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‘Brexit poses major risks to almost every part of the NHS’

Health must be top of the agenda during negotiations

Jo Carlowe

Friday, 29 September 2017

Leaving the EU poses threats to the NHS workforce, its finances, the licensing of medical products, and to health and scientific research. 

This warning comes in a Health Policy review* published, this week, in The Lancet. The authors model the likely impact of three possible Brexit outcomes: soft Brexit (a similar agreement to countries in the European Economic Area, with access to single market but restrictions on free movement of people), hard Brexit (a free trade agreement between the UK and EU) and failed Brexit (falling back on World Trade Organisation rules).

They highlight that each of the Brexit scenarios pose major risks to health, which will require serious considerations that should be incorporated into Brexit negotiations.

Even under a soft Brexit, which would minimise the impact on health, they say there are serious issues that government and policy makers need to consider, including workforce recruitment and retention, NHS financing, and governance issues on competition, trade as well as the vast amount of new legislation – such as public health protections on tobacco, air quality, but also legislation of medicinal products – which once transposed into UK law by the EU Withdrawal Act could be changed without scrutiny by elected MPs.

Professor Martin McKee, one of the authors from the London School of Hygiene & Tropical Medicine, and member of the advisory board of Healthier In (a NGO which campaigned to remain in the EU) says: “Our analysis of how Brexit will affect the NHS, although the UK's desired outcome remains unclear, is that Brexit in any form poses major risks to almost every part of the NHS, with a ‘no deal’ scenario potentially catastrophic. The EU has shown that it recognises many of these threats, and we hope that our paper encourages the UK negotiating team to make health issues a priority.”

One of the major risks is to NHS staff. The authors note that it will be increasingly difficult for the UK to be self-sufficient in terms of its NHS and social care workforce. Estimates for 2017 suggest that 60,000 people from the EU work in the NHS and 90,000 work in adult social care, with an aggregation of staff working in London and the South East, which makes these regions especially vulnerable to a loss of labour. Equally, with Northern Ireland and the Republic of Ireland sharing a health and social care workforce, Northern Ireland is also susceptible.

Another risk is the loss of funding to the NHS, which could occur directly through loss of European funds and indirectly as a result of the possible impact of Brexit on the UK economy, say the authors. The NHS has benefitted from €3.5 billion in funds from the European Investment Bank since 2001, helping to fund various public-private partnerships. Additionally, the NHS forms the largest part of the UK’s public expenditure and would naturally be impacted by any events which affect the UK economy. The authors warn that, while the UK economy has performed relatively well since the referendum, once changes due to Brexit are put in place, they will likely have a significant long-term impact, which will likely put pressure on NHS finances.

Other major issues relating to funding would likely affect individuals living abroad and people travelling to the EU for work, study or leisure – all of whom may lose their health coverage. Currently, the UK pays around £650 million per year for care provided to British people abroad (including £500 million for pensioners living abroad), which is marginal compared to the NHS budget and represents good value for money as treatments costs for pensioners in the EU are about half of their equivalent value in the UK. With an estimated 190,000 British pensioners living in other EU countries, this is likely to impact them most profoundly.

In terms of public health, the loss of the EU’s structures for managing public health pose a range of threats. For example, the UK relies on EU law for its tobacco policies, and the authors warn that without these the UK could become a prime target for the tobacco industry post-Brexit. Equally, without EU laws to improve air quality and the risk of sanctions for not achieving these, the UK’s environmental standards for air pollution levels may slip further.

Lastly, Brexit poses a significant issue to research funding in the UK, state the authors. The EU’s direct funding accounts for 17% of research contracts held by British universities and an estimated 16% of academics in the UK are from other parts of the EU. The UK attracts substantially more EU grants than it contributes to, and loss of this would have severe consequences – particularly as the UK lags behind comparative economies in its investments in research and development nationally. Even more, the EU provides research networks, infrastructure, legal frameworks, research standards and policies that underpin scientific research, and replacements will be needed after Brexit.

Lead author, Nick Fahy, University of Oxford, and formerly employed by the European Commission, said: “Health is often thought to be a purely national matter, relatively insulated from the consequences of Brexit. That is not the case; as this analysis shows, leaving the EU will have wide-ranging impacts on health and the national health service. These must be addressed now if the consequences of Brexit are not to be borne by the sick and the vulnerable."

Responding, Professor Helen Stokes-Lampard, chair of the Royal College of GPs, said: "Brexit is an unknown quantity for the NHS, along with many other sectors – whilst we don't actually know what will happen, this analysis paints a bleak picture and urgent action is needed to ensure these predictions don't become a reality.

"In fact, in terms of workforce this analysis doesn't take into account GPs and practice staff potentially affected by Brexit negotiations, so we are concerned the situation could be far bleaker. The College's own research earlier this year showed that 2,137 GPs across the UK – delivering care to over 3 million patients – could be forced to leave if their status is not protected.

"General practice is really struggling – our workload has increased 16% over the last seven years, but investment in our service over the last decade has declined, and our workforce has not risen at pace with demand. We are incredibly grateful to all EU staff currently working in general practice, supporting us to deliver vital care to over 1 million patients a day, and we welcome any other appropriately trained doctors or healthcare professionals from the EU and further afield who want to join our profession.”

She added: "The NHS was promised an extra £350 million a week during the referendum campaign – and whilst this figure has been hotly disputed, this will have influenced many people's vote. Unfortunately, there is no one to hold to account for this, but that does not mean it should be brushed under the carpet.

"We join the paper's authors in calling for health to be top of the agenda during Brexit negotiations – and from the point of view of general practice, we must ensure the status of every EU national working in UK general practice is protected as a matter of urgency, and for efforts to recruit overseas doctors as part of NHS England's GP Forward View, not to be hampered in any way.

"Negotiators must also be very clear that public health must not suffer as a result of Britain exiting the European Union – there are many laws and regulations that have been introduced to protect the health of our nation, and they must not be compromised.”

* Fahy N, Hervey T, Greer S, et al. How will Brexit affect health and health services in the UK? Evaluating three possible scenarios. The Lancet, published: 28 September 2017. DOI: 10.1016/S0140-6736(17)31926-8

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