The sharp decline in European Union nurses joining the NHS following the 2016 Brexit referendum may have contributed to more than 1,200 additional patient deaths each year in England, according to a new study led by the University of Surrey in collaboration with the University of Aberdeen, Harvard Business School and Vienna University of Economics and Business. Published in The Economic Journal, the research found that hospitals which had relied most heavily on recruiting EU nurses before Brexit experienced the greatest deterioration in patient outcomes after the referendum.

Researchers estimate that during the first three years after the Brexit vote, hospitals with the highest dependence on EU nurses recorded 3,714 additional emergency patient deaths and nearly 14,000 extra emergency readmissions following discharge. The study found no evidence that these poorer outcomes were driven by reductions in hospital funding, bed capacity or increases in patient numbers, suggesting that staffing changes played a significant role.

To examine the impact, the research team analysed more than 32 million emergency hospital admissions across 130 NHS hospitals between 2012 and 2019. By combining patient records with NHS workforce data, they compared hospitals based on their reliance on EU nurses before the referendum. While many hospitals successfully replaced departing European staff with nurses recruited from outside Europe, those that had previously depended most on EU workers still experienced worsening patient care, including higher emergency mortality and readmission rates.

The findings challenge the assumption that simply filling vacancies is enough to maintain healthcare quality. Researchers argue that restrictions on international recruitment can shrink the pool of skilled applicants, forcing employers to recruit less experienced workers. Supporting this conclusion, the study found that nurses hired after the referendum were more likely to be appointed to lower NHS salary bands, indicating they generally had less experience or fewer qualifications than the EU nurses they replaced. Staff in the most affected hospitals also reported lower satisfaction with the quality of care they were able to provide.

Professor Giuseppe Moscelli, Professor of Economics at the University of Surrey and the study’s principal investigator, said hospitals were able to recruit replacement nurses, but often from “a smaller and less experienced pool of applicants”, with measurable consequences for patients. He said the findings highlight that the quality and experience of healthcare workers are just as important as maintaining overall staffing levels, particularly in critical hospital settings where skilled nursing directly influences patient outcomes.

The researchers say the study has important implications for countries that rely on internationally trained healthcare professionals. According to Professor Moscelli, immigration policies can produce unintended effects that extend well beyond the labour market, ultimately influencing the standard of care patients receive. He urged policymakers to recognise that healthcare systems competing for skilled international workers must consider not only how many staff they recruit, but also how immigration policies affect the willingness of experienced professionals to work in the country.

More information: Henrique Castro-Pires et al, Immigration, Workforce Composition, and Organisational Performance: The Effect of Brexit on NHS Hospital Quality, The Economic Journal. DOI: 10.1093/ej/ueag088

Journal information: The Economic Journal Provided by University of Surrey