The association between the referendum for withdrawal from the EU and the health-care workforce in England: an interrupted time series

Abstract

BackgroundAfter the referendum for withdrawal of the UK from the EU, uncertainty about the rights of EU citizens is driving doctors from Europe to seek jobs outside the UK. This study aimed to evaluate the effect of the referendum on changes in total numbers of health-care staff. MethodsFrom National Health Service (NHS) Digital, we obtained a dataset of national NHS hospital and community health service (HCHS) staff groups in trusts and Clinical Commissioning Groups in England (excluding primary care staff). This dataset includes information about the monthly numbers of full-time equivalents. The study covered 108 months (September, 2009, to August, 2018). We used an interrupted time series analysis (ITS) to evaluate the association between the referendum and the total number of health-care staff and subgroups. FindingsDuring the study period, the average monthly number of NHS staff varied between 963 000 and 1 067 000. More than half of the NHS workforce were professionally qualified clinical staff (varying between 527 000 and 575 000), of which around 26% were nurses and health visitors. There was no evidence that the referendum was associated with changes in the total number of NHS staff (with relative change of 3·9%, 95% CI 0·0 to 7·9). However, looking at each subgroup separately, a significant decrease in relative change was estimated for midwives by –4·0% (95% CI –5·5 to –2·4), representing 22 412 fewer midwives during the 26 post-referendum months on the basis of trends in the pre-referendum period. A significant increase in relative change was estimated for HCHS doctors (2·8%, 95% CI 1·8 to 3·8%) and NHS infrastructure support workers (14·7%, 3·7 to 25·6). InterpretationOur findings show that overall there was no significant association between the referendum and the health-care workforce. Increases were found for several groups, although many of them had an increasing trend before the referendum. However, a significant decrease was observed for midwives, which might be caused by the uncertainty of the rights of EU citizens. Continued surveillance is necessary to monitor changes in NHS staff, specifically for midwives, and further research is needed to evaluate any adverse clinical outcomes. The main strength of the study is the use of ITS, which is the most robust quasi-experimental research design, and the main limitation is unavailable data on the nationality of NHS staff. FundingNone