What will Brexit really mean for the NHS?

The NHS was high on the agenda during the EU referendum.  Vote Leave’s claim that money sent to Europe could be diverted to the NHS caused great controversy.  The message emblazoned on the campaign bus grabbed many newspaper headlines, but it was one which politicians were quick to distance themselves from immediately after the vote. vote.  So what will really be the impact of Brexit on the NHS?  We take a look at the 5 potential big issues for health identified by The King’s Fund.

1. Funding

The NHS is facing the biggest financial crisis in its history.  The latest forecasts from NHS Improvement show a deficit of £644m for 2016/17,  whilst recent research published by the Guardian and campaign group 38 Degrees estimates that the financial shortfall will reach a staggering £20bn by 2020-21 if no action is taken. It’s therefore not surprising that Vote Leave’s pledge of £100m more per week for the NHS struck a chord with many voters.

Whatever the pledge, the most important factor in the future funding of the NHS will be the performance of the economy.  Brexit sent shockwaves throughout Europe and the rest of the world leading to immediate concerns over the British economy and a climate of uncertainty which could last for years.  The NHS would be lucky to escape any contraction in public spending, which for a service which is already unable to live within its existing budget would be disastrous.

According to Jonathan Puddle, head of healthcare at Aecom, many NHS Trusts are already having to divert funds from capital investment and maintenance budgets to fund the operational needs of hospitals in meeting the increasing needs of patients.   If the NHS does not receive increased funding it seems unlikely that Trusts will be able to fund the construction of new hospitals or refurbish existing facilities.

2.  Staffing

The right to freedom of movement of EU citizens within member countries was a hotly debated issue during the referendum campaign.  What will happen to EU citizens currently working in the UK and British citizens living and working abroad is now one of the biggest unanswered questions.  Currently 55,000 of the NHS’s 1.3 million workforce come from other EU countries.  Whilst the policy on freedom of movement will remain in place until we extract ourselves from EU membership (which could take some years), the uncertainty could lead EU staff to leave to work in other EU countries.  The NHS is already facing a recruitment crisis with approximately 50,000 full-time vacancies unfulfilled and Brexit is likely to exacerbate this issue.

3. Collaboration

There is a huge sharing of knowledge and information across EU members which enables countries to rapidly react to cross border health threats and to make significant advances in scientific research.   Between 2007-2013 the UK received €8.8 billion for research, development and innovation activities against a UK contribution of €5.4 billion.  The impact on the ability of UK researchers to access funding post Brexit is already being felt and medical experts predict that Brexit could be a disaster for British science.

4. Regulation

EU regulations currently affect many important areas within healthcare.  These include:

• The working time directive
• Procurement and competitive law
• Medicines and medical devices
• Professional standards

The UK government will need to clarify whether it intends to repeal EU regulations in these areas or draft alternatives.  For example, the working time directive limits the time employees can work to 48 hours per week (doctors can opt out of this limit).  If the government were to repeal this, NHS contracts would have to be re-drafted.

5. Access to treatment in the UK and abroad

There are approximately 1.2 million British people living in other EU countries.  Under the European Health Insurance Card scheme they are able to access state provided healthcare in other member countries, the cost of which is reclaimed via reciprocal health care agreements.

A high proportion of British citizens living abroad are pensioners who have greater health needs leading to concerns that if they were to return they would increase the pressure on the NHS.   This could be offset by a reduction in EU migrants in the UK (approximately 3 million), however, statistics suggest migrants tend to be less of a drain on our public health services as they tend to be a lot younger than British citizens living abroad.

The UK Government faces a huge task in disentangling the country from the EU.  It may take years before we know the full extent on how this could affect the NHS.  However, whether we eventually do or don’t fully exist the EU, one thing is for sure –  the NHS is in crisis and the budget deficit will continue to grow unless our healthcare system is re-designed.  So in the NHS of the future (Brexit or non-Brexit) it seems we are all going to have to get a bit better at taking responsibility for managing our own health.