Delving into the detail of Brexit in a devolved nation | Vanessa Young

Vanessa Young

The head of the Welsh NHS Confederation throws the spotlight on the implications of Brexit in Wales and why alarm bells have been sounded over its ability to maintain responsibility for health and care in a post-Brexit UK. 

Many aspects of health and social care services in Wales have been influenced by European Union policies and legislation. Depending on the settlement, the exit from the EU could have profound implications for the UK economy, the healthcare workforce, and the delivery of healthcare services. 

Although the future landscape is uncertain, in Wales we are considering the effect leaving the EU could have on our healthcare system and the health and wellbeing of our communities. 

Among the top issues of concern for the Welsh NHS Confederation are the implications for the workforce, research funding and accessibility, and the ability of Wales to maintain responsibility for its own health and care systems in a post-Brexit UK.

Workforce challenges
The NHS is the biggest single employer in Wales, currently employing around 89,000 staff. But we face a huge challenge around recruitment and retention across a range of specialities. EU nationals make up less than 2 per cent of directly employed staff, but around 7 per cent of medical and dental employees and up to 50 per cent in some specialities. 

Any immigration controls that result in a reduction in EU nationals working in the NHS in Wales will compound workforce challenges, especially as our reliance on EU workers is higher in health boards that face the greatest recruitment challenges.

The priority therefore is to maintain a continuing ‘pipeline’ of staff for the sector. This involves ensuring there is a robust domestic workforce strategy, alongside an approach to international recruitment.

There is concern that applications to work in the UK are being impacted by the debate on post-Brexit citizens’ rights, specifically in relation to immigration controls and regulation. Recent statistics issued by the Nursing and Midwifery Council show a 67 per cent increase in the number of EU nurses and midwives leaving the nursing register across the UK, alongside a sharp decline in those joining.

The Welsh NHS Confederation welcomes the in-principle agreement on citizens’ rights and, like our Cavendish Coalition partners, would like to see this agreement ring-fenced in the context of ongoing Brexit negotiations, so we can safeguard the existing workforce. 

At the same time, it will be important to tailor workforce planning to address any gaps that may result from any future immigration policy.

Research funding and accessibility
Clinical research and innovation are key components of NHS activity across the UK and in Wales, with a long tradition of EU collaborative research. Through Horizon 2020, Welsh organisations have secured just over €76 million in funding since its inception. This has involved 162 participations, over 1,600 international collaborations and helped Welsh organisations take part in ground-breaking research projects.

EU research grants have also been crucial for the Welsh NHS’s ability to attract and retain some of the most renowned clinicians in the world, bringing benefits to our communities and supporting our response to the health challenges we face as a country.

The free movement of researchers, innovators and specialist technicians, along with the ability to collaborate with the best in the world, is central to ensuring Wales remains highly regarded and active in research and innovation. 

As a member of the Brexit Health Alliance, the Welsh NHS Confederation seeks to ensure that systems are in place when the UK leaves the EU to maintain our excellent standard of healthcare research and access to technologies and treatments for the people of Wales.

Policy and regulations as a devolved nation
Wales is a devolved nation within the UK and as such the Welsh government has legislative, policy and delivery responsibility for health and care services in Wales. With Brexit negotiations ongoing, there is considerable discussion within the Welsh government about ensuring any agreement addresses the legal requirements of devolution. 

The current EU (Withdrawal) Bill would see all EU laws which affect the UK brought on to the British statute book on the day of Brexit. The Welsh government is concerned that the bill prevents the devolved institutions from making any changes to the EU rules and regulations which are being written into UK law. 

There is real concern that this would constrain the legitimate powers of the devolved nations and enable UK ministers to amend devolved legislation, bypassing the government in Wales. 

The First Ministers of Wales and Scotland have written jointly to the UK Prime Minister to fight off what they perceive to be a power grab by Westminster for powers that will return to the UK following Brexit. 

They have argued that they will not recommend the bill as currently drafted to their legislatures for their consent and have put forward a number of amendments. It is hoped that these amendments will be accepted so that Brexit negotiations can progress in a way which respects the hard-won devolution settlements of the UK.

In the meantime, the Welsh NHS Confederation continues to work with its members to understand the different Brexit scenarios and their implications for the NHS in Wales. We are working with the Welsh government and stakeholders to keep abreast of developments and to begin to develop contingency plans to manage the practical consequences of whatever form Brexit takes. 

As a member of the Cavendish Coalition and the Brexit Health Alliance, we are ensuring that the impact for Wales is made clear at a UK level by highlighting the likely effects on Welsh policy and legislation.

Vanessa Young is director of the Welsh NHS Confederation. Follow the organisation on Twitter @WelshConfed

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