Record number of EU citizens quit working in NHS last year

A record number of EU nationals left the NHS last year, renewing fears that Brexit could exacerbate a staffing crisis.

The figures, compiled by NHS Digital, prompted medical leaders to call for more reassurances to European workers about their future in the UK. A total of 17,197 staff, including nurses and doctors, left their posts in 2016, compared with 13,321 in 2015 and 11,222 for 11 months in 2014.

Even though EU staff numbers rose across the period analysed, experts fear the number of people leaving is the more significant trend.

As Britain embarks on fraught Brexit negotiations, the Royal College of Physicians (RCP) and the British Medical Association (BMA) blamed the increase in departures on the prime minister’s lack of assurances about the position of EU nationals resident in the UK. Theresa May has said such a pledge would weaken her ability to negotiate a good deal for Britain as it prepares to leave the trade bloc.

Prof Jane Dacre, the RCP president, said: “These figures confirm our fears that EU doctors are feeling unsettled and, at worst, leaving or planning to leave the UK. We need the government to provide reassurance that we will be able to keep our European colleagues, in the NHS and research, as we will not be able to replace them with homegrown doctors for many years to come.”

The BMA’s council chair, Dr Mark Porter, said: “Following the EU referendum, thousands of EEA [European Economic Area] nationals working in the NHS and wider health and social care system have been left feeling uncertain as to whether they and their families will have the right to live and work here.

“Worryingly, one in four EEA doctors working in the UK have told the BMA that they are considering leaving following the referendum, with many feeling substantially less appreciated by the government. These are people who have dedicated years of service to healthcare, staffing our hospitals, GP surgeries and leading medical research.”

Analysis by the Guardian shows 2,348 doctors from the 27 other EU states left NHS England between July and September 2016 compared with 1,281 in the same period in 2015. That is a rise of 83% year on year. The figures mirror concerns raised about the growing numbers of nurses leaving the health service and the falling number EU nationals registering as nurses in England, which dropped by 92% since the Brexit vote last June.

Number of EU doctors who left NHS England each month between February 2014 and November 2016

The NHS Digital data also shows an increase in other members of NHS staff leaving the health service. In total, 6,391 EU workers quit in the three months after the EU referendum, compared with 4,125 in the same period in 2015 – a 55% increase. The increase in the number of EU staff employed by NHS England in the same period was 15%.

A number of NHS staff told the Guardian they knew colleagues who were considering leaving. One health worker from London, who asked to be anonymous, said: “I am worried. I work in operating theatres and I walk into some of them and they are all EU staffed.

“Every theatre in London has a European citizen in it. Heaven help us if they leave. A few of my colleagues have already left – the good ones.”

A midwife from Worcester, an EU national, said: “I do know of quite a few of my colleagues who are considering leaving. Also junior doctors who aren’t eligible for permanent residency because they don’t meet the criteria. It’s a total disaster.”

Jonathan Ashworth, the Labour party health spokesman, said: “Safeguarding the future of these staff should be an absolute priority in the Brexit negotiations. Theresa May and Jeremy Hunt [the health secretary] have been totally negligent in failing to guarantee a future for these staff before article 50 was triggered.”

Concern has also been raised about a slowdown in EU nationals joining the NHS since the referendum. Figures from the Nursing and Midwifery Council show a 90% drop in the number of nurses from EU states registering to join in December.

Barry Pactor, the managing director of TTM Healthcare, an international recruitment company, said: “Since Brexit TTM Healthcare has seen a marked difference in UK perception among EU healthcare professionals.

“Overwhelmingly concern centres on a lack of clarity around their status and not knowing whether they should plan a long-term future in the UK. With such concerns it is unavoidable that EU specialists will choose alternative countries to continue their careers.”

Some were more cautious about linking the departures with the Brexit vote. Jackie Smith, registrar and chief executive of the Nursing and Midwifery Council, said: “This is the first sign of a change and it is too early to say definitively that changes in this area are due to any one reason.”‎

The Department of Health sought to downplay fears of a staffing crisis. “As the secretary of state has repeatedly made clear, overseas workers form a crucial part of our NHS and we value their contribution immensely,” a spokesperson said.

“We are continuing to invest in the frontline: there are over 34,800 more professionally qualified clinical staff, including over 11,600 more doctors and over 13,400 more nurses on our wards since May 2010. Furthermore, there are 30,000 students training to be doctors and over 52,000 training to be nurses.”

Record number of EU citizens quit working in NHS last year

Why the need for empathetic citizens has never been greater

We are in the midst of an empathy deficit, according to Peter Bazalgette in his latest book, The Empathy Instinct. He believes focusing on empathy can contribute to ‘kinder health and social care, and more effective criminal justice’.

Neuroscientific findings shows that empathy works in more complex and subtle ways and has particular relevance to arts and culture. Studies conducted at UCL a decade ago provided some interesting evidence about how your perceptions and enjoyment of an activity change, depending on whether or not you’ve tried it yourself. Using ballet dancers as subjects, we compared the brain activity when you’re watching a movement you have performed yourself with one that you’ve seen many times but can’t do. It turns out that you use the parts of your brain that control movement to help you see.

This means that we need audiences that have experience of doing as well as seeing, thus grass-roots participation in the arts is essential. The need for ‘empathetic citizens’, as Bazalgette calls them, has never been greater.

Dr Daniel Glaser is director of Science Gallery at King’s College London

Listen to this week’s podcast at theguardian.com/lifeandstyle/series/neuroscientist-explains

Why the need for empathetic citizens has never been greater

Citizens must get a say in NHS sustainability and transformation plans

A recent report on sustainability and transformation plans (STPs) has sparked quite a debate about the importance of citizen engagement in redesigning health and care services.

The report, commissioned by the campaign group 38 Degrees and produced by health policy consultancy Incisive Health, found that the “extent of ‘co-production’ with patients and the public appears to have been limited” in the plans. The Nuffield Trust, in its review of STPs, arrived at a similar conclusion.

NHS England has since published a guide on community engagement, which is welcome news. But guidance, as we know, is never enough on its own. We need concerted action at all levels to ensure STPs aren’t a wasted opportunity for meaningful involvement.

We have been here before. Earlier in the decade, in an attempt to shift costs out of hospitals and into communities, the NHS ran what were called “acute service reconfigurations”. This involved reshaping services at a sub-regional level.

Not only were these met with public protests, but the lack of citizen engagement led to ill-considered plans that didn’t reflect people’s aspirations or needs. We must avoid the same thing happening with STPs. Engaging people should not merely be a step in the process, but part of everything we do. We must think all the time about how we can involve citizens in the design, commissioning and delivery of services.

While STPs will soon be signed off, it is crucial that as we move into implementation, citizen engagement is at the heart of decision making. Thankfully there is a powerful set of principles that can guide our thinking and behaviour. As part of the NHS’s Five Year Forward View, the People and Communities Board, with support from the National Voices coalition, developed six principles for engaging people and communities.

Those principles require those undertaking STP planning to work with the knowledge, skills and experience of people in their communities. This should also apply to the implementation of plans.

One of the principles is about ensuring that the “voluntary, community and social enterprise, and housing sectors are involved as key partners and enablers”. This is vitally important, as the reach of a health or care service will be limited by various parameters. However, the combined reach of the voluntary and community sector, alongside services, is far greater.

Another of the principles is that “carers are identified, supported and involved”. Carers have vast experience and knowledge of the strengths and weaknesses of existing services, and great ideas on how they can be improved. They also have needs that are not always sufficiently supported. Involving carers in decision-making is vitally important.

All of these principles are underpinned by the notion of co-production – that is, a way of developing services that has service users and communities as equal partners in shaping how services are delivered.

In parts of the country, efforts are being made to ensure citizens are more closely involved shaping STPs. In both Leeds and Nottinghamshire, officials have gone to great lengths to involve local people in developing their STPs. In York, we have established an integration and transformation board that will co-produce a vision for person-centred and integrated care with local people. But, of course, much more could be done.

As Simon Stevens, the chief executive of the NHS, said recently, STPs are just the start of a process of massive change; the implementation that follows will be the much longer and harder part. We could have started sooner in engaging citizens in STPs, but getting engagement right from now on is still vital to the work.

Martin Farran is director of adult social care, housing and public health at York council and Ewan King is director of business development and delivery at the Social Care Institute for Excellence.

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Citizens must get a say in NHS sustainability and transformation plans

Why do one in seven US citizens still have to fight to vote? | Mary O’Hara

The spectacle of Donald Trump repeatedly demeaning and insulting just about every minority group in the US during his campaign for the presidency has been toxic and unprecedented. High up on the long list of ignominious behaviour was the contempt he displayed for people with disabilities in his mocking of a disabled reporter, captured on video.

As with the battles disabled people have fought in Britain against austerity policies from the bedroom tax to the work programme, Trump’s casual disdain is a potent reminder of how fragile inclusion and hard-fought-for disability rights can be.

Beyond the media focus on the race for the White House a new report explores evidence that, regardless of political rhetoric, people with disabilities in the US routinely encounter barriers within the broader electoral process. There are at least 35 million voting-age people [pdf] with disabilities in the US – one in seven of the electorate. According to the study, co-authored by Norman Ornstein of the American Enterprise Institute for Public Policy Research, many are treated like “second-class citizens” as a result of obstacles to voting. The wide-ranging paper points out how “despite a patchwork of legislation” to ensure access to voting serious problems persist.

Donald Trump mocks reporter with disability – November 2015

Pulling on an array of research and interviews it details the scope of the issue, including how in parts of the US people with disabilities are unable to reach polling stations because of a lack of public or adapted transport and inaccessible buildings. Alternative options such as absentee ballots or assistance with casting a vote aren’t adequate substitutes for a fully accessible, inclusive system it argues because, among other things, these can impede a voter’s right to choice and privacy.

Other hurdles it lists involve election materials and online voter registration (for example for people with visual impairments), poll workers who are poorly trained in disability access and limited resources to improve services. In 2013, the US Government Accountability Office [pdf] estimated that in 2008 73% of polling stations had “a potential impediment”, something this latest report rightly concludes is “stunning and troubling”. Almost three-quarters translates as millions of disabled voters possibly being denied their vote.

The report also says stigma is a huge problem, especially for people with learning and mental disabilities. According to research, in 27 US states large numbers of people in these groups are barred from or have restrictions placed on voting.

It might be tempting to think of voting access for people with disabilities as a predominantly US problem but as the last UK general election showed, it is far from alone. During that election activists including Operation Disabled Vote, which campaigned on voter registration, highlighted the obstacles in place across Britain. Meanwhile a report from the charity Scope, found two-thirds of polling stations had at least one significant barrier to access. Research published in 2014 by Mencap revealed that 60% of people with a learning disability reported difficulties registering to vote.

When it comes to mental health, charities including Mind and Rethink Mental Illness have argued for years that vulnerable people such as those who are homeless with mental health problems can face multiple barriers to voting. None of these problems, be they in Britain or the US, are universal or irreversible. During the 2016 presidential campaign it has been encouraging to see positive perspectives on disability. Hillary Clinton has repeatedly highlighted disabled people’s employment rights and other areas where exclusion and underrepresentation are common.

And in the run-up to next week’s election, activists in the US have been mobilising and political engagement is high. The American Association of People With Disabilities launched a successful campaign in the summer promoting voting accessibility and registration among the millions of people with disabilities who are eligible to vote. Grassroots activism has also been spurred into action with networks such as SignVote, for people who are deaf and hard of hearing, and Crip the Vote, an online campaign encouraging disabled people to participate in local and state elections as well as voting for president.

The right to vote, and not being precluded from exercising that right, is fundamental to citizens in any society wishing to call itself democratic or inclusive. It is intolerable that people continue to face barriers to voting because of their disability.

Why do one in seven US citizens still have to fight to vote? | Mary O’Hara

Girls are 2nd-class citizens when pregnancy can make us potential criminals | Jessica Valenti

Late in my pregnancy with my daughter, Layla, I had a glass of red wine each and every after in a although. And while I took prenatal nutritional vitamins, I am confident I missed a day somewhere in there. I definitely – completely, without having-a-doubt – ate far more junk foods than is advised by most overall health organizations. Does that imply I should go to jail? It may possibly sound ridiculous, but that is the really genuine slippery slope we’re on, thanks to laws criminalizing pregnant females – and treating their personhood as secondary to their pregnancy.

Earlier this month in Tennessee, 26-12 months-outdated new mother Mallory Loyola grew to become the initial man or woman arrested below a new law that makes using narcotics even though pregnant a criminal offense. Loyola is facing charges of assault against her fetus – she was arrested two days following birth, soon after she allegedly tested good for amphetamines.

Even though Tennessee is the only US state with an explicit law criminalizing drug use by pregnant women, Lynn Paltrow, the executive director of the Nationwide Advocates for Pregnant Females, says that a number of states arrest pregnant ladies anyway, basically by classifying fetuses as youngsters.

Alabama, for instance, has arrested over a hundred pregnant girls because 2006 beneath a law meant to quit men and women from bringing kids to spot where medication are created, like meth labs. And earlier this year, that state’s supreme court ruled that women can be charged with “chemical endangerment” of a kid if they use a managed substance although pregnant. The definition of pregnancy is so broad, Paltrow says, that a woman could smoke some pot with her boyfriend one particular evening, have intercourse, get pregnant and, below Alabama law, face ten many years in jail for that one use of marijuana.

Clearly, undertaking medicines even though pregnant is a horrible thought. But criminalizing addicted pregnant ladies who want remedy is negative for babies and their mothers. It is a quick-phrase, punitive measure with no optimistic lasting impact to merely make sure that pregnant women who require drug remedy and pre-natal care will not look for either of those possibilities, for fear of getting their youngsters taken away from them.

It also raises queries of just how a state will go about obtaining pregnant ladies to prosecute: I’m betting the local prosecutor’s office will not be performing random drug-testing in hospitals populated largely by affluent white patients.

And Paltrow says that targeting drug-utilizing females is just the start. “This is about generating pregnant women – from the time an egg is fertilized – subject to state surveillance, manage and excessive punishment.”

But beyond the troubles of these present laws, criminalizing women’s actions for the duration of pregnancy is a harmful street to go down. How extended will ahead of drinking whilst pregnant is illegal? Will we arrest a person like me who had an occasional glass of wine? What if a woman decides not to get prenatal vitamins? Or has a C-segment towards her doctor’s suggestions? (That one is less hypothetical: a girl in Utah was charged with murder because she delivered a stillborn little one following her medical doctor advised towards a vaginal birth.)

Even worse, what happens when we determine that policing presently-pregnant females isn’t ample?

As I reported in my book, Why Have Little ones?, the government has lengthy been on a mission to minimize ladies to vessels for pregnancy. In 2006, the Centers for Disease Management and Prevention launched suggestions instructing all women of childbearing age – whether they have been pregnant or not, whether they even had strategies to turn out to be pregnant or not – to care for their “pre-conception” overall health. Starting as quickly as ladies got their first time period right up until they hit menopause, the CDC said that girls need to take folic acids, not smoke or “misuse” alcohol, refrain from drug use, steer clear of “high chance sexual conduct” and sustain a healthy weight. (There go my twenties!) What could eventually take place if a female have been to not follow these guidelines and have a miscarriage or stillbirth? Could she be sent to jail, also?

A world in which all females who can get pregnant are considered “pre-pregnant” – and in which the state has more of a vested curiosity in safeguarding any embryo or fetus at any stage of development than the woman herself – is the stuff of nightmares, and a scary potential that’s previously upon us.

But a pregnant female is still a person below the law, with the appropriate to make selections – even poor ones – about her personal entire body. Alternatively of residing in some Margaret Atwood-design dystopian world in which we regulate, check and punish vulnerable pregnant ladies, let’s instead make positive that people who require help, get it – and not from within a jail cell.

Girls are 2nd-class citizens when pregnancy can make us potential criminals | Jessica Valenti

Mental wellness: "We support men and women from becoming support end users back to citizens"

Community Restart maps pursuits from sport to voluntary opportunities and builds backlinks with organisations. Photograph: Alley Cat Productions/Brand X/Corbis

Three years in the past, Sharon Stott was depressed and rarely left house. She was unemployed, unable to feed herself appropriately, and as a result, had produced diabetes. She wore only black clothing and identified it challenging to method people, allow alone speak to them. She remembers: “I was anxious and didn’t want to leave the home.”

Soon after some counselling, she was referred to Local community Restart, a support in East Lancashire that aims to get psychological wellness service customers and others who truly feel isolated back into society.

Now Stott, fifty five, has two cleaning jobs which give her with a steady cash flow, and she has injected some colour into her wardrobe. She says: “I’d say my daily life is 100 times greater. I am earning income now so I can feed myself … I’ve come out of my shell. I can actually strategy men and women and talk to them which I could not do prior to.”

Community Restart, a partnership among Lancashire care NHS basis believe in and Lancashire county council, started in 2010 in response to Division of Health guidance to commissioners aimed at tackling social isolation and helping folks to become more involved in their local community. It replaced a day service and caters for adolescents onwards, helping men and women to get paid employment, find housing or join in an action. The service maps what is offered in the local community, regardless of whether it be sport, art, theatre or voluntary possibilities, and builds links with organisations.

Liz Hodge, an occupational therapist and crew leader, says: “I think it is essential. It’s not one thing you get in each and every trust and we perform differently from a clinical staff since we’re much more about a social model. We facilitate people from becoming services users back to citizens that truly feel nicely linked and can entry companies that the local community delivers.”

In accordance to Keith Isherwood, the services manager, there has been a tenfold increase in the quantity of men and women employing the services: “Originally 124 individuals were being supported in East Lancashire in formal day companies. This year, it really is one,200. We have exceeded targets for stopping homelessness and receiving folks into paid employment.” Despite the hard economic climate, the support has aided 98 men and women locate paid perform, while 28 have been supported to retain their jobs.

Community Restart worked with Stott for twelve months obtaining her prepared for perform. One particular of the team accompanied her to a neighborhood centre and assisted her with pc courses and a member of personnel aided her to discover her jobs, apply for them and put together for interview. “Now I’m going out,” she says. “I do panic in the streets and things like that even now but I am managing. I have acquired the centre to fall back on. They’ve helped me back into the community.”

Isherwood says there is a actual need to have for this variety of services: “We know that loneliness affects both physical and mental overall health. But I consider there’s a stigma connected to being lonely and I do not consider folks will admit that they don’t have any pals.”

He adds: “It is possible to be a tourist in your personal local community. It truly is achievable to go out and about, and not speak to anyone apart from the person you acquire goods from.”

This is some thing that was all also familiar to Tara Lane, 52. She was referred to Local community Restart following encountering depression and suicidal ideas. “I was really withdrawn, staying indoors by myself. Things had been receiving genuinely bad … Most days I wouldn’t get dressed and I would not get out of bed. I’d just feed myself and view telly. My daily life had rather much come to a halt with the depression.”

Lane, who is transgender and transitioning from male to female, commenced attending a peer help group for anxiousness and depression. She made pals who assistance her outside of the groups. She says it has improved her social daily life and got her back into the community: “1 of the major problems with mental well being troubles is that folks do withdraw they go into themselves. They get in their home, lock the door and never go back out you have a tendency to sit there and fester with your troubles. At Neighborhood Restart, it truly is about social inclusion, receiving you back out into society and acquiring on with your lifestyle.”

Lane was encouraged to set up a group for transgender individuals. Personnel at the centre helped her with the administration and the legalities they located a venue and supported her by means of the method. “The peer assistance groups are the issue which is aided me the most and the private help is amazing. They are specifically what I need to have,” she says. “They get me out of myself, socialising with people. Transitioning, you do feel nervous and a lack of confidence. The peer assistance groups are fully non-judgmental, they get everybody as they are. It isn’t going to instantaneously make you better but it improves the way you feel in yourself.”

Isherwood adds: “In potential many years, there will be a lot more men and women residing alone and that will be a better issue. People with mental well being concerns tend to be much more impacted by social isolation because of stigma.”

He continues: “It is really hard to say if [Neighborhood Restart] has prevented people from going back into hospital but what we do know is in which individuals have excellent social networks, they tend to remain out of hospital for longer. Most of us, if we have a dilemma, will go to our loved ones and buddies prior to we go to formal solutions. Exactly where folks never have those networks, they will come via to public companies. If individuals can build up individuals networks, individuals tend to use them 1st.”

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Mental wellness: "We support men and women from becoming support end users back to citizens"

Ministers treating middle class elderly like "second class citizens"

Caroline Abrahams, charity director at Age United kingdom, mentioned: “Under the current program, two older folks in the very same care residence can acquire really various ranges of safety underneath the Human Rights Act based mostly solely on how their care has been arranged and paid for.

“This is not only fundamentally wrong, it indicates that if an older individual who pays for their care is abused or suffers from neglect and poor care they have much less legal redress than an individual in the exact same unfortunate place whose care is funded by the State.

“We are disappointed and amazed that the Government desires to preserve this loophole intact simply because they have said they want to enhance the place of older individuals who spend for their personal care by means of this legislation.

“There is no greater way to attain this than by granting every older man or woman equal accessibility to legal redress if their care goes badly incorrect.”

Care houses can be taken care of as “public bodies” beneath the Human Rights Act, meaning that they could be sued for failing to treat elderly folks with respect.

But this applies only to state – funded residents, which means that the forty per cent who pay out their personal way are not protected. Even so, the amendment could be blocked when the care bill passes via the Property of Commons.

A spokesman for the Division of Well being said: “Extending the Human Rights Act in this way would not make individuals or companies deal with individuals they care for with any a lot more dignity and respect than they need to. Men and women with personal care will even now have rights and protections underneath recent law.”

Ministers treating middle class elderly like "second class citizens"