All forms of Brexit will negatively impact the UK National Health Service (NHS), but a No-Deal Brexit presents by far the worst scenario, according to a new health policy review* published in The Lancet. There would be negative effects for the NHS workforce, NHS financing, availability of medicines and vaccines, sharing of information and medical research, it says.
The impact of Brexit would be slightly lessened if parliament accepted the Withdrawal Agreement negotiated between the UK government and the EU, but there are serious concerns about the negative impact of Brexit on the NHS beyond the transition period.
The authors of the analysis, who are leading experts in public health and law, used the available legal and political texts on four possible Brexit scenarios - a No-Deal Brexit under which the UK leaves the EU on March 29, 2019 without any formal agreement on the terms of the withdrawal, the Withdrawal Agreement including a transition agreement until the end of 2020, the Northern Ireland Protocol’s Backstop, and the Political Declaration on the Future Relationship between the UK and EU.
Remaining in the EU has previously been shown** to be the best option for health.
Professor Martin Mc Kee, co-author from the London School of Hygiene & Tropical Medicine said: “Some people will dismiss our analysis as ‘Project Fear’. But with just over a month to go to Brexit, we need to move beyond slogans. We have set out the problems in detail, based on the best available evidence. If others disagree, then they owe it to the British people to say why. It just isn’t good enough to keep saying that “something will work out” without any details of exactly how.”
Recruitment and retention to the health care workforce represents a major challenge post Brexit. The Withdrawal Agreement provides reciprocal arrangements and mutual recognition of professional qualifications up to 2020, but, no provisions for health care workers have been made in the Backstop or Political Declaration and under a No-Deal Brexit a minimum salary threshold of £30,000 per year has been proposed which could seriously limit immigration of many health workers to the UK.
Under the Withdrawal Agreement, the continuity of legal provisions will secure supply chains for medicines, vaccines, medical devices and equipment until 2020. Under a No-Deal Brexit, the absence of a legal framework for imports and exports would have an immediate and drastic effect on supply chains. Despite government reassurance of contingency plans in place, shortages are likely because stockpiling arrangements cannot cope more than a few weeks, proposals that doctors offer “best alternative medication” can be distressing for patients, and some products (such as radioisotopes) cannot be stockpiled.
Under any form of Brexit, the UK will no longer be part of the European Medicines Agency, and while the UK’s Medicines and Health products Regulatory Agency will continue to licence medicines, without laws in place to secure regulatory alignment, the UK would become less attractive for global pharma to launch new medicines, potentially meaning launch dates up to 24 months later.
Access to capital financing for NHS infrastructure via the European Investment Bank would be negatively impacted in all scenarios. As one of the largest areas of public expenditure, any negative impact in the UK economy will put additional pressure on NHS financing, and the UK has already seen a slower rate of economic growth than if it had remained in the EU.
Under the Withdrawal Agreement, reciprocal health care arrangements (e.g. via the European Health Insurance Card- EHIC) would remain but only until 2020 as there is no mechanism to continue them subsequently, although some limited bilateral agreements may be possible with time. All reciprocal health care arrangements would cease in 2019 under a No-Deal scenario. This would be particularly harmful to older UK residents and people with pre-existing conditions for whom health insurance cover in the EU would be particularly expensive.
Any form of Brexit will also harm the UK’s European and global leadership role in health. Membership of the European Centre for Disease Control is not mentioned in the Withdrawal Agreement, and while the Political Declaration mentions global collaboration on public health, it does not reference European collaboration. UK laws on air pollution, workplace health and safety, and tobacco trade derive from EU law. With the UK having failed to meet standards on air quality, there is concern that the UK might use Brexit to roll back some of these measures.
Finally, Brexit has required the mobilisation of hundreds of civil servants, but the task ahead is immense, requiring government and parliament to pass several major pieces of legislation and up to 600 statutory instruments within a month. Meanwhile important legislation, such as social care, has suffered prolonged delays.
*Fahy N, Hervey T, Greer S, et al. How will Brexit affect health services in the UK? An updated evaluation. The Lancet, February 25, 2019. DOI: 10.1016/S0140-6736(19)30425-8
**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, September 28, 2017. DOI:10.1016/S0140-6736(17)31926-8