Unions are preparing for Brexit - and working with industry will be key
Jon Skewes, Vice Chair Unions 21, Director of Policy, Employment Relations and Communications for RCM / 22 November 2017
The Government concedes that Brexit “is an all-of- government operation,” with
thousands of extra officials being hired to cope with the colossal workload. The
Secretary of State in charge of it has even said that the task ahead of him makes the
Moon landing look simple in comparison.
One of the challenges that Brexit throws up for decision makers in the NHS is
workforce. There are over 20,000 NHS nurses in England who are from elsewhere in
the EU, 1,200 surgeons, 800 paediatricians, 300 cardiologists, 200 cancer specialist
doctors, 200 paramedics, and many others.
In maternity services, around 1,400 NHS midwives in England are nationals of other
EU Member States. That many midwives, employed full-time, could provide care for
40,000 women per year. They make a massive contribution to the maternity care
provided by the NHS each year.
But EU nationals trained and ready to work as midwives in the NHS have already,
pretty much, stopped coming. The regulator, the Nursing and Midwifery Council, has
published numbers of how many people from elsewhere in the EU are registering to
practise as midwives in the UK. In June last year, 36 EU midwives registered; in
June this year, it was two. A 94 per cent drop in 12 months. In March and April, just
one single midwife per month from another EU Member State registered with the
Our EU midwives and other staff need clarity and certainty, and they need it as soon
as possible. First and foremost, it is the right thing to do – but it may also help us
stem the growing outflow of workers; after all, the number of EU nationals leaving the
UK is up more than a third on last year.
A big part of why we are where we are is that there was no plan or preparation for
what Brexit might look like. The Government did none of the spadework needed
before 23 June last year, meaning that, when it was set up, the Department for
Exiting the European Union was little more than a broom cupboard and a pot plant.
This has left us all with a mountain of questions to answer. If the Government
changes the rules on which midwives can come here, how much will that affect
supply and to what extent and how should we expand our domestic capacity to
compensate? Would we have enough midwifery lecturers? If not, are enough being
trained now? Are there enough available clinical placements? And how is all of that
impacted by the pre-referendum decision to introduce tuition fees for healthcare
students and abolish their bursaries? Does that need to change? If it does, how will
that be paid for? Issues like these are just some of those that unions, employers and
others are grappling with. Answers need to be worked out, and details hammered
So, what is the value of unions in this whole process? What is it that we bring to the
debate over what to do next?
I think it’s important for us to speak up, of course, on behalf of our members, and
many of these EU nationals will be our members. It is important for unions to play
But it would not be right or constructive for us just to complain from the sidelines.
There are a huge number of questions and issues to be grappled with, and we need
to get stuck into that – working with other unions as well as employers and others in
Take the Cavendish Coalition, of which the RCM is a member. This is a group of
health and social care organisations that seeks to influence and lobby on the issues
we face as a result of the vote to leave the EU. The group seeks to provide those
leading the negotiations with expertise and knowledge on the issues affecting the
health and social care workforce. Most recently it has submitted evidence to the
Migration Advisory Committee as it attempts to map out the contribution of EU
nationals to the entire UK workforce.
As a group of organisations we are committed to working together to ensure a
continued domestic and international pipeline of high calibre professionals and
trainees in health and social care in a post-Brexit Britain.
One question the group has looked at, for example, is when the cut-off date should
be for free movement as it affects health and social care staff? We’d argue it needs
to be as late as possible.
Another question has been what should the transitional arrangements be between
free movement and whatever the new system for health and social care workers
turns out to be? We’d want these to be simple.
And what should happen to EU – and indeed EEA – nationals already here who wish
to stay long-term. We would say that they need to be given permanent leave to
remain, and that the process for applying for that should be quick, simple and
We sometimes hear encouraging noises from the Government on issues like this,
but with many pulling ministers towards an ever tougher line on immigration, we
need voices, like those from this coalition, making the pragmatic arguments needed
to avoid a catastrophic drop off the infamous cliff edge.
In everything we do, we need to recognise the contribution that EU nationals make
and that they are good news for Britain. They are helping us by being here and
working in our health and social care services. Whatever systems we have will need
to acknowledge that and treat them appropriately.
The coalition is perhaps a useful blueprint that other sectors may wish to look at.
Brexit is a massive undertaking, and it is consuming a sizeable chunk of the
Government’s capacity to develop policy. So, if unions, employers and others can
come together to offer advice to the Government on what would work best for their
areas, that strikes me as a good idea.
In addition to the need to find answers to questions the Government wasn’t even
aware of in the immediate aftermath of Brexit, there are also many areas we need to
protect and defend too.
This is the challenge of defending many of the rights enjoyed by working people in
this country, currently underpinned by our membership of the EU: the right to paid
holidays, time off for family emergencies, equal pay for women, and the right to paid
time off for antenatal appointments – for example. If passed into law, the proposal to
give the Government so-called Henry VIII powers would enable ministers to sweep
these rights away without anyone being much able to stop them.
The Government is clearly somewhat overwhelmed by the whole process. As scary
as that may be for us as citizens, this is also a tremendous opportunity for unions
and others to step in and influence the decisions that will be made about life in a
Time has passed since Article 50 was triggered, but to be honest not much progress
has been achieved – not much has probably been thought about, which means there
is still plenty of opportunity for unions and others to shape what comes next. Based
on the experience of the RCM through things like the Cavendish Coalition, I’d
encourage you to get out there and do just that.