Taking healthcare workers from abroad is not the solution: I’m Alright Jack! Freedom of movement the Brain Drain.

Freedom of movement is one of the cornerstones of the European Union. When it comes to providing health care in the bloc’s poorest countries, it’s also a problem.

We are constantly told that due to Brexit there is a staff shortage in NHS. The truth is there were always staff shortages and stealing other countries’ trained healthcare workers is not going to solve the crisis.

The European Commission published an annual report on skill shortages and surpluses in Europe. Its latest report confirms what our action showed on 29 October. Almost all EU countries (22) report a shortage of health care professionals such as doctors, nurses and health care assistants.

Richer EU countries due to FOM have allowed doctors and nurses to chase money high wages and better working conditions which ultimately leaves their native countries short-staffed.

The truth is more doctors and nurses move from one country to another than any other highly regulated profession in the EU, and the flows often go from East to West, from poorer EU countries to richer ones. Analysis of European Commission data found the exodus of healthcare professionals is especially pronounced from Eastern and Southern Europe. In effect, these countries are training doctors for their richer neighbours.

Romania lost half its doctors between 2009 and 2015. A few years after Poland joined the EU, more than 60 percent of fifth- and sixth-year medical students planned to pursue work abroad. Slovakia had about 15,000 practicing physicians when it joined the EU in 2004; 3,800 have applied to leave since then.

Hardest hit by the exodus of doctors and nurses: the EU’s newest members, plus crisis-hit Portugal and Greece, according to POLITICO’s analysis of Commission data.

Across Poland, in 2021 it was reported patients in need of hospital treatment are facing a growing crisis: Wards are closing due to a lack of staff.

The country is already short of 20,000 to 50,000 doctors.

The EU Single Market. Results: According to the data from national registers, between 7–9% of practising doctors and nurses have applied for certificates, which confirm their right to practice their profession in other European countries (most often the United Kingdom, Germany, Sweden, Spain, and Ireland).

Younger doctors out of training are applying to work in Western countries more and more leaving the Poland that trained them short-staffed. This is a pattern throughout Eastern EU countries.

Brexit staff shortages have becomes a convenient excuse for the government and politicians and a rallying call for remainers and rejoiners.

Instead of tackling the issues the liberal elite just wants to maintain the status quo with no answers or solutions. The right wants to exasperate the situation and push towards private healthcare for those that want to jump the waiting list. While the liberals want to exploit the shortages as an ‘in’ towards rejoining the EU in one form or another.

Let’s be really clear this is not internationalism, this is globalisation and the commodification of people.

It’s all very convenient and lets government off the hook. Instead of carrying out a real national vocational training plan to recruit and find an army of healthcare workers for social care and the NHS, it’s cheaper to take from poorer countries with lower wages that have put investment into their people.

While the real working class are finding their worth and leveraging for wage rises and better working conditions knowing the reserve army of labour the system has relied on called freedom of movement is over.

The only way to resolve this is to incentify a generation of healthcare workers, we should include bursaries,  contracts and vocational colleges with on-the-job training. 

The truth about the NHS runs deep and is not new, we have always had staff shortages. The only way to resolve this is to train the healthcare army we need.

The NHS was haemorrhaging staff long before Brexit but like most things today Brexit is the convenient excuse.

Way back in 2010, the BMA warned

Hospital staff shortages costing lives says BMA 

23 FEBRUARY, 2010

The British Medical Association, which carried out the survey of more than 1,500 junior doctors, said hospitals are still struggling to cope six months after the European working time directive came into force.

The directive cut the number of hours doctors can work to 48 per week.

Dr Shree Datta, chair of the BMA’s junior doctor committee, said: “In August last year the Department of Heath declared that rota gap vacancies accounted for only 2 per cent of posts, yet six months on our survey paints a very different picture.

“It is clear that it is an everyday experience for junior doctors to be working on inadequately staffed rotas.

“Given that inadequate staffing levels have been identified as a major factor in the delivery of substandard care, it is essential for patient safety that this problem is taken seriously.”

Of the vacancies, four out of 10 were for specialist trainees with at least five years’ experience.

Overall, six out of 10 doctors working in accident and emergency said there were vacancies on their rotas.

Dr Datta said: “It is hugely alarming to find so many doctors are working in teams short of experienced doctors.

“In settings like A&E, which is experiencing the highest levels of understaffing, it is especially critical that experienced specialists are on hand to make the decisions that can mean the difference between life and death.”

A spokesman for the Department of Health said the majority of the NHS is compliant with the average 48-hour working time regulations.

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This has been an ongoing theme for the best part of the last 20 years of Doctors, Nurses, and dentists’ constant shortages.

Extract from the BMJ 1 May 2002

Mind the gap: the extent of the NHS nursing shortage

The NHS is struggling to recruit and retain nursing and midwifery staff in a time of high turnover rates and low morale. The problems are most acute in inner cities and teaching trusts. The government is tackling the crisis, but the reasons behind the staffing shortages are complex

The government has a mission to “modernise” Britain’s NHS. Success will depend on NHS staff—in particular, whether their numbers can be boosted, whether staff can change how they work, and whether they can be motivated to “go the extra mile” for the NHS. Yet the service is struggling to attract and retain staff in crucial areas, particularly in nursing and midwifery. Here we assess the extent of recruitment and retention problems in nursing in England, comparing acute NHS trusts in London with those in other cities. In another article in this same issue we examine the government’s initiatives for tackling these problems.

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NHS suffers ‘brain drain’ of doctors

2010 we talked about the Brain Drain and how our brightest and best were lured away.

The National Health Service is suffering a “brain drain” of doctors as more medics trained at taxpayers’ expense choose to pursue their careers overseas, according to Financial Times research.

Most go to Australia or New Zealand, say recruiters and doctors’ organisations, and data suggest more now choose to stay longer or settle permanently.

Tracking the numbers of medical professionals leaving and returning to the UK is difficult because neither the government nor health industry bodies record that information.

However, the number of certificates of good standing – which the UK’s General Medical Council issues at a doctor’s request and are necessary to take up a post in another country – has risen steadily since records began in 2008. Since then, more than 8,000 people have requested such certificates for Australia and New Zealand alone.

Additionally, the number of Australian permanent visas issued to UK-trained doctors has almost tripled during the past five years, with 645 granted in 2010-11, according to immigration data.

But the lure of an improved lifestyle and better weather, along with higher pay, shorter hours and superior arrangements for professional study, are not the only reasons many are opting for a life abroad.

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The truth is it’s a lot cheaper to employ ready made qualified professionals than for a country to train and educate homegrown talent.

Professionals from all fields follow the Money and why not!

They study hard putting time effort and grey matter into their chosen profession, offers of money and lifestyle that countries like America, Australia or New Zealand attract lots of our young talent from the UK while Freedom of movement allows for the UK to counter the loss pooling in EU nationals from the poorer Eastern bloc for the same reasons.

Educating doctors is a long and expensive process, but not every country can reward its graduates equally. Health spending per capita varies drastically in EU countries, from €816 per year in Romania to more than €4,000 in Luxembourg, Germany and other Western European countries. And so doctors and nurses follow the money.

A survey just before Estonia’s accession to the EU in 2004 — just three years after Lindström graduated from medical school — shows that more than half of Estonia’s 17,749 healthcare workers were considering working abroad. The country had 4,312 practising doctors in 2004; more than 1,800 doctors have applied for qualifications abroad since then.

But that’s become a problem on a whole new scale, it’s not only the UK in competition for medical personnel it’s all the other western EU countries. The excuse of western governments of being short-sighted and not seeing this coming does not hold water. The lack of investment in our NHS and training of staff is not new and although the BMA  blame Brexit for staff loss the reality is they suffer from short-term memory loss knowing the shortages have been an ongoing problem for nearly two decades

I’m alright Jack.

The Hospitals are suffering from staff shortages and freedom of movement is to blame.
But as long as they are not our hospitals, our patients who cares?

The UK Government have failed to invest in young people while opting to compete for the professionals ready trained and ready to go but where does that leave the eastern countries like Romania, Bulgaria, Poland and others who are losing their lifeblood, bleeding away Doctors, Nurses, Dentists.

There is nothing socialist or remotely international socialist about this. There is no social EU there is only a grab for what assets the richer countries can grab careless to the desperation left in its wake.

So where does that leave the EU countries like Romania?

Thousands of doctors and nurses have left the two Balkan countries to find better jobs abroad, deepening the crisis in their already dysfunctional health systems.

The situation in the Romanian system, doctors go through six years of medical school and then three to five years as a hospital residents, treating patients while working under the supervision of senior staff. Finding a job abroad will be easy. Cluj, one of Romania’s largest cities and a university and business hub, hosts several agencies recruiting for western European hospitals.

Romania has bled out tens of thousands of Doctors, nurses, Dentists and pharmacists since joining the European Union a decade ago, lured abroad by what the country lacks: significantly higher pay, modern infrastructure and functional healthcare systems. France, Germany and Britain are among the most popular destinations. The consequences are dire. Romania is one of the EU states with the fewest doctors. Nearly a third of hospital positions are vacant and the health ministry estimates one in four Romanians has insufficient access to essential healthcare.

German labor market profits from immigration.

Thousands of young Bulgarians have embarked on the journey that Dimitrova completed. According to German statistics database Statista, more than 225,000 Bulgarians were living in Germany in 2015 – many with an above average education. While Germany’s labor market has profited from this influx, Bulgaria has suffered: The Bulgarian Academy of Sciences estimates that in five to ten years the country will have lost some 400,000 qualified workers.

Romania, which joined the EU alongside Bulgaria in 2007, is plagued by similar problems. Though both countries profit from remittances sent home to families, the lack of skilled workers has become clearer over time. The medical sector has been hit hardest. Some 43,000 pharmacists have left Romania in the ten years since the country joined the EU, with 5,000 Romanian medical specialists working in Germany alone.

Three years ago, Kostas Ifandopol, a young Romanian dentist, decided to emigrate to Berlin, a move he says was mainly prompted by money considerations. After completing his studies in Bucharest, he spent a year working as a dentist in Romania, but he soon realized that he would not be able to fulfil his dream of opening his own practice in his home country.

“In the long-term I have much better chances in Germany. I can secure good bank loans here, and only have to work 15 or 20 years to pay them off, not 40,” Ifandopol told DW. He is currently working at a Berlin dental practice: “I earn about ten times as much here as I would in a Romanian practice.”

Ever more Bulgarian doctors are taking the same route. Today, the country, which has roughly seven million inhabitants, has only 28,000 doctors. Seven years ago there were 35,000. Though this has led Bulgaria and Romania to look to the future with trepidation, German clinics have profited greatly from the influx of specialists from Eastern Europe: “Brain drain” for some is “brain gain” for others.

“Some regions in Germany would not have medical personnel if it weren’t for doctors moving here from Eastern Europe,” says Jalid Sehouli, director of the Charité’s Gynecology Department. Born to Moroccan immigrant parents in Berlin, Sehouli likes the multicultural character of the Charité team: “My senior physician is from Bulgaria, Ms Braicu comes from Romania, and we have an assistant from Bulgaria as well. All of these colleagues have a very good education, have a talent for languages and quickly learn how our system works.”

Very negative effects.

According to a recent United Nations study, some 3.4 million Romanians work abroad. Bulgaria’s population has also shrunk dramatically over the last decade: More than a million Bulgarians have emigrated since the fall of the Iron Curtain in 1989.

“This emigration has had a very negative effect on the Bulgarian economy, for most of those émigrés were highly qualified specialists,” says Mitko Vassilev, chairman of the German-Bulgarian Chamber of Industry and Commerce, before pointing out that German investors often complain about the lack of well-trained skilled labourers in Bulgaria.   

But migration research tells us that “it is not necessarily a bad thing when skilled persons emigrate,” argues Herbert Brückner, a researcher at the Institute for Employment Research (IAB) in Nuremberg. “A country’s human resources need not be depleted just because more is invested in education.” Moreover, a lot of people spend a few years abroad and then return home. Though he admits there are problems – especially in the medical sector: “Emigration has certainly had negative consequences in that area.”

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The social costs of immigration.

Since Poland joined the EU in 2004, some 20,000 trained nurses have left the country.

Since Poland joined the EU in 2004, some 20,000 trained nurses have left the country, mainly to work as caregivers. Today there are 280,000 nurses in Poland; only 42,000 of them are under the age of 40. The average age is 51. In 2015, Poland had 5.2 nurses and 2.3 doctors per 1,000 citizens (in Germany, the ratios are 13 and 4.1 to 1,000). The country’s health-care system is chronically underfunded. It thus comes as no surprise that ever more personnel consider leaving. The social costs of that situation, however, are massive. In 2007, three years after Poland joined the EU, 1,300 children were forced to live in orphanages or foster families because their parents were working abroad. Currently, it is estimated that Poland has roughly 100,000 “Euro orphans,” as well as a number of “Euro seniors” whose grown-up children work and live abroad.

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This situation will not improve anytime soon the government have only compounded the problem in taking away Nurses Bursaries. Since the Government axed bursaries in 2016, applications for nursing degrees have fallen by a third and student nursing numbers have dropped by 11%. There are currently 41,000 nursing vacancies in NHS England.

Janet Davies, RCN Chief Executive, said: “Failing to recruit more nurses puts patients at risk, and with 40,000 nurse vacancies in England alone, we cannot sit back and watch applications fall year on year. It is clear now that removing the bursary has been a disaster. It is time ministers looked again at this policy, before patients suffer the consequences.

“On top of the serious decline in overall nursing applications, the 40% drop in mature students applying to study nursing is a particular concern. These students represent a vital part of the nursing workforce, particularly in mental health and learning disabilities. It is these areas that benefit most from the life experience mature students bring, and where the shortage of nurses is most keenly felt.”

The independent NHS Pay Review Body (PRB) warned this workforce gap could persist until 2027 unless immediate action is taken, jeopardising patient care for much of the next decade. In its official report to the Government last month, the PRB told ministers the removal of the nursing bursary had resulted in a marked drop in applications. 

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We need to have Government that plan for the well being of the people and not what’s cheapest. Although attracting foreign workers can be a short-term band-aid it is not the answer we need a complete overhaul of how we recruit and train NHS staff, only real investment in education with vocational training will change NHS staff shortages.