- 15 Aug 2018
FOI reference: FOI/18/01921
Date received: 16 July 2018
Date responded: 13 August 2018
1. Any written assessment of the effects of leaving (a) European Union (b) the European Medicines Agency (c) Euratom on (i) the Scottish NHS (ii) the Scottish NHS workforce (iii) Scottish patient access to medicines and treatments;
2. Written records of any communications within the last six months between Health and Social Care Directorate and (a) the Strategy and Constitution Directorate (b) any NHS Scotland Board (c) any other Directorate of the Scottish Government (d) any Ministry of the UK Government (e) the UK Permanent Representation to the EU on the impact of leaving the European Union on the NHS workforce;
3. Any written impact assessment, assessment, situation analysis, risk register or similar document produced by (a) the UK Government (b) the Scottish Government (including the Directorate) (c) a third party on the effects of leaving the European Union on the NHS workforce;
4. Information on the number of NHS Scotland staff who are (a) are non-UK citizens (b) are non-UK EU citizens (c) are non-UK non-EU citizens and how many staff have left since the Brexit referendum?
In terms of your first, second and third requests, I attach copies of some of the information you requested.
The Scottish Government remains extremely concerned about the impact of leaving the EU, not least because a great deal of uncertainty continues to characterise both the negotiations and the UK Government's ultimate objectives with regard to the future relationship with the EU, making detailed analysis and assessment of the many scenarios we might face very difficult. For example, if free movement of EU nationals in the UK is modified or curtailed as a result of the Brexit negotiations this could have potentially serious consequences for the recruitment and retention of health and social care workers in Scotland. It could also negatively impact the free movement of medical researchers between Scotland and other EU countries and it could affect the ability of our academic institutions to attract medical students to come here to study and train, impacting on the provision of health care.
The Scottish Government believes that Scotland's health workforce benefits enormously from the contribution made by staff from across the EU. The free movement of people from the EU and EEA allows skilled and experienced health professionals to work in our NHS, where they fill skilled vacancies in hard to recruit specialisms and geographical regions. Many EU citizens work in social care, in roles that may be low skilled or relatively low paid and so would likely fall below the thresholds in the non-immigration system. We need to retain the ability to recruit from this diverse and experienced talent pool in order to be able to continue to provide high-quality services. The Scottish Government's published its analysis of the contribution of EEA workers to Scotland, sector by sector and including health, in its contribution to the UK's Migration Advisory Committee, which can be found at:
Further analysis in this area can be found in the Scottish Government publication 'Scotland's Population Needs and Migration Policy', from 7 February 2018:
You might also find it helpful to know that Scottish Ministers update the Scottish Parliament regularly, including on EU withdrawal preparedness issues, as the UK's negotiations to leave the EU progress. Further information on the work being conducted by the Scottish Government can be found at:
In addition, the former Cabinet Secretary for Health and Sport has written three times over the past 6 months to the Scottish Parliament's Health and Sport Committee in the context of its inquiry into the implications of leaving the EU for health and social care in Scotland, to provide Scottish Government assessments of the situation. The former Cabinet Secretary for Health and Sport also provided oral evidence to the Committee on 18 March. In addition, the inquiry received detailed submissions on this subject from a wide range of stakeholders, covering issues including the possible impacts both for the NHS in Scotland and for patients in Scotland of leaving the EU, the European Medicines Agency (EMA) and Euratom. All of this information can be found on the Scottish Parliament's website at:
You may also be interested to view the briefing notes available on the Scottish Parliament website at http://www.parliament.scot/ which provide a range of SPICe briefing papers in relation to the UK's negotiations to leave the EU.
Securing access to medicines and treatments for Scottish patients is of the highest priority to the Scottish Government. With regard to the effects of leaving the European Medicines Agency, I enclose copies of letters from the Cabinet Secretary for Health and Sport to Jeremy Hunt, former UK Secretary of State for Health, seeking both clarification on the UK's future relationship or membership and assurance about Scottish patient access to medicines and treatments. I also attach the Scottish Government's contribution to the House of Commons Health Select Committee Brexit Inquiry on medicines, medical devices and substances of human origin. It is important to emphasise that licensing, safety and efficacy of medicines is reserved to the UK Government and is the responsibility of the Medicines and Healthcare Products Regulatory Agency (MHRA), which operates on a UK wide basis. It is the Scottish Government's view that the reserved matters are the most likely to impact on access to medicines and treatments in Scotland and the wider UK.
In relation to the other parts of your first, second and third requests, we are unable to provide some of the information you have requested because of exceptions that have been applied under sections 28(1), 29(1)(a) and (b) relating to relations with the UK and the formulation or development of government policy and Ministerial communications, under sections 30(b)(i) and (ii) which allow for the free and frank exchange of advice and views, under 30(c) as it would be likely to prejudice substantially the effective conduct of public affairs and under section 38(1)(b) relating to third party personal data. The reasons why these exemptions apply are explained in the Annex to this letter.
In terms of your fourth request about information on the number of NHSScotland staff who are (a) non-UK citizens (b) non-UK EU citizens and (c) non-UK non-EU citizens, due to the lack of comprehensive data available the main source of data we use is the Annual Population Survey (APS). The APS combines results from the Labour Force Survey (LFS) and is a household survey of people in the UK. Its purpose is to provide information on the UK labour market and it also includes data such as country of birth and nationality. Further information on the APS can be found at: http://www.gov.scot/Topics/Statistics/Browse/Labour-Market/Publications
We also use data published by regulatory bodies such as the General Medical Council (GMC) and the Nursing and Midwifery Council (NMC). Further information can be found at the GMC and NMC websites:
For NHS workforce data, National Services Scotland Information Services Division (ISD) publish a range of NHS workforce data that you might also find helpful. Further information on this can be found at: http://www.isdscotland.org/
Reasons for not providing information
Exemptions under section 28(1), 29(1)a and (b), sections 30(b)(i) and (ii), 30(c) and 38(1)(b) FOISA apply to some of the information you have requested.
These exemptions are subject to the 'public interest test'. Therefore, taking account of all the circumstances of this case, we have considered if the public interest in disclosing the information outweighs the public interest in applying the exemptions. We have found that, on balance, the public interest lies in favour of upholding the exemptions.
We recognise that there is strong public interest in release in the interests of open, transparent and accountable government and to inform public debate and discussion on the potential impact that leaving the EU will have on the people in Scotland and indeed on the NHS workforce. The Scottish Government has been at great pains ever since the EU referendum to make every attempt to inform public debate, including through publication of a number of detailed discussion papers. One such paper specifically addressed workforce issues. Scottish Ministers have also actively contributed to and expressed views in a number of areas as part of the public debate in the Health and Sport Committee's inquiry into the implications of EU withdrawal for health and social care in Scotland.
However, to ensure the Scottish Government can maintain effective delivery of health services to the people of Scotland post-EU Withdrawal, we need access to information from other organisations, including the UK Government. To continue receiving such information, we need to preserve the trust of those bodies that have shared information with us and do not expect us to release it. Therefore, we have concluded that the public interest in the release of the information in question is outweighed by the public interest for upholding application of the exemptions, in the interests of maintaining working relations with the UK, formulation or development of Scottish Government policy, Ministerial communications, free and frank provision of advice and views, the effective conduct of public affairs and personal data relating to third parties.
The Scottish Government is committed to publishing all information released in response to Freedom of Information requests. View all FOI responses at http://www.gov.scot/foi-responses
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Please quote the FOI reference:
Central Enquiry Unit
Phone: 0300 244 4000
The Scottish Government
St Andrews House