If the British public wants a functioning NHS, it will have to accept freedom of movement

Anyone with recent experience of the NHS will have good reason to confirm the generally fine standards of care – and realise that the service depends crucially on health professionals and auxiliaries from throughout the European Union.

Soon it may be the case that anyone using the NHS will be forced to realise that that high and reliable medical treatment cannot be supplied in the absence of such workers – because of the consequent shortcomings in that care. Brexit, in other words, means a worse NHS. As with so many other things, that was certainly not on the ballot paper on 23 June 2016.

Confirmation that the NHS faces severe shortages of skilled staff comes with the latest figures on vacancies – up about 10 per cent on this time last year, with worrying signs that EU nationals are returning to their former homes. Even if it were the case that Britain could train the sort of numbers required to meet the ever more intense demands on the NHS, that would take years. Yet the sheer scale of the demand for labour, set against the UK’s poor supply of potential workers in the correct age groups, suggest that even that is a forlorn hope.

At least two things, therefore, need to happen to ameliorate matters before the crisis becomes more desperate. First, the Government has rapidly to conclude the first stage agreement with the EU 27 on the future status of EU nations in the UK, their families and their rights. Allowing some say for the European Court of Justice in this matter, at a time when so many are anxious about their protection, does not seem a high price to pay. The ECJ, by its nature, is seldom invoked in any case, and its vestigial presence on the British legal scene doesn’t constitute any great offence to sovereignty (for those who believe in such simplicities). That would at least help stem the drain of talent from surgeries and wards on these shores.

Second, the Government has to face up to the realities of immigration, and start to explain to the great British public that they cannot both have extreme reductions in migration and a functioning health service. The NHS needs foreign workers and of course there can be a rational debate about where they can come from – and there is no necessary reason, post-Brexit, why an Austrian medic would enjoy a stronger claim to work in Britain than one from Australia. However, ministers do need to start that process of education and explanation as soon as possible, and they cannot do so while the Government clings to a long-discredited migration cap. Lifting the cap is a prerequisite for a healthier NHS.

Ministers might also care to examine the case for lifting the public pay cap, either to encourage potential trainees from the UK itself to enter nursing, in particular, or to retain and motivate those who have come from overseas, or both. They might also care to reflect on the effect on wages and the cost of the NHS from severely restricting the supply of workers from the rest of the world, whether we are inside the EU or not.

The crisis in the NHS, then, is real and likely to intensify for all manner of reasons. It wasn’t debated much in the EU referendum campaign and certainly not with much veracity – we are still waiting for the injection of £350m a week into the NHS form funds diverted from Brussels, as promised by the Leave campaign bus. It represents yet another reason why the realities of Brexit have to be put before the British people in a referendum on its terms and conditions.