The impacts of Brexit on healthcare staffing and services

In Irish healthcare, Brexit is likely to have most impact on workforce supply and cross border healthcare, Mr. Leo Kearns, CEO of the Royal College of Physicians of Ireland told the Conference.

Leo Kearns
Leo Kearns

“In my lifetime Brexit is probably one of the most significant political events to have happened, and is notable for the degree of uncertainty and volatility it has created.

“Brexit does mark a change in the relationship not only between the UK and the EU but between Ireland and the UK.  This is not a single moment of crisis that will pass, but a long-lasting change and we do not know yet what will be the nature or consequences of that change.

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Speaking on the “Impact of Brexit,” her said “much of the Brexit debate will be focused on the political and economic aspects. As it progresses, the question is how does healthcare get a voice with influence and power to ensure the impact on healthcare is understood and dealt with.

“The Academy of Medical Royal Colleges in the UK has already outlined concerns relating to workforce supply, medical regulation and recognition of qualifications, medical science and research, regulatory alignment for health technology, pan-European public health issues, reciprocal health arrangements, funding and sustainability of the NHS, public procurement requirements, the Working Time Directive and infrastructure investment.
“According to data published by the NHS, ten per cent of NHS doctors come from elsewhere in the EU (almost seven per cent of the UK medical workforce); 20 per cent of surgeons in England have trained in other EU countries; five per cent of NHS nurses are from elsewhere in the EU and over 1,000 midwives in England (16 per cent of NHS midwives) are from elsewhere in the EU.”
It is clear that workforce supply across all the healthcare professions is of primary concern within the UK health system.

There is no way to be certain at this point how potential regulatory divergence will impact on Ireland’s ability to recruit and retain healthcare professionals.

“The UK is our nearest neighbor with a shared border and common travel area.  We have a shared island, population and history, and we are the only other English speaking country in Europe.   Healthcare, while very local, has key global aspects – particularly for the small island of Ireland. Irish doctors in particular have always travelled abroad as part of their development and then benefit Irish healthcare with that experience. The UK has been a prime location for Irish doctors, and indeed nurses to travel to.

There had been a long medical history between the UK and Ireland. For example, 1654 marked the Foundation of RCPI, as the Fraternity of Physicians of Trinity Hall.   In 1692, a Royal Charter was granted to re-establish the College on the model of the Royal College of Physicians, London.  In 1838, the Irish Poor Law Act, modeled on the English Act of four years earlier was introduced.  This was replaced by County Boards of Health in the 1920s.   In 1877, the Dublin Branch of the British Medical Association, which would eventually become the IMO, was founded.  In 1858, the Medical Act introduced medical registration to British Isles for the first time, and it was the foundation of all subsequent Medical Acts including the Medical Practitioners Act 2007.  Ireland had representation on the GMC.  Throughout the 19th and early 20th century the opinion of RCPI was sought on healthcare and related legislation by Westminster.

Mr. Kearns said throughout this history, there had been a general alignment between Ireland and the UK on medical practice, education and training, professional examinations, specialist societies, continuous professional development, research, standards and regulation.  In more recent times there had been some regulatory divergence at national level, but such divergence had been constrained within EU frameworks which allowed for recognition of specialties, recognition of degrees, recognition of professional qualifications and eligibility for registration.

“For example the Medical Practitioners Act is specific to Ireland but under EU rules and frameworks, specialist qualifications from Ireland must be recognised in other EU countries.

We should recognise that we are in a competitive global market for healthcare workers, that may become more competitive post-Brexit, and move decisively to improve the experience of people working in the Irish health service.

“Post-Brexit, future regulatory divergence in the UK will not be required to align with EU rules and frameworks. This could lead to significant variation and I think this will have an impact more on Ireland than other EU countries, given our proximity, history and current high degree of alignment.  When the UK moves out of the EU, it will be acting in its own national self interest in making decisions on professional reciprocity and over time the framework and agreements that have held us together may become more difficult to maintain. Central to that self-interest will be the need to ensure that it can staff its healthcare system with doctors, nurses and health and social care professionals.

“We are already significantly challenged staffing our hospitals and community services and we have to focus on what we can do to ensure Ireland is a really fulfilling place for all staff to work in.  There is no way to be certain at this point how potential regulatory divergence will impact on Ireland’s ability to recruit and retain healthcare professionals.

“The global shortage of healthcare professionals is going to get more challenging. Instead of waiting to see what the impact of Brexit will be, we should recognise that we are in a competitive global market for healthcare workers, that may become more competitive post-Brexit, and move decisively to improve the experience of people working in the Irish health service. Our emphasis should be on making Ireland a place where people will get excellent training and which is a professionally rewarding place to work. This is our best protection.

Mr. Kearns then raised the question as to whether Brexit would have implications for development of cross-border care. The past number of years had seen some very positive developments of cross-border services such as the Congenital Heart Disease Network, an important all-island model of clinical care with collaboration between Our Lady’s Children’s Hospital Crumlin, The Mater Hospital Dublin and The Royal Hospital Belfast. This and other initiatives in areas such as Paediatric Cardiology and Cancer Care in the North West, demonstrated the value of taking an all-island approach to specialist services. Would these and possible other future services be at risk of not achieving their full potential because of complications in areas such as professional registration, medical training, staff and patient movement and data and service standards, post-Brexit?

Mr. Kearns concluded by saying that “On the day Brexit happens nothing will have changed. But from then on, over time, there is the real prospect that standards and regulations between the EU and the UK will diverge, and we have no way of knowing in detail what the consequences will be. However, it is likely that a high priority for the UK will be to address a workforce deficit, and we must do everything possible to ensure that Ireland’s health system is attractive to our healthcare professionals. We need to pursue and protect the concept of looking at an island of Ireland approach to specialist and community care, continue to invest in training, research and education,  focus on maintaining recognition across jurisdictions, and adopt long term, multi-government and multiyear strategic planning and delivery for the health service as promoted in Slaintecare.”