Brexit lässt Pflegerinnen ihre Koffer packen
Proud Health Service Scrambles as Doctors And Nurses Leave
LONDON — Tanja Pardela was leaving London. Her last day was November 26. She welled up talking about it. She will miss jacket potatoes, and Sunday roasts, and her morning commute — past playing fields, small children in school uniforms and a red telephone box — to the hospital where she has been a pediatric nurse for 11 years.
Ms. Pardela does not want to leave the country she came to over a decade ago. But that country no longer exists. On June 24 last year, she said, “We all woke up in a different country.”
Seventeen months after Britain voted to leave the European Union, many Europeans are voting to leave Britain — with their feet. Some 122,000 of them packed their bags in the year through March, according to the latest figures available, while the stream of new arrivals has slowed.
In London, a city long sustained by European bankers, builders and baristas, the departures are beginning to hurt. Construction companies and coffee shops are struggling to recruit. Top universities worry about retaining talent. And nowhere are the concerns more elemental than in Brit- ain’s treasured National Health Service.
Long before Brexit, the N.H. S. suffered from chronic staffing shortages, and today the country has 40,000 nursing vacancies. But recruiting nurses from the European Union had helped plug the gap — especially
in London, where the share of nurses from the Continent is about 14 percent, or twice the national average. King’s College Hospital, the massive institution where Ms. Pardela works, is short of 528 nurses and midwives, and 318 doctors.
Brexit seems certain to make it harder and costlier to recruit from the Continent. Many European Union citizens in Britain fear they could lose rights, job security, pensions and access to free health care. This uncertainty is one reason that some European health care professionals are either leaving, or thinking about leaving. In the year following the referendum, almost 10,000 quit the N.H. S. The number of nurses from other European Union countries registering to practice in Britain has dropped by almost 90 percent
As yet there is no mass exodus back to the Continent — the number of European Union staff members in the health service even grew slightly in the year after the referendum. But the trends are unmistakable: The number of Europeans leaving the system is rising, and the number joining it is falling.
“If those E.U. colleagues who have not yet left are not given an unequivocal right to remain, the very safety of the capital’s care settings will be under threat,” said Tom Colclough, regional spokesman for the Royal College of Nursing in London.
The N.H. S., with its philosophy of free universal health care, is a pillar of postwar British identity, once described by a former minister as the closest thing the English had to a national religion. During the Brexit campaign, an argument about the N.H. S. helped tip a tight vote. Brexit advocates said leaving the European Union would allow the government to repatriate 350 million pounds a week from Brussels and spend it on health care. It was a powerful promise — but it was false.
King’s is a complex of buildings with Europe coursing through its circulatory system. Dutch workers built the helipad on the roof. Eastern Europeans are helping to build a new intensive care wing and serving cappuccino in coffee shops. Of the 9,300 clinical staff members, one in seven holds a non-British European passport.
In the emergency room, Cyril Noël, a French doctor, is wrestling with how a country he loved rejected him. In critical care, Georg Auzinger, an Austrian physician, has built a world- class facility but now worries about finding enough doctors and nurses.
“The N.H. S. is in Britain’s DNA,” said Shelley Dolan, chief nurse and executive director of midwifery at King’s. “Europe is in the DNA of the N.H. S.”
Five Stages of Brexit
Working with Dr. Noël one recent Friday night were a Czech doctor and nurses from Ireland, Poland, Spain and Portugal. “Everyone is nervous,” said Alexandra Cunderlikova, a senior nurse from Slovakia.
Ms. Cunderlikova came to Britain in 2003, a year before her country joined the European Union. She remembers lining up outside the Home Office at 4 a.m. for her work visa.
“I wonder,” she said. “Will it go back to that?”
Dr. Noël grew up as an Anglophile in eastern France, near the German border. When he was 5, he paraded across the local market, pretending to speak English. At 30, he fell in love with a British exchange student. Twelve years ago, they moved to Britain and Dr. Noël instantly felt “at home.”
But now, when he works outside London in places where people voted for Brexit, resentment rises in his throat. “I’ve had very torn feelings about helping people who expressed the wish to get rid of us,” Dr. Noël said.
“Psychologically Brexit has had a huge impact,” he said. “You feel rejected as a group.”
He talks about the “five stages of Brexit.”
First there was shock, he said. Then there was denial. (“Don’t worry,” he would tell the young nurses from Portugal and Spain. “Nothing is going to change.”) Then Dr. Noël reached the anger stage, following a cascade of nasty news reports: about a government request for companies to compile lists of foreign nationals ( later retracted); about a man being stabbed for speaking Polish; about a Finnish professor who, along with scores of other Europeans, was served a deportation notice.
The notice was a bureaucratic mistake. “But after Brexit, such mistakes are not easily forgotten,” Dr. Noël said.
If the N.H. S. has managed to pro- duce health outcomes comparable to countries with vastly more resources, it is in large part because of the people, Dr. Noël said.
“The N.H. S. is an incredibly resilient system,” he said. “People are so dedicated. When the system is squeezed, they work even harder.”
But Brexit has made many European employees reconsider. After depression, the fourth stage of Brexit, Dr. Noël said he had now reached the final stage, acceptance. For him, that means leaving Britain early next year. He has a new job at a hospital in Dubai.
Replacing Immigrants
Dr. Auzinger was checking on two patients who were recovering from emergency liver transplants on extracorporeal membrane oxygenation, a pioneering bypass technology.
The liver department at King’s is world-famous. It is also very European. “The English are in the minority,” Dr. Auzinger said.
The liver department’s clinical director is Irish. Its academic director is Spanish. The hospital recently tried to hire a German as academic head of department, but he declined: He had been awarded a high-value European grant that he could not take to Britain after Brexit.
This worries Dr. Auzinger, who has to hire 407 nurses and doctors for the new intensive care wing. In October, not a single European applied for an advertised position as a senior consultant. “Before, at least a third of applicants were European,” he said.
Dr. Auzinger would hire Britons. “But there are not enough doctors and nurses in this country,” he said.
That is one reason Peter Absalom, associate director for recruitment at King’s, is now trying to replace one immigrant group with another. “We are looking to the Philippines, Australia and India,” he said. Three major recruitment drives are planned over the next 12 months.
Dr. Auzinger thinks the way Brexit is affecting the N.H. S. is symptomatic of a poor treatment plan. Britain is ailing. People are angry. Brexit was the treatment offered to them. What worries Dr. Auzinger is the lack of a diagnosis.“If you think Brexit is the medicine, my concern is that you’re treating something blindly,” he said. “If you don’t have a diagnosis, you cannot treat the patient properly.”
‘ Why Am I Still Doing This?’
Ms. Pardela is keeping her British bank account open because she hopes that one day the pound will rise again. It has lost as much as 20 percent of its value against the euro since the referendum. So have her savings.
After the Brexit vote, a British colleague urged Ms. Pardela to apply for citizenship. Her skills were needed. No way, she answered. “I respect the vote,” she had said. “But I’m not going to bend to it.”
Last September, she called an old friend from nursing school and asked about job opportunities back in Germany.
“Brexit was a trigger,” Ms. Pardela said. “It makes you reassess your life. You find yourself thinking: ‘I’m working really hard. I haven’t had a pay raise in four years. Now they’re telling me they don’t want immigrants? Why am I still doing this here?’ ”
One reason Ms. Pardela thinks the N.H. S. is one of the best health care systems in the world is that it empowers nurses. “The range of opportunities and responsibilities is much greater here,” she said. In Germany, many of the things she has been doing — assessing blood results, adjusting treatment plans for transplant patients — would be handled by a doctor.
When the hospital required the department to cut one nurse from every shift, Ms. Pardela fought hard to win the role back. It took a year. In the end, she was successful.
“The irony,” she said, “is that now we can’t find anyone to fill it.”
The position has been empty since September.