The Royal College of Midwives believes the threat of leaving the EU is already damaging maternity services
With Brexit talks now under way, the breezy promises made by the Leave campaign last year are beginning to be tested by cold, hard reality.
One of those tests is the impact of Hard Brexit on the NHS. And if what is happening in midwifery is anything to go by, things are not looking good.
Our maternity services are desperately short-staffed. The latest estimate from the Royal College of Midwives is that in England alone, where the shortage is most acute, the NHS needs around 3,500 more midwives.
That is a big shortage and our midwives and maternity support workers are under intense and sustained pressure as a result.
Just imagine then what would happen if the midwives working in the NHS in England who are nationals of other EU member states – who numbered 1,385 at the most recent count in February – were not permitted to stay. With those midwives gone, the NHS would be short of almost 5,000.
Services in some areas would be devastated.
When the RCM looked in depth at where midwives from elsewhere in the EU work, we found that in April last year 18 hospital trusts in England had workforces where more than one in 10 midwives were from Europe. In one central London trust, the figure was one in three.
I would be worried about the safety of maternity services if the Government does not offer EU midwives the unconditional right to remain should Brexit go ahead.
Ministers in the Department of Health have said that EU nationals who work in the NHS ‘make a valuable contribution’ and that ‘securing their futures will be a priority in the Brexit negotiations.’ But what we need to happen is so much more than that. It is not enough simply to stamp the passports of those already here with a permit to remain and assume that will solve the problem.
The RCM has looked at the numbers of midwives who come here from elsewhere in the EU each year and how many leave. We found that in the year to September 2015, 250 midwives joined the NHS from elsewhere in the EU and 200 left. The number that we have right now is not a static group; some are arriving and some are leaving all the time. So, if we simply give existing EU midwives the right to stay, that would not stop numbers dwindling as many left to return home.
And this is not guesswork or speculation. It has already started. Between June and August last year – the month of the referendum and the two following months – 102 people from elsewhere in the EU registered to work as midwives in the United Kingdom. You have to register with the Nursing and Midwifery Council if you want to practise as a midwife in the UK, so this is a number we can monitor very easily. In the most recent three months, March to May this year, that same figure was just five. That is a fall of more than 95%, and amounts to less than one midwife every fortnight arriving – ready and registered to practise – from one of the 27 other EU member states.
EU midwives have basically stopped coming to work in the UK. The threat of Brexit is already damaging our maternity services by repelling people who were previously happy to come and make their life here.
During the referendum campaign, voters were told that, post-Brexit, the British people would be empowered to pick and choose who could enter the country. But it will not be like that. As the collapse in the number of EU midwives coming to the UK shows, the actual truth is that it is the best and the brightest who get to pick and choose the country they want to live in, not the other way around. We were always lucky that so many talented EU nationals chose to build lives here in the UK. We are now throwing that away.
And the context here is that the number of midwives retiring is climbing fast, because midwifery is an ageing profession. In the four years to September 2016, the number of midwives retiring from the NHS in England each year rose by over a quarter to 600. They need to be replaced, but we are shutting ourselves off from the inflow of midwives from the EU.
Train more of our own, many say. We agree that we should train more midwives. But from this autumn, the Government in England will cancel all bursaries for student midwives, nurses and other healthcare students, replacing bursaries with loans. And for the first time, those training for professions such midwifery will face full tuition fees. Just at the time we need more home-grown midwives, it just got a lot more expensive to choose to become one.
An extra £350 million per week extra for the NHS would cover all that and eliminate the midwife shortage too, but I am not holding my breath on that commitment repeated by the Leave campaign at every available opportunity and plastered on the side of their bus.
The Royal College of Midwives spoke out during the referendum in favour of the UK remaining a member of the EU. Events since then have not persuaded me that we were wrong to do so. From where we are now, I hope we do not either crash out of the EU with no deal, or sign up to a Brexit so hard that it inflicts unnecessary damage on the UK.
With events moving so fast, maybe we will not leave after all. Who knows? But what I can say is that I hope that in the coming years it remains as simple as possible for people who want to work hard and make a contribution to continue to move freely between the UK and the EU, be they midwives or whatever. Free movement has, frankly, served us well. Let it continue.
• Professor Cathy Warwick is the chief executive of the Royal College of Midwives