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Matt Haig: ‘There is no more shame in mental illness than having tonsilitis’

The problem we have with talking about mental health is that we still don’t think of it as an equal priority with physical health. This is wrong not simply because it leads to less money being spent on mental health service provision by governments, but also because it fails to see that the whole idea of mental health shouldn’t be an isolated one.

As a species, we love to divide things up. We draw a straight line in a map between the Atlantic and Indian Oceans while the water remains oblivious. We also draw a line between the mental and physical and base our entire system of healthcare on that false division.

Once upon a time, the medical world detailed the makings of the human body by saying there were four distinct humours. Every single health complaint could be explained as an excess or deficiency of one of four distinct bodily fluids – black bile, yellow bile, phlegm and blood. And these in turn were related to the four elements, as well as the four seasons and the four ages of man.

If in those golden olden days you were feeling depressed, or melancholic, that was down to an overload of black bile. In fact, the very word melancholia, as with melancholy, stems via Latin from the ancient Greek words melas kholē, which literally meant “black bile”. It seems funny, now, this idea. But in one way at least it was more advanced than much of our present approach. Namely, it did not see a rigid divide between physical and mental health. Mental illness was seen to have physical roots, and was associated with the four elements.

Now, of course, if you visit your doctor about persisting feelings of worthlessness and despair and the futility of existence they will be unlikely to talk of bile of any kind. But then, before we think we are at the end of progress, and have all the answers, we should remember that our doctors might not talk about your body at all.

And yet everything I have come to learn about my own experience of mental health and illness has taught me that this is also a mistake. Even if you have the idea that mental illness is solely an illness of the brain, the brain is a physical thing. The brain is the body. Mental health is physical health. Bodies and minds interact.


You can’t draw a line between a body and a mind any more than you can draw a line between oceans

I would go even further. I don’t want to get too cross-legged on a Himalayan mountain top, but mental health isn’t just brain health. Mental health is intricately related to the whole body. And the whole body is intricately related to mental health. You can’t draw a line between a body and a mind any more than you can draw a line between oceans.

It’s comforting to realise that many cognitive scientists these days acknowledge this. Thoughts aren’t just the products of brains, and vice versa. As Guy Claxton – himself a cognitive scientist – writes in Intelligence in the Flesh, “the body, the gut, the senses, the immune system, the lymphatic system, are so instantaneously and so complicatedly interacting with the brain that you can’t draw a line across the neck and say ‘above the line it’s smart and below the line it’s menial’.” In short: “we don’t just have bodies. We are bodies.”

The word “holistic” is so often associated with scientifically dubious kinds of therapies, but the science is slowly leading us towards a more holistic view of minds and bodies, so our healthcare needs to acknowledge that. We need to realise the physical nature of mental illness and the mental nature of physical illness. Mental hospitals and physical hospitals should all be mental-physical hospitals (but maybe they should be called something catchier).

A happy side product of erasing the line between mind and body, a line that has been boldly drawn since Descartes, would be to destigmatise mental health by placing it on an equal footing with stigma-free physical issues such as asthma and arthritis. It would also lead to a better health service. If mental health was understood in physical terms, it would stop being the poor relation of health when it comes to government funding.

Ultimately, it wouldn’t just help doctors and nurses to understand us better. It would also change the way we view ourselves. The idea that our minds are in our control, and that free will is all, still pervades, and makes people feel a kind of guilt or shame for being ill. A guilt that in itself exacerbates symptoms. We need to truly understand the way minds and bodies interact with each other, and how both are affected by the world.

So a new, more integrated, healthcare system would not only be good because it would help patients, it would also help anyone feeling distress to understand that there is no more shame to be felt than if they had tonsillitis. Illness is illness, and health is health. There can be no “mind over matter” when we understand that mind is matter.

How to Stop Time by Matt Haig is published by Canongate. To order a copy for £7.99 (RRP £12.99) go to bookshop.theguardian.com or call 0330 333 6846. Free UK p&p over £10, online orders only. Phone orders min p&p of £1.99.

A moment that changed me: listening to, rather than trying to fix, my suicidal wife | Mark Lukach

One afternoon my wife, Giulia, asked me: “Mark, if I kill myself, will you promise me that you will find a new wife so that you can still be happy?” I sighed and leaned back into the chair next to her, unsure of what to say.

Actually, that’s not entirely true. I knew exactly what I wanted to say. I had been saying it for eight months. It’s just that at that moment, I was so tired – tired from work, tired from worry, tired from so many conversations about suicide – that I didn’t have the energy for it again. So I sat in silence.

My wife had been hospitalised eight months previously with a psychotic break. It started with a new job, which made Giulia more stressed than she had ever been, to the point of work paralysis, loss of appetite and inability to sleep. The slide into psychosis was rapid and entirely unexpected. Sure, she had been stressed out before, but nothing like this. Out of desperation, I took her to the emergency room, where they admitted her to the psych ward for 23 days to address her escalating paranoia and delusions.

She came home from the hospital heavily medicated and suicidally depressed. She had little to no energy for anything, and spent much of her time wishing that she could kill herself.

This was terrifying for me. I took a few months off work, so that she wouldn’t be alone all day, a prospect that worried me and her doctors. When she brought up suicide, which was all the time, I panicked. I treated her feelings like a fire, and I was the extinguisher. I had to act quickly, otherwise the warning sparks could grow.

Her first fixation was on overdosing on her medication, so I concocted a plan to hide the pills. I changed the hiding place every few days, and retrieved the medication each night as she waited for me in the bathroom, and then hid them again after she took them. Can’t overdose on pills if you can’t find them.

Mark Lukach and his wife, Giulia, on their wedding day.


Mark and Giulia Lukach, on their wedding day.

Then her focus shifted to the Golden Gate Bridge. She wanted to drive there on our scooter and jump off, and she told me about this, over and over again. I couldn’t hide a bridge.

She told me these things when we were walking on the beach together, or at home cooking dinner, but I was so afraid that I responded in full emergency mode, as if we were up on the bridge, Giulia on one side of the railing and me on the other. I couldn’t not see it that way. Someone I loved was in pain, and I needed to do something about it.

“Doing something” meant reminding her of all the reasons it was worth staying alive – how good we had it, how much our families loved us, how much there was to look forward to. It almost became a script, a choreographed dance: she told me she felt suicidal; I tried to overwhelm her feelings with why she shouldn’t feel that way. It never convinced her of anything. But on that afternoon, exhaustion had beaten me down into shutting up. I sat quietly and held her hand.

She looked at me in surprise. Cautiously, she ventured with another thought. “I hate myself so much, and I want to die,” she said, and I said nothing.

“I wish I had never been born,” she said.

More silence.

She continued through her tortured feelings. I listened, and hated what I heard, but I knew that at this moment she was safe. We weren’t actually there on the bridge railing. We were at home, together, and there was no way she could act upon her pain. These were just words.

And then she left me stunned. “Thank you for listening to me,” she said, pulling my hands to her lips to kiss. “It’s so nice to talk to you. I feel a lot better.”

I hadn’t said a word. It dawned on me how little I had been listening to her, without judgment or rush to action. She didn’t need me to tell her that everything was going to be OK. That didn’t help. She needed me to hear her pain. Being heard somehow made it more manageable.

On that afternoon I finally learned that when any of us is in pain, the greatest gift you can give is to listen, patiently and purely.

In the UK, the Samaritans can be contacted on 116 123. In the US, the National Suicide Prevention Hotline is 1-800-273-8255. In Australia, the crisis support service Lifeline is on 13 11 14. Hotlines in other countries can be found here.

I’d rather crawl around in squalor than go into a care home

I’m rather worried by the news that one in three care homes are unsafe and unclean. I thought they were just unpleasant, dreary, the food was crap and you weren’t allowed to take your dog. I was already thinking: “No, thank you, I’d rather struggle on at home, even if I have to crawl around on my hands and knees in squalor because I haven’t the strength to tidy, and can barely wipe my own bottom. I don’t care. I’m not going into one of those dumps.”

Now I’m even more determined. Imagine if you were booking your holiday hotel and were told there was a one-in-three chance it would be rubbish, and cost a fortune. Wouldn’t you rather stay at home? It’s all very well the Care Quality Commission (CQC) revealing these “shocking” findings, but what are they going to do about it? Inspectors seem to have been finding shocking things for years. They tell us all about them, they frighten the life out of us, and that’s more or less it until the next lot of findings, with elderly people sitting in excrement, not being given adequate food or water, falling over or being assaulted by staff. I can do most of that myself at home for free, without the assault.

Thank you, Andrea Sutcliffe, head of the CQC, for telling us this can “have a profound impact on people’s lives”. I know that, but what are you going to do about it? I heard Sutcliffe on the Today programme last week beginning most of her answers with: “So …” or, “And …” It sounded very odd, as if she wasn’t answering at all. “Why aren’t these places closed down?” asked John Humphrys. “So,” said she, “we think one of the most important things we can do is identify the problems and make sure they’re put right.”

“And what if they’re not?” asked Humphrys. What indeed? And what happens to elderly residents stuck therefor at least six months while things are, or possibly are not, being put right? I hope I never have to find out.

I’d rather crawl around in squalor than go into a care home

I’m rather worried by the news that one in three care homes are unsafe and unclean. I thought they were just unpleasant, dreary, the food was crap and you weren’t allowed to take your dog. I was already thinking: “No, thank you, I’d rather struggle on at home, even if I have to crawl around on my hands and knees in squalor because I haven’t the strength to tidy, and can barely wipe my own bottom. I don’t care. I’m not going into one of those dumps.”

Now I’m even more determined. Imagine if you were booking your holiday hotel and were told there was a one-in-three chance it would be rubbish, and cost a fortune. Wouldn’t you rather stay at home? It’s all very well the Care Quality Commission (CQC) revealing these “shocking” findings, but what are they going to do about it? Inspectors seem to have been finding shocking things for years. They tell us all about them, they frighten the life out of us, and that’s more or less it until the next lot of findings, with elderly people sitting in excrement, not being given adequate food or water, falling over or being assaulted by staff. I can do most of that myself at home for free, without the assault.

Thank you, Andrea Sutcliffe, head of the CQC, for telling us this can “have a profound impact on people’s lives”. I know that, but what are you going to do about it? I heard Sutcliffe on the Today programme last week beginning most of her answers with: “So …” or, “And …” It sounded very odd, as if she wasn’t answering at all. “Why aren’t these places closed down?” asked John Humphrys. “So,” said she, “we think one of the most important things we can do is identify the problems and make sure they’re put right.”

“And what if they’re not?” asked Humphrys. What indeed? And what happens to elderly residents stuck therefor at least six months while things are, or possibly are not, being put right? I hope I never have to find out.

I’d rather crawl around in squalor than go into a care home

I’m rather worried by the news that one in three care homes are unsafe and unclean. I thought they were just unpleasant, dreary, the food was crap and you weren’t allowed to take your dog. I was already thinking: “No, thank you, I’d rather struggle on at home, even if I have to crawl around on my hands and knees in squalor because I haven’t the strength to tidy, and can barely wipe my own bottom. I don’t care. I’m not going into one of those dumps.”

Now I’m even more determined. Imagine if you were booking your holiday hotel and were told there was a one-in-three chance it would be rubbish, and cost a fortune. Wouldn’t you rather stay at home? It’s all very well the Care Quality Commission (CQC) revealing these “shocking” findings, but what are they going to do about it? Inspectors seem to have been finding shocking things for years. They tell us all about them, they frighten the life out of us, and that’s more or less it until the next lot of findings, with elderly people sitting in excrement, not being given adequate food or water, falling over or being assaulted by staff. I can do most of that myself at home for free, without the assault.

Thank you, Andrea Sutcliffe, head of the CQC, for telling us this can “have a profound impact on people’s lives”. I know that, but what are you going to do about it? I heard Sutcliffe on the Today programme last week beginning most of her answers with: “So …” or, “And …” It sounded very odd, as if she wasn’t answering at all. “Why aren’t these places closed down?” asked John Humphrys. “So,” said she, “we think one of the most important things we can do is identify the problems and make sure they’re put right.”

“And what if they’re not?” asked Humphrys. What indeed? And what happens to elderly residents stuck therefor at least six months while things are, or possibly are not, being put right? I hope I never have to find out.

I’d rather crawl around in squalor than go into a care home | Michele Hanson

I’m rather worried by the news that one in three care homes are unsafe and unclean. I thought they were just unpleasant, dreary, the food was crap and you weren’t allowed to take your dog. I was already thinking: “No, thank you, I’d rather struggle on at home, even if I have to crawl around on my hands and knees in squalor because I haven’t the strength to tidy, and can barely wipe my own bottom. I don’t care. I’m not going into one of those dumps.”

Now I’m even more determined. Imagine if you were booking your holiday hotel and were told there was a one-in-three chance it would be rubbish, and cost a fortune. Wouldn’t you rather stay at home? It’s all very well the Care Quality Commission (CQC) revealing these “shocking” findings, but what are they going to do about it? Inspectors seem to have been finding shocking things for years. They tell us all about them, they frighten the life out of us, and that’s more or less it until the next lot of findings, with elderly people sitting in excrement, not being given adequate food or water, falling over or being assaulted by staff.

Thank you, Andrea Sutcliffe, head of the CQC, for telling us this can “have a profound impact on people’s lives”. I know that, but what are you going to do about it? I heard Sutcliffe on the Today programme last week beginning most of her answers with: “So …” or, “And …” It sounded very odd, as if she wasn’t answering at all. “Why aren’t these places closed down?” asked John Humphrys. “So,” said she, “we think one of the most important things we can do is identify the problems and make sure they’re put right.”

“And what if they’re not?” asked Humphrys. What indeed? And what happens to elderly residents stuck there for at least six months while things are, or possibly are not, being put right? I hope I never have to find out.

More patients waiting longer than a week for GP appointments

Growing numbers of patient are waiting a week or more to see their GP or are unable to get an appointment at all, according to a major annual report.

A survey of more than 800,000 patients in England reveals that the proportion of patients waiting longer than seven days to see a doctor has risen 56% in five years – with 20% waiting this period compared to 12.8% in 2012.

The number unable to get an appointment has also risen to 11.3%, an increase of 27% since 2012. Of those who were not able to get an appointment or found the appointment offered was not convenient, 14.6% did not see or speak to anyone as a result.

Rising numbers are also struggling to even get through to surgeries over the phone, according to findings of the annual GP survey in 2017. The poll, published by NHS England with Ipsos Mori, also found fewer patients are seeing their preferred GP.

Prof Helen Stokes-Lampard, chair of the Royal College of GPs, said it was “very concerning” that more people had to wait longer for appointments, putting it down to a “decade of under-investment”.

“It is particularly worrying that some patients are deciding not to seek medical advice at all if they are not able to get an appointment initially,” she said.

There are an estimated 370 million patient consultations a year, up by 60 million on five years ago. Stokes-Lampard said: “GPs are working flat out to provide care for as many patients as we possibly can, but there are limits beyond which we can no longer guarantee safe care.”

Despite declining access, however, overall satisfaction with GPs remains high, with 85% of people rating their experience as good. A further 92% also had confidence and trust in the last GP they saw.

Rachel Power, chief executive of the Patients Association, said that it was reassuring that patient satisfaction was holding up, but described the findings of long waits for appointments as “worrying”.

“We know there are multiple pressures on general practice in terms of both its workforce and the ageing profile of patients. There will be no solution unless and until the government gets serious about investing in the NHS, and even then the path back to consistently high quality in services will be a long one,” Power said.

The survey showed 27.8% of those surveyed said they found it difficult to get through to their doctor on the phone, this was a 50% increase from 2012.

People were also asked how often they see or speak to their preferred GP, of who 383,770 answered. Of these, 56% see their preferred GP always or a lot of the time, down from 65% in 2012. Almost one in 10 patients said they never or almost never get to see the GP of their choice.

NHS England’s GP Forward View pledges to provide an extra £2.4bn a year for general practice and 5,000 additional GPs by 2020. Stokes-Lampard called for this to be delivered as a “matter of urgency”.

Dr Arvind Madan, director of primary care for NHS England, said: “General practice is the foundation of the NHS and this survey shows patients appreciate the fantastic job GPs and the wider primary care workforce are doing in times of real pressure with more patients having increasingly complex conditions.

“Access to GPs is already expanding with 17 million people now able to get an appointment in the evening and at weekends, and everyone will be able to by March 2019.”

More nurses and midwives leaving UK profession than joining, figures reveal

More midwives and nurses are leaving the profession in the UK than joining for the first time on record, with the number departing having risen by 51% in just four years.

The figures, which will add to concerns about NHS staff shortages, show that 20% more people left the Nursing and Midwifery Council (NMC) register than joined it in 2016/17. The overall number of leavers was 34,941, compared with 23,087 in 2012/13.

While concerns have previously been raised about a large drop in EU registrants in the wake of the Brexit vote, the NMC figures, published on Monday, show that it is the departure of UK nurses – who make up 85% of the register – that is having the biggest impact. In 2016/17, 29,434 UK nurses and midwives left the register, up from 19,818 in 2012/13, and 45% more UK registrants left than joined last year.

Unions say there is a shortage of 40,000 nurses and 3,500 midwives in England alone and they, and NHS trusts, blamed the pay cap and workplace pressures.

Saffron Cordery, director of policy and strategy at NHS Providers, said: “The NHS is severely stretched and we need to keep and value our staff. This is important for the quality and particularly the continuity of care. We need to follow through on the investment in training staff by consolidating and building on their skills, motivating them and giving them reasons to stay in the NHS.”

After consecutive yearly rises in the number of people on the register since 2013, the number fell by 1,783 in 2016/17. It has dropped more steeply since then, by a further 3,264 in April and May.

The average age of those leaving the register has fallen from 55 in 2013 to 51. Of those who left in 2016/17, 2,901 were in the 21-30 age group, almost double the 2012/13 number.

Janet Davies, chief executive and general secretary of the Royal College of Nursing, said patients were paying the price of government policy. “The average nurse is £3,000 worse off in real terms compared with 2010,” she said. “The 1% cap means nursing staff can no longer afford to stay in the profession and scrapping student funding means people can no longer afford to join it.”

Davies said it was worrying that many were going abroad. The NMC logged 4,153 “verification requests” from overseas licensing authorities – mostly in Australia, the US and Ireland – in relation to UK registrants in 2016/17.

An NMC survey of more than 4,500 nurses and midwives who left the register over the previous 12 months found that about a half had retired. Among those who had not, the top three reasons cited for leaving were working conditions, including staffing levels (44%), a change in personal circumstances, such as ill health (28%), and disillusionment with the quality of patient care (27%). Other reasons included leaving the UK (18%) and poor pay and benefits (16%).

Jon Skewes, the Royal College of Midwives’s director for policy, employment relations and communications, said: “The incredible pressures midwives are under due to increasing demands on services are a factor here. This combined with years of pay freezes and pay restraint has left our health professionals demoralised and disillusioned.”

The number of EU workers – who make up 5% of the register – leaving increased to 3,081 from 1,173 in 2012/2013. There were 247 responses to the NMC survey from EU registrants, with 32% saying Brexit had persuaded them to consider working elsewhere.

A Department of Health spokeswoman said: “We are making sure we have the nurses we need to continue delivering world-class patient care – that’s why there are almost 13,100 more on our wards since May 2010 and 52,000 in training.”

The spokeswoman highlighted the NHS Improvement programme to increase staff retention, which launched last week. However, Cordery said it would have limited impact unless the pay cap and “unsustainable workplace pressures” were addressed.

More nurses and midwives leaving UK profession than joining, figures reveal

More midwives and nurses are leaving the profession in the UK than joining for the first time on record, with the number departing having risen by 51% in just four years.

The figures, which will add to concerns about NHS staff shortages, show that 20% more people left the Nursing and Midwifery Council (NMC) register than joined it in 2016/17. The overall number of leavers was 34,941, compared with 23,087 in 2012/13.

While concerns have previously been raised about a large drop in EU registrants in the wake of the Brexit vote, the NMC figures, published on Monday, show that it is the departure of UK nurses – who make up 85% of the register – that is having the biggest impact. In 2016/17, 29,434 UK nurses and midwives left the register, up from 19,818 in 2012/13, and 45% more UK registrants left than joined last year.

Unions say there is a shortage of 40,000 nurses and 3,500 midwives in England alone and they, and NHS trusts, blamed the pay cap and workplace pressures.

Saffron Cordery, director of policy and strategy at NHS Providers, said: “The NHS is severely stretched and we need to keep and value our staff. This is important for the quality and particularly the continuity of care. We need to follow through on the investment in training staff by consolidating and building on their skills, motivating them and giving them reasons to stay in the NHS.”

After consecutive yearly rises in the number of people on the register since 2013, the number fell by 1,783 in 2016/17. It has dropped more steeply since then, by a further 3,264 in April and May.

The average age of those leaving the register has fallen from 55 in 2013 to 51. Of those who left in 2016/17, 2,901 were in the 21-30 age group, almost double the 2012/13 number.

Janet Davies, chief executive and general secretary of the Royal College of Nursing, said patients were paying the price of government policy. “The average nurse is £3,000 worse off in real terms compared with 2010,” she said. “The 1% cap means nursing staff can no longer afford to stay in the profession and scrapping student funding means people can no longer afford to join it.”

Davies said it was worrying that many were going abroad. The NMC logged 4,153 “verification requests” from overseas licensing authorities – mostly in Australia, the US and Ireland – in relation to UK registrants in 2016/17.

An NMC survey of more than 4,500 nurses and midwives who left the register over the previous 12 months found that about a half had retired. Among those who had not, the top three reasons cited for leaving were working conditions, including staffing levels (44%), a change in personal circumstances, such as ill health (28%), and disillusionment with the quality of patient care (27%). Other reasons included leaving the UK (18%) and poor pay and benefits (16%).

Jon Skewes, the Royal College of Midwives’s director for policy, employment relations and communications, said: “The incredible pressures midwives are under due to increasing demands on services are a factor here. This combined with years of pay freezes and pay restraint has left our health professionals demoralised and disillusioned.”

The number of EU workers – who make up 5% of the register – leaving increased to 3,081 from 1,173 in 2012/2013. There were 247 responses to the NMC survey from EU registrants, with 32% saying Brexit had persuaded them to consider working elsewhere.

A Department of Health spokeswoman said: “We are making sure we have the nurses we need to continue delivering world-class patient care – that’s why there are almost 13,100 more on our wards since May 2010 and 52,000 in training.”

The spokeswoman highlighted the NHS Improvement programme to increase staff retention, which launched last week. However, Cordery said it would have limited impact unless the pay cap and “unsustainable workplace pressures” were addressed.

More nurses and midwives leaving UK profession than joining, figures reveal

More midwives and nurses are leaving the profession in the UK than joining for the first time on record, with the number departing having risen by 51% in just four years.

The figures, which will add to concerns about NHS staff shortages, show that 20% more people left the Nursing and Midwifery Council (NMC) register than joined it in 2016/17. The overall number of leavers was 34,941, compared with 23,087 in 2012/13.

While concerns have previously been raised about a large drop in EU registrants in the wake of the Brexit vote, the NMC figures, published on Monday, show that it is the departure of UK nurses – who make up 85% of the register – that is having the biggest impact. In 2016/17, 29,434 UK nurses and midwives left the register, up from 19,818 in 2012/13, and 45% more UK registrants left than joined last year.

Unions say there is a shortage of 40,000 nurses and 3,500 midwives in England alone and they, and NHS trusts, blamed the pay cap and workplace pressures.

Saffron Cordery, director of policy and strategy at NHS Providers, said: “The NHS is severely stretched and we need to keep and value our staff. This is important for the quality and particularly the continuity of care. We need to follow through on the investment in training staff by consolidating and building on their skills, motivating them and giving them reasons to stay in the NHS.”

After consecutive yearly rises in the number of people on the register since 2013, the number fell by 1,783 in 2016/17. It has dropped more steeply since then, by a further 3,264 in April and May.

The average age of those leaving the register has fallen from 55 in 2013 to 51. Of those who left in 2016/17, 2,901 were in the 21-30 age group, almost double the 2012/13 number.

Janet Davies, chief executive and general secretary of the Royal College of Nursing, said patients were paying the price of government policy. “The average nurse is £3,000 worse off in real terms compared with 2010,” she said. “The 1% cap means nursing staff can no longer afford to stay in the profession and scrapping student funding means people can no longer afford to join it.”

Davies said it was worrying that many were going abroad. The NMC logged 4,153 “verification requests” from overseas licensing authorities – mostly in Australia, the US and Ireland – in relation to UK registrants in 2016/17.

An NMC survey of more than 4,500 nurses and midwives who left the register over the previous 12 months found that about a half had retired. Among those who had not, the top three reasons cited for leaving were working conditions, including staffing levels (44%), a change in personal circumstances, such as ill health (28%), and disillusionment with the quality of patient care (27%). Other reasons included leaving the UK (18%) and poor pay and benefits (16%).

Jon Skewes, the Royal College of Midwives’s director for policy, employment relations and communications, said: “The incredible pressures midwives are under due to increasing demands on services are a factor here. This combined with years of pay freezes and pay restraint has left our health professionals demoralised and disillusioned.”

The number of EU workers – who make up 5% of the register – leaving increased to 3,081 from 1,173 in 2012/2013. There were 247 responses to the NMC survey from EU registrants, with 32% saying Brexit had persuaded them to consider working elsewhere.

A Department of Health spokeswoman said: “We are making sure we have the nurses we need to continue delivering world-class patient care – that’s why there are almost 13,100 more on our wards since May 2010 and 52,000 in training.”

The spokeswoman highlighted the NHS Improvement programme to increase staff retention, which launched last week. However, Cordery said it would have limited impact unless the pay cap and “unsustainable workplace pressures” were addressed.