Thousands of extra deaths in UK hospitals have been linked to the collapse of the recruitment of nurses from the EU after Brexit, new research suggests.

The research estimates that within the first three years after the 2016 referendum, hospitals which had been most dependent on EU nurses experienced over 3,700 additional emergency patient deaths and nearly 14,000 extra emergency readmissions following initial discharge.

The study, led by the University of Surrey, says that that the problem was not simply about staffing gaps, but also about the quality of the replacement workers.

The study’s headline figures are drawn from large-scale hospital and workforce data rather than small clinical samples.

The research team analysed more than 32 million emergency admissions across 130 National Health Service (NHS) hospitals between 2012 and 2019.

The team then matched patient records with NHS workforce information, allowing them to compare outcomes across hospitals with different pre-Brexit exposure to EU nursing staff.

The research found no evidence that the worsening outcomes were driven by reduced funding, fewer beds, or a rise in the number of patients.

Rather, it points towards how hiring constraints reshaped the composition of hospital nursing teams.

After the referendum, hospitals did recruit to replace departing EU staff. But the researchers found that newly hired nurses were “more likely to be placed in lower NHS salary bands, suggesting less experience or fewer qualifications relative to those they replaced”.

“The effect appears to be strongest where EU recruitment had previously been heavily relied upon,” the research report says.

“Hospitals that depended more on EU-trained nurses showed the largest declines, with higher rates of emergency deaths and unplanned readmissions in the post-referendum period,” it says.

The research refutes a common recruiting assumption that filling vacancies automatically protects care quality. Rather, it suggests that abrupt restrictions on international recruitment can reduce applicant pools and unintentionally lower hiring standards when shortages hit.

Nurses working in the most affected hospitals also reported being less satisfied with the quality of care they could provide, aligning workforce-level shifts with frontline experience.

“Immigration policy can produce downstream impacts that extend well beyond employment statistics,” the research report says.

It says that skilled international recruitment is tightly linked to patient safety and operational performance.

“Healthcare systems may need to consider not only how many workers are recruited, but how policy changes influence who chooses to apply – and at what experience level,” the research report says.

Professor Giuseppe Moscelli, an economist at the University of Surrey and lead researcher of the study, said: “Hospitals were able to recruit replacement nurses, but our findings suggest they had to recruit from a smaller and less experienced pool of applicants. That appears to have had real consequences for patients.” 

“Many countries, including the UK, depend on internationally trained healthcare professionals. Our findings show that immigration policy can have unintended consequences far beyond the labour market. Decisions that make a country less attractive to skilled workers can ultimately affect the quality of care received by patients. 

“Policymakers should recognise that healthcare systems competing for skilled international workers need to consider not only the number of staff they recruit, but also how immigration policies influence who chooses to apply.”  

Read the full report: Brexit nurse exodus linked to more than 3,700 extra hospital deaths, researchers warn | EurekAlert!