While the prime minister struggles to find a Brexit that pleases a few hundred MPs, there are a good few thousand doctors who feel considerably less consulted on the details, and who view what is happening with dismay.
Doctors who qualified in other EEA (European Economic Area) countries – 9 per cent of all those licensed to practise in the UK – have had their loyal service rewarded with years of uncertainty since the referendum in June 2016.
There are very many concerns the BMA has been highlighting on the implications of Brexit, especially in the event of leaving without a deal. These include the supply of radioisotopes for cancer treatment, the end of reciprocal healthcare arrangements, and the return of a hard border between Northern Ireland and the Republic.
But in some ways, it’s the stories of individual doctors – many of whom were drawn to the NHS and who expected to spend their full working lives here – which are the most compelling rebukes to political intransigence and inactivity.
‘Brexit makes you feel like you’re not accepted’
Senior clinical fellow in intensive care Michael Kalogirou came to the UK from Greece in 2013, after the challenging economic climate in his home country left him unable to secure employment.
Having never visited the UK before, Dr Kalogirou spent his first six months in the country alone before being joined by his wife and two children.
‘I came from Greece in 2013 because there were no interesting hospital jobs. I wanted to expand my knowledge in intensive-care medicine, so I decided to come to the UK.
‘The NHS differed a lot from the system that I was used to in Greece which [back in 2013] was quite chaotic. Here I found the NHS was much more organised and everything I wanted [in my job] was available. In Greece from 2009 to 2013 we lacked basic things like gloves and gauze, the situation there was very difficult when I left.’
After securing a job at the Royal London Hospital, Dr Kalogirou says he and his family began to adapt and start to enjoy their new lives in the capital.
‘We settled in to life in London quite easily. My kids went to an English school rather than a Greek school as I thought it would be of benefit to them to learn another language and experience a different school system.’
The cloud descends
When the EU referendum result arrived in June 2016 he says it felt like a cloud had suddenly settled over his life and sense of belonging in the UK.
‘It’s not a good thing, [Brexit] makes you feel like you’re not accepted now, although in my everyday experience this is not the case,’ he says.
‘It is still not decided how it will happen; a no-deal Brexit is still in the air and seems like a high possibility now and that bothers me a lot.’
A policy paper on citizens’ rights published by the Department for Exiting the EU insisted EU citizens and their family members living in the UK would be able to stay even in the event of a no-deal scenario.
‘After the vote I did not feel as welcome in the UK as I had before’
The paper added that eligibility for the EU Settlement Scheme for all those already living in the UK by 29 March would also remain in place under no deal.
Having lived continuously in the UK for more than five years, Dr Kalogirou has been able to apply for settled status, which has given him and his family a certain degree of reassurance over their futures in the UK.
However, he is worried that Brexit, particularly a no-deal scenario, could potentially make it harder for his family in Greece to come and visit. He adds that he also worries about the overall effect leaving the EU could have on the UK economically.
He adds that because medical posts such as his tend to be offered on six- to 12-month contracts, he also has the lingering concern over the stability of his employment in the UK.
‘Until there’s a deal on paper that’s signed and agreed I will not feel reassured,’ he says.
Dr Kalogirou adds he still has a home in Greece and could return there to find work but adds that he and his family want to stay in the UK.
‘I have no imminent desire to go back; we’re quite happy and settled here and feel very happy doing the job that I do – it’s very rewarding. If the situation meant that I felt that I had to leave, it would not be an easy decision.’
Rights at risk
As a process, Brexit appears to have been all about the necessity of tough decisions. For European doctors who have come to the UK to train or work in the NHS, constant uncertainty and having to decide whether to leave or to stay is something they have had to deal with for more than two years.
A survey of EEA doctors published by the BMA in November 2018 reveals some sobering realities as to the outlook of European doctors working in the NHS less than six months away from the UK’s exit.
The survey found that 78 per cent of respondents were not convinced or assuaged by the Government’s pledges to protect their rights after March in the event of no deal.
This lack of trust is all too familiar to one Belgian junior doctor who arrived in the UK just a month after the vote to leave to join her partner, another EU citizen.
The doctor, who asked not to be named, spelt out her concerns as to what the reality of life after Brexit might be for her and for the health service.
‘I came to the UK shortly after qualifying in Belgium at the end of July 2016 and started my first job in the NHS just over a month later,’ she says.
‘The result of the referendum was announced on the day of my graduation, although I had already finalised our plans to come here. Obviously, we were quite shocked and a bit uncertain as to how this [Brexit] would affect any future we might want to build in the UK.’
‘A no-deal Brexit is still in the air and seems like a high possibility now and that bothers me a lot’
She adds that while being in a training post gave her some security towards being able to remain in the UK for at least the next few years, she is already concerned as to whether any qualifications gained here would be recognised if she moves to another part of Europe.
She says that the loss of freedom of movement post-Brexit would have a significant effect on the NHS and describes Brexit negotiations as having been a ‘complete shambles’.
‘I feel a lot of politicians are just attacking one another because of their personal attributes and that a lot of the political parties are being very selfish and pushing their own agendas rather than trying to come to a compromise as to how Brexit should be carried out,’ she warns.
‘Looking back at the Windrush scandal it’s hardly reassuring that if something like that can happen to people who have been living here for 30-odd years, how can they [the Government] provide any assurance that something similar won’t happen to EU citizens 10 years down the line?’
In its survey, the BMA finds that although 66 per cent of respondents said they were committed to working in the UK, a sizeable 35 per cent were considering moving abroad.
Among the reasons cited for this position were:
– the UK’s exit from the EU in general along with the attendant effects of negative attitudes toward EU workers
– uncertainty over personal immigration status
– the Government’s treatment of EU citizens.
‘One of the reasons that my husband and I left was that we felt uncertain about our futures and our child’s future, even if the Government says that we are still welcome,’ says Italian junior doctor Federica Ceroni (pictured below).
Upon arriving in the UK in 2012, having gained her medical qualification in Italy the previous year, Dr Ceroni first worked in Basildon, followed by stints in Luton, Watford and eventually Great Ormond Street.
Despite intending to gain only a few years of experience in the UK, Dr Ceroni decided to begin specialty training in paediatrics.
‘Initially, I came to the UK just to gain a couple of years of experience in another country, mainly because I have English as my main second language and because my husband [who works in finance] was being transferred there.
‘I ended up staying longer and starting to put down roots. After Brexit, however, the situation changed. After the vote living in the UK felt “different”, difficult to explain. I did not feel as welcome [in the UK] as I had before … it felt as if all that I had done while in the country had not been appreciated.’
While emphasising that most of her patients were sympathetic and apologetic regarding Brexit, Dr Ceroni says that after her husband, who works in finance, was relocated from the UK by his employer, she took the decision to take an out-of-programme career break and has now returned to Italy where if she wants to work as a trainee, she has to apply again, probably losing the years done in the UK, owing to how the Italian training system is legislated.
She has grave concerns for the fate of the NHS in the aftermath of the UK’s exit from the EU and feels the referendum has permanently changed her perspective of the country.
‘Before the vote, the NHS was talked about as one of the priorities for Brexit in the sense that they make people believe if the UK left there would be more money for the health service,’ she says.
‘Obviously, this hasn’t happened and won’t happen because I don’t think the NHS is a priority for the Government at the moment.
‘The NHS will lose precious staff coming from Europe, not only doctors but nurses and other professionals who will not come or will go back or to another country because of the situation [in the UK].’
Following the association’s latest survey of EEA staff, BMA council chair Chaand Nagpaul (pictured below) wrote to Theresa May to urge her government to give further reassurances on the rights of EU citizens following Brexit.
He said: ‘Doctors from Europe are a much valued and integral part of our NHS. The past two and a half years of Brexit negotiations have been an unending ordeal for them. It is clear from the BMA’s latest survey that many of these doctors feel either uncertain about their futures in the UK or even unwelcome, despite the Government’s attempts to address these concerns.
‘While the BMA welcomes the Government’s pledges to maintain EU citizens’ right to remain even in the event of a no deal, ministers have a responsibility to offer further assurances while the final outcome of the UK’s exit from the EU is yet to be determined.’