The sharp fall in EU nurses joining the NHS after the Brexit referendum may have contributed to more than 1,200 additional patient deaths each year in England, according to new research led by the University of Surrey in partnership with the University of Aberdeen, Harvard Business School and Vienna University of Economics and Business (WU).
The research suggests the biggest impact was felt by hospitals that had relied most heavily on recruiting nurses from the EU before the 2016 vote. While these hospitals largely replaced departing EU staff with nurses from outside Europe, patient care still worsened, with higher rates of emergency deaths and unplanned readmissions.
The study, published in The Economic Journal, the official journal of the Royal Economic Society, estimates that, across the first three years after the referendum, hospitals with greater dependence on EU nurses experienced 3,714 additional emergency patient deaths and almost 14,000 extra emergency readmissions to hospital after initial discharge. The researchers found no evidence that these patient health outcomes were caused by reduced hospital funding, fewer beds or an increase in patient numbers.
Researchers say the findings challenge the idea that simply filling vacancies is enough to protect healthcare quality. Instead, they argue that sudden restrictions on international recruitment can force employers to lower hiring standards when skilled workers become harder to attract.
To investigate the impact, researchers analysed more than 32 million emergency hospital admissions across 130 NHS hospitals between 2012 and 2019. They linked patient records with NHS workforce data to compare hospitals according to how reliant they had been on EU nurses before the referendum. They found that hospitals with the highest proportions of EU nurses before Brexit experienced the greatest decline in patient outcomes afterwards.
Giuseppe Moscelli, Professor of Economics at the University of Surrey and principal investigator of the study, said:
“Hospitals were able to recruit replacement nurses, but our findings suggest they had to recruit from a smaller and less experienced pool of applicants. That appears to have had real consequences for patients.”
The researchers found hospitals responded to the drop in EU applicants by recruiting more nurses from outside Europe. However, newly recruited nurses after the referendum were more likely to be appointed to lower NHS salary bands, suggesting they had less experience or fewer qualifications than those they replaced. The research also found nurses working in the most affected hospitals reported being less satisfied with the quality of care they were able to provide.
Professor Moscelli continued:
“Many countries, including the UK, depend on internationally trained healthcare professionals. Our findings show that immigration policy can have unintended consequences far beyond the labour market. Decisions that make a country less attractive to skilled workers can ultimately affect the quality of care received by patients.
“Policymakers should recognise that healthcare systems competing for skilled international workers need to consider not only the number of staff they recruit, but also how immigration policies influence who chooses to apply.”