figure stood at 5,389.

Mark Dayan, policy analyst at the Nuffield Trust, says that in other clinical professions “the picture’s a bit more nuanced; numbers have basically flatlined since the referendum”. But for nursing “it’s been a marked turnaround for nursing, going from very large net inflows to a net outflow”.

Danny Mortimer, chief executive of NHS Employers, argues the impact of the vote on the workforce cannot be downplayed.

“We shouldn’t underestimate how the referendum result, as well as the Windrush scandal [in which migrants from the Caribbean were deported ‘in error’ following new immigration rules], has made international colleagues – EU and non-EU – feel,” he contends.

Adds Mr Dayan: “You’ve got to remember that until November last year, when the withdrawal agreement started to emerge, it was actually less than fully clear what the legal status of EU nationals in this country would necessarily be.”

But those charged with analysing workforce trends emphasise that Brexit is not the sole explanation for recent fluctuations in EU staff working in the health and care sector.

One significant factor at play is admittedly closely related to Brexit: the fall in the value of the pound. “It makes the UK a less attractive country to go to if you want to, for example, send remittances back to your home country or if you’d like to save up the money to buy a house when you eventually return to your own country,” explains Mr Dayan.

But others are not so directly related. Take the introduction of more stringent language tests for international nurses wanting to work in the UK. Mr Mortimer describes it as having been “problematic” though says “improvements are being made”.

Another issue: the broader economic picture across Europe. “The peak of nursing migration came at a time when many economies in South Europe were in an extremely bad state and at the same time the UK economy was doing quite well,” explains Mr Dayan. “There’s been something of a recovery in parts of Southern Europe, so that gap’s not necessarily as marked.”

“It’s probably the case,” reflects Ms Charlesworth, “that Brexit has happened at the worst possible time.”

Request the full paper at

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