From Promises to Collapse: The Measurable Damage Brexit Caused the NHS

Staffing Gaps, Medicine Shortages, and Avoidable Harm- the Everyday Reality of a Broken Promise.

Whenever there’s a conversation about Brexit - be it online, in a pub, between some friends or (very rarely) in the mainstream media - I feel like things become strangely nebulous. Esoteric, almost.

People make grand pronouncements about GDP percentages, trade coefficients, migration impact and, from time to time, a bit of a chat about whether the herring off our coast are now, in fact, happier.

And it frustrates the living hell out of me.

For the past several years, I’ve worked for the NHS. I’ve been part of daily meetings (08:30 every damned morning) where we talk about staffing gaps, patients waiting - we go beyond statistics and discuss what we can and can’t do anymore. I listen to my team talk about whether we’ll be able to send someone on a visit on Tuesday, or whether it is, in fact safe, for an urgent patient to wait until Thursday (if at all). I’ve listened in on calls where we discuss the fact that we just about have safe staffing levels for the day in A&E - not because of poor management, despite what the Daily Mail might want you to believe - but the workforce we once relied on has… left.

These things happen while the political class continues the exact same conversations - sovereignty, tariffs, migration, “taking back control” - and they’re resulting in patients falling through the cracks, and sometimes die, because of measurable, Brexit-driven consequences.

And I’m sick to the damned back teeth of it.

Our workforce, as a direct result of Brexit, has been all but decimated - and it’s been happening for years. Right at the time that the Brexit vote first went through, new registrations of EU nurses in the UK collapsed. Spectacularly. Between 2016 and 2018, EU nurse registrations collapsed by 87%, going from 6,400 a year to just 800 - which isn’t all that surprising when you consider just how poorly European migrants were painted by the Leave campaign.

Source: The Migration Observatory

By 2021 we reached the point where not only had new registrations of EU nurses had collapsed, but we were also looking at a mass exodus of this group, with a net decrease from 38,992 EU nurses to 30,311.

Now, I will acknowledge now that the government has increased these nurses with Non-EU recruitment, with international recruitment up by 46% since 2016 - much to the eternal consternation of those who pushed for Brexit to begin with, but this comes with its own issues, because unfortunately, it isn’t just about numbers, but skill mix as well.

It’s easy to fill a rota with warm bodies, but when you’ve swapped ten experienced EU nurses for ten newly qualified staff still in the earlier stage of their careers, your care quality will take a hit. And unfortunately, it has done so. Hard.

A study published earlier this year found that there were an approximate additional 1,485 deaths per year associated with Brexit workforce shocks since 2016. To put that into a bit of horrifying perspective, that averages out to around 34 extra deaths per affected hospital per year. That is an intolerable number. Imagine being told that your local district general hospital now has the equivalent of a coach crash’s worth of extra deaths every year?

Not because of new diseases. Not because of funding cuts. But because the nurses who used to keep people alive went home to Spain, Poland or Portugal because people wanted more “sovereignty.”

And when it comes to the subject of social care, the picture becomes even more grim. Once upon a time, EU workers made up around between 5 and 7% of the social care workforce, but by 2022 that had dropped to less than 1%. To add to this change, the introduction of new visa restrictions in 2024 meant that overall health and care worker applications fell by 83% almost overnight, all because people who “did not get the Brexit they voted for” were terribly worked up by the fact that non-EU migration had skyrocketed (predictably) after we cut off a major source of the labour workforce.

The result of all of this? A sector with a vacancy rate of 8.3% when compared with the 6.9% vacancy rate in the NHS and 2.8% in the wider economy.

What’s been created here isn’t a staffing gap so much a staffing chasm.

Predictably, when social care collapses, it bodily drags the NHS right down with it. When patients can’t be discharged safely, hospital beds become blocked. This in turn means patients can’t be admitted, meaning that A&E becomes a holding pen for people who should not be there, and this creates a whole new level of risk, with boarded patients facing much worse outcomes than ones admitted promptly onto wards.

Image Source: Royal College of Nursing

There’s also the matter of families having to pick up far more of the care than ever before to look after relatives, with support for this safety net being beyond non-existent.

And yes, I’ve written recently about the fact that we have a rapidly ageing population, and that is in and of itself a major crisis waiting in the wings, but what Brexit’s wholesale erosion of our health and care workforce has done is kick away one of the few props that kept the system vaguely, sort of, kind of upright.

Beyond just the staffing impact, medicines are another slow-burning disaster of a minefield. Since 2010, the United Kingdom has had the lowest import growth of medicines of any G7 country, while post-Brexit, “supply notifications”, a terribly mundane and very polite term for “we cannot get this drug for love nor money” has risen dramatically, while pharmacists now regularly claim price concessions¹ ten times higher than before we made the decision to leave the European Union.

In actual human impact terms, what this translates to is that if you’re on a long term medication for diabetes, hypertension or depression, there’s a more than decent chance that you’ve been told at least once or twice in the last couple of years that “sorry, we can’t get your usual medications, we’ll try and give you something else instead.” Fine for some people, yes - it may just be an inconvenience, but for other groups, especially with multiple co-morbidities reliant on complex regimes, it’s destabilising, frightening and occasionally dangerous.

One of the most ethically troubling parts of this all is also exactly where we’re getting our healthcare staff from.

Anyone who has read anything I’ve written before knows that my view on migration is that it’s a necessity for where we find ourselves at the moment, but even with that said, I’m deeply troubled the fact that we are recruiting healthcare staff from places that simply cannot afford to lose them.

As of late 2024, nearly 9% of all NHS doctors had been recruited from WHO “Red List” countries - countries that the WHO specifically says we should not be recruiting from because their own health systems are in deep crisis. This is not a sustainable, moral or ethical recruitment method. We’ve effectively swapped the Polish Nurse working in a Kent A&E for a Ghanaian nurse whose absence now leaves a clinic in Accra dangerously understaffed. It’s a game of robbing Peter to pay Paul on a global scale, except Peter is in a country with a functioning healthcare system while Paul is in one without anything.

We also have take into consideration the geography of this impact - because when you look too deeply into aggregates, you can miss the specific impacts that can be far worse.

If you live in London, chances are you may not have noticed the same degree of collapse we’ve seen in the health service because international recruitment, as a rule, flows into big teaching hospitals. London trusts can offer far higher pay, better career progression and a global city lifestyle.

What we see happening then is a two-tier system being slowly created. London, Manchester and Birmingham are muddling through, sustained by international recruitment and higher overall funding, while coastal and rural areas sink ever further, inexorably into crisis, offering patchier services with fewer beds, fewer GPs and fewer secondary care specialists. It’s postcode lottery 2.0 now with added flavours of Brexit!

And the problem is that once a service degrades in an area, it takes a monumental effort to get it back on its feet - if it ever does. Lower service provision becomes the norm. Local A&Es are closed or downgraded. Residential homes start offering “basic” care instead of much needed dementia services. The inequality that was already baked into the system has now been turbo-charged by Brexit.

These things keep me awake at night. Working for the NHS, the pressure does not ease. Ever. If anything, it’s just intensified. When I started out managing NHS services there was at least the whiff of a hope that “winter pressures” would give way in the warmer months, giving us all an opportunity to regroup. Now? Winter is all year round. Acute trusts are almost constantly in OPEL² 3 or 4 - the highest levels of operational pressure - which basically means that terms like “serious concern” are no longer exceptional events, they’re just the baseline we function at. That has a massive psychological effect, because staff don’t even feel like they’re firefighting anymore - they’re just living in the fire now.

The financial backdrop? Grim doesn’t even begin to describe it. Every year, we deliver more with less. Every year CIP³ targets get more steep. Savings become less plausible. It’s reached the point where I get home, three days out of five, and ask myself:

“Am I actually improving services? Or am I just managing decline and risk mitigating for the very worst? Am I doing anything more than shuffling resources around while patients - real people, hundreds of thousands of them across my patch and staff, dedicated, loyal desperately tired staff - bear the brunt of it all?

These are questions that gnaw at me. It means sleepless nights, staring up at the ceiling wondering if “holding the line” is just really another way of describing an excruciating, slow motion collapse. It means conversations with colleagues where gallows humour is literally the only way to cope. (“Well, at least once the system completely collapses in on itself, we’ll finally get some sleep,” someone on a call said to me recently, and we laughed and immediately went quiet because it wasn’t really all that funny at all).

This is the reality of Brexit for the health service. It took a system that had already stretched to near breaking point after years of austerity and stripped out one of the few stabilisers that it had left. The resilience is all but gone. The buffers have disappeared. Every new shock - a bad flu season, COVID, industrial action or even just a bad week of A&E attendances - now lands harder and harsher because there is just no give left whatsoever in the system. It leaves people like me feeling like we’re running on fumes pretty much constantly, desperately trying to keep an ever increasingly rickety show on the road with some medical tape, spreadsheets and rapidly diminishing hope.

This is diametrically opposed to what we were promised by the Leave Campaign. They promised that Brexit would be the biggest fix ever seen, £350m a week extra, no more waiting, your nan would sit smiling in the A&E waiting room and we would have more beds than we’d be able to figure out what to do with. Absolutely none of this happened. Not a single damned thing.

And yet, I know that when I next hear a conversation about Brexit, it’ll be about GPD percentages and fish. Honestly, I’m at the point if I hear one more person explain at me that the real win was “sovereignty over our waters”, I will assume the foetal position and just start screaming. Sovereignty over our waters does not matter if patients are being boarded in hospital corridors because there are no nurses to care for them. Happy herring do not comfort the families of 1,485 people a year who might still have been alive had EU staff not left their wards.

Brexit was not an abstract shift. It was not esoteric. It was not a vague change. It has translated into measurable harm, counted in vacancies, waiting times, drug shortages, and most painfully, avoidable deaths. The cost is not only trade coefficients, but human beings who have suffered and sometimes died earlier than they should have, and until we have our politicians and leaders speak honestly about this, all the talk about it, “getting Brexit done” will remain the most expensive and damaging political catchphrase in living memory.

1. The Top-Up that the NHS pays when pharmacies can’t source at the tariff price.

2. OPEL: Operational Pressure Escalation Levels

3. Cost Improvement Plans - three words that give NHS managers across this country nightmares.