Brexit. Love it? Loathe it? Utterly confused? The UK’s planned exit from the European Union is the biggest political and economic event of the last 50 years. Three years on from the referendum there remains huge uncertainty about the how the process shall take place or even if it shall happen at all! One thing is assured: whatever form of Brexit occurs will have a profound impact on the NHS.
Last year, most of Applican’s students faced this tricky question at an MMI interview station - How will Brexit affect the NHS? Here is Applican’s answering model.
1 – Availability of Medicines
Though the UK has a strong pharmaceutical industry, it still imports 37 million packs of medicine from the EU each month. A no-deal Brexit would likely result in huge delays at ports where these medicines enter the UK, potentially precipitating a serious shortage of vital drugs. This fear is so real that the government has taken the precaution of asking firms to stockpile a six-week supply of medicines.
Stockpiling drugs has its own problems. Some drugs, such as insulin for diabetes or vaccines, require refrigeration, so more fridges must be bought to allow stockpiling. Other drugs have very short shelf lives, so cannot be realistically stockpiled. There are plans to airlift these drugs into the UK at short notice, however this will be extremely expensive. Even normal medicines pose difficulties as stockpiling drugs involves large, upfront costs which small firms or the cash-strapped NHS may not be able to afford.
2 – Staffing
Currently about 1 in 20 members of the NHS workforce are from the EU. With staff shortages common throughout the NHS, these workers are vital. It is likely that any deal made with the EU would allow all staff currently working to remain in the UK. However the situation in a no-deal Brexit is less clear.
The government has indicated that a new immigration system which allows skilled migrants (e.g. doctors and senior nurses) to be recruited from overseas would help fill any gaps. This system is currently exists for workers applying from countries outside the EU. However, concerns have been raised that this system will miss lower-paid nurses and non-clinical staff (e.g. health care assistants) because workers must be earning more than £30,000 a year.
Brexit poses other problems for recruiting overseas staff. Brexit may be seen as an “anti-immigration” policy, thus making the UK a less attractive place to move to as a migrant. Furthermore, the economic damage and weakening value of the pound means any earnings sent back home will be worth less.
A potential benefit is that fewer overseas staff may increase the jobs available for UK citizens. The government has promised to increase the number of training places for doctors and nurses. However, training a doctor takes 5/6 years of university and then further training after that, so it is unlikely that this will compensate for any immediate drop in staff.
3 – Medical Research
The UK is a powerhouse in medical research with a number of world-leading institutions and universities. The EU supports research through programmes such as Horizon 2020 which allocate billions of euros in research and innovation grants. The UK’s strength in medical research means that it receives a disproportionate share of this funding (i.e. we get out more money than we put in). There is a risk that leaving the EU will reduce the funding available for research and jeopardise the UK’s world-leading status.
It is not all about money. A significant number of researchers and academics working at UK universities are from the EU. Similarly to NHS workers, their right to stay in the UK has not yet been established. Science is a strongly collaborative discipline; the sharing of knowledge, ideas and data is central to success. Therefore there are worries that restriction to the movement of researchers between the UK and EU could negatively impact science. In addition, conducting research across multiple countries, which is sometime necessary for rare diseases, could be more difficult.
4 – Demand on NHS services
As you are probably aware, the NHS is under significant strain with target waiting times being missed in every part of the UK. There are multiple reasons for this: an ageing population with more healthcare requirements, an increased prevalence of chronic diseases, staffing shortages and underfunding. In addition, it is a common belief in the general public that migrants are a contributing factor. In 2017 a survey found that 58% of people agreed that immigration placed pressure on public services.
However, a government review found that migrants were actually net contributors to the health service. This is because many migrants work in the health service and that they tend to be younger and healthier than the average UK citizen. It is foreseeable that a decrease in immigration following Brexit might actually make the demands on public services worse.
5 – Health Insurance
Many people in the UK have European Health Insurance Cards (EHIC) which entitle the individual to state-provided medical treatment across the EU when visiting. In addition, UK citizens living in an EU country have the same rights to healthcare as the citizens of the country they live in (the same applies to the EU citizens living in the UK).
While it is likely that any deal would ensure EHIC and these rights are retained, a no-deal Brexit would theoretically terminate these agreements. This could put patients at risk of considerable costs for treatment should they fall ill when abroad.
That was a quick overview of some of the biggest issues that Brexit may pose to the healthcare system of the UK. The uncertainty around Brexit means that much of what we have covered is still hypothetical. Nevertheless, it is clear that Brexit is going to have a profound impact. If we hope to maintain the levels of care we have come to expect, these issues must be carefully considered and solutions proposed. As it stands, we have until the 31st October 2019 – the clock is ticking.
***Disclaimer – The information that follows was correct at the time of writing. The latest Brexit deadline is the 31st October 2019. After this date, the UK shall be leaving the EU unless a further extension is granted. Currently it remains unclear what form of Brexit shall occur. As a result, the issues raised in this article are hypothetical. Nearer the deadline, we should have a better idea of the UK’s future relationship with the EU and be able to predict Brexit’s effects more accurately. Most university interviews shall be occurring after deadline so we shall review the article to ensure the information is up-to-date.