MAJOR question marks hang over the health service's exposure to a split with the EU after it emerged there are no accurate figures on how many European doctors and nurses are currently employed by the NHS in Scotland.

The Royal College of Nursing Scotland warned that while there are "various estimates" for how many EU nationals work in the health and care sector in Scotland "none are reliable". BMA Scotland - the trade union for doctors - has called on Scottish Government to pin down EU employment figures "as a matter of urgency" to avoid a staffing crisis.

READ MORE: How Brexit could lead to Scotland and the UK becoming "the dirty man of Europe" again

RCN Scotland stressed that Brexit "presents an additional challenge to safe staffing levels and workforce planning" at a time when nursing vacancies are on the rise and the bill for agency staff to plug the shortfall has soared 47 per cent in a year, to £7.5 million.

While statistics from the Nursing and Midwifery Council indicate that there are 33,000 EU-trained nurses registered to work in the UK, they have not yet been able to compile a breakdown on how many are working in Scotland. For the UK as a whole, seven per cent of all nurses and midwives and five per cent of all nursing auxiliaries and assistants across both the NHS and private sector are non-UK EU nationals.

The care home sector could also come under strain, with the most recent available figures - from 2008 - indicating that 6.1 per cent of staff in Scottish care homes for the elderly were born in EU countries other than the UK.

Herald View: Brexit pressure on staffing in the NHS

Norman Provan, associate director of RCN Scotland, said: “The uncertainty about freedom of movement since the Brexit vote potentially creates an additional challenge to workforce planning at a time when our health and social care services are already overstretched.”

A briefing paper distributed to MSPs earlier this month by RCN Scotland stressed that uncertainty over Brexit risked exacerbating the recruitment and retention problems already being caused by an ageing workforce, stress-related sickness and a real-terms fall in nursing pay of around 14 per cent since 2010.

Certain specialities, such as mental health nursing, are particularly vulnerable to shortages because they are eligible to retire earlier, at 55.

It added: "These factors could cause a major problem for staffing in the NHS and other health and social care organisations, either directly through new restrictions preventing EU-born NHS staff from working in Britain or indirectly because EU-born staff may choose to leave the UK due to the uncertainty created before new rules are put in place on migration restriction."

READ MORE: How Brexit could lead to Scotland and the UK becoming "the dirty man of Europe" again

The paper also raised fears about a "loss of safeguards" against suspended and banned professionals. Currently, health regulators across the EU are duty-bound to share this data with one another.

There is a similar lack of clarity over how big a role EU doctors play in Scotland's NHS. While statistics from the General Medical Council show that 30,000 doctors who qualified in another EEA country are registered to practise medicine in the UK, a paper also submitted to MSPs by BMA Scotland stresses that "there is not currently data available to show how that is reflected within the medical workforce in Scotland". The GMC figure also discounts the substantial number of EU doctors who studied medicine in the UK.

The paper urges the Scottish Government to "[carry] out research into the number of non-UK EU nationals working in health and social care in Scotland with a view to recording and reporting on this in the future".

Herald View: Brexit pressure on staffing in the NHS

It also highlights how important EU medics have been to "filling shortages in specialities which may otherwise have remained empty", adding: "Given the length of time taken to train a doctor, failure to offer doctors from the EU certainty about their future status risks not only undermining workforce planning in the NHS but also the ability of the health service to maintain safe staffing levels and patient safety.

"In the midst of significant recruitment and retention problems, the last thing the NHS needs is any further loss of medical staff."

Dr Peter Bennie, chair of BMA Scotland, said: “There is still a worrying lack of detail about what Brexit will mean for the significant numbers of medical staff from other EU countries working in our NHS and on whom the health service absolutely depends.

“The continued uncertainty our friends and colleagues from other EU countries face over their future status is deeply irresponsible and it is long past time for the UK Government to provide assurances to NHS staff from EU countries that they will still be welcome here after Brexit.

“As long as this uncertainty persists, there is also a need for the NHS in Scotland to prepare for all possible consequences and to be able to do that far better information on how many doctors and other NHS staff could be affected by any change in status or visa requirements is needed.

READ MORE: How Brexit could lead to Scotland and the UK becoming "the dirty man of Europe" again

“The last thing that the NHS in Scotland needs is for the recruitment and retention problems it already faces to be made significantly worse through any loss of medical staff.”

Health Secretary Shona Robison said: “Professionals from all over the world have been integral to our NHS for decades and their valued commitment to the health service is reflected in our commitment to them. We want them to stay as we hugely appreciate the work that they do and the contribution they make to life in Scotland. We are working to see their rights and place in Scotland places are protected.

Herald View: Brexit pressure on staffing in the NHS

“We will ensure that the needs of the NHS and social care sector, and the value of being able to recruit staff from across the EU, is fully reflected in our national workforce plan that is currently under development. 

“This will include working with staff representative organisations, like the BMA and RCN, to provide reassure and support to their members from elsewhere in the EU.”