The impact of Brexit on the NHS
While the UK political world was busy trying to start World War Three, I noticed an academic report was published looking at the impact of Brexit on the NHS.
The report was released by The UK in a Changing Europe – a group promoting rigorous, high-quality and independent research into the complex and ever-changing relationship between the UK and the EU. It is funded by the Economic and Social Research Council and based at King’s College London.
The report can’t find any positives for the NHS in the post-Brexit UK. Their conclusion is sobering and makes a mockery of the message on the side of the Vote Leave bus.
Brexit and the NHS
The impact of Brexit on the NHS and public policy will hinge on a number of factors. Clearly, the state of the UK government’s finances will be crucial in determining future health provision. In common with the broad consensus among independent economists, and the official forecasts produced by the OBR, our analysis does not foresee any dividend for the NHS from the UK leaving the EU.
On the contrary, there are likely to be further pressures on public-service funding more broadly from a hit to economic growth caused by Brexit. This will mean tough choices for the government. It could decide to increase healthcare funding, but this will have to come from raising taxes, borrowing or diverting funds from other priorities.
The UK’s decision to leave the EU has not created the funding pressures on the NHS, but it is likely to exacerbate them. Similarly, should funding pressures become more acute after Brexit, there will be direct knock-on effects on waiting times, and thus recovery rates, as well as the quality of care that can be delivered.
Brexit is also likely to worsen existing staff shortages, potentially reducing service quality.
There has already been a fall in the number of EU-origin nurses, attributed at least in part to uncertainty about their future status. Longer term, the NHS and the social care sector are dependent on immigration policy for fulfilling staffing needs, and it is as yet unclear what this policy will be. The risks, however, are evident.
The government may decide to put greater funding into training places for doctors and financial support for training nurses, as well as other support staff. However, the budget constraints alluded to above stand here too. The UK has benefitted greatly from importing skilled health workers that other countries have paid to train. There is a balance to be struck between an immigration regime that provides enough skilled workers on the one hand and training sufficient staff in the UK to fill vacancies on the other. However, the latter does not represent a quick fix, as training takes the better part of a decade.
Reliance on EU staff differs widely across the UK.
This means that we should expect different areas to experience different levels of disruption, with London, the south east of England and Northern Ireland most likely to be affected. It should also be noted that our analysis does not cover social care in any depth, which will be particularly badly affected if future immigration requirements become more restrictive for key personnel in this sector.
For patients, there are likely to be disadvantages from leaving the EU, mainly by virtue of losing access to healthcare in their country of residence (especially for pensioners) or to the EHIC.
Although the EHIC itself is by no means comprehensive, it does offer security to UK citizens travelling to the EU, who make up the vast majority of UK visitors abroad. This is not to say that some form of reciprocal healthcare agreement cannot be reached, but it would probably only cover current EHIC holders, and for future patients probably be more limited in scope than it is now. Although agreeing this individual measure may seem eminently achievable in isolation, dozens if not hundreds of such agreements will be required to maintain current benefits in the health policy area alone.
In sum, the effect of these changes is likely to increase costs for UK travellers to the EU by virtue of requiring health insurance, which itself will be more expensive than it would have been without the EHIC behind it. Those worst affected will be the elderly and those with serious underlying conditions, who may not qualify for health insurance or for whom it will be expensive.
Furthermore, Brexit might impact on the socioeconomic determinants of health, such as employment, income and living costs.
A recent paper found that the life expectancy of a boy from the richest fifth of neighbourhoods in England was 8.4 years higher than that of a boy from the poorest fifth; for girls, this gap was 5.8 years. Although this is a complex issue, and many other factors as well as the UK’s relationship with the EU will drive changes, most economic analysis suggests that there will be a hit to the UK economy from Brexit, which will translate into worse health outcomes. Wealth and health are very closely connected, so it follows that if the population becomes less wealthy, then health outcomes will be affected.
It is too early to say what degree of alignment will exist between the UK and the EU after Brexit.
There are numerous health systems and databases, such as the Clinical Trials Database and the Rapid Alert System for Blood and Blood Components (RAB) that will require specific agreements in order that the UK retain access. This issue is particularly acute on the island of Ireland, where the two healthcare systems are well integrated. Although specific agreements allowing, say, ambulances to operate across borders would conceivably be possible, any restrictions on the movement of healthcare goods, services and people will be to the detriment of patients on both sides of the border.
There are wider concerns from the devolved governments that areas of healthcare competence previously held at EU level being recentralised will shift the balance of policymaking powers, jeopardising existing projects funded through EU projects and having wider impacts on the socio-economic determinants of health.
Yet it will be the detail of the agreements that the UK will need to sign with the EU that will be decisive for
public health and the NHS. We have set out what we consider the central areas that need to be addressed in order for the NHS to be successful and improve health outcomes after Brexit. What cannot be in doubt, though, is the complexity and scale of the task facing the government. Many of these issues can be resolved with political will and appropriate resources. When it comes to both, however, the pressure will be significant as the Government will need to deal with Brexit in tandem with pre-existing ones over long-term sustainability and social care provision.
Ensuring a well-functioning health service, and protecting public health, after Brexit is by no means impossible, but the challenges are significant.
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