The Impact of Brexit on the NHS: Cure or Disease?

Brexit will have a significant impact on the NHS across multiple domains. Here, Marianthi Pappa, Researcher at the University of Aberdeen, outlines the impact of Brexit on the NHS workforce, financial resources for healthcare, public health, medicines and much more. 

The National Health Service (NHS) is one of the UK’s most important institutions. Since its establishment in 1948, it provides healthcare to all citizens of the United Kingdom of Great Britain and Northern Ireland, regardless of their economic status. It is also one of the country’s largest employers, employing thousands of medical and non-medical staff members. The impact of Brexit on this national pride is still uncertain. For the campaigners in favour of Brexit, the departure from the EU was portrayed as saving the UK £350 million per week, which could be reinvested in the NHS. But as time passes, this argument faded away despite the recent pledge made by the Prime Minister.

An inquiry was commenced by the House of Commons Health Committee about that issue, but was abruptly disrupted by the general election of June 2017. In its report, the Committee pointed out six areas which are likely to be affected by Brexit: health and social care workforce; reciprocal healthcare coverage and cross-border healthcare; medicines, products medical devices, clinical trials and wider health research; public health, including environmental protections and communicable diseases; resources, including EU agencies, funding programmes, networks and health in overseas aid; and market functioning and trade agreements. Because of its disruption by the 2017 election, the Committee has managed to cover only the first two areas from the above list. This article explains the Committee’s views on the examined topics and sheds some light on the areas which remain unaddressed.

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Doris, cleaner to the chattering classes, and the NHS

Doris brexit 1Doris cleaner to the chattering classes

A new UCL European Institute series of cartoons by Ros Asquith featuring Doris, a cleaning lady that witnesses the divides of a society shaken by Brexit. This series will be composed of a monthly cartoon shedding light on a particular issue around the British society and Brexit from July 2018 till the departure of the UK from the EU in March 2019.

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Can the UK be an independent leading regulator in the development of new medicines and medical devices?

device pic

The Chequers summit on 6 July and the subsequent resignation of ministers illustrates how controversial it is to decide whether the UK should share a “common rule book” with the EU after Brexit, or set up its own independent regulators. In this blog, Derek Hill looks at the regulation of medicines and medical devices as examples of the thin margin of action that the UK has to innovate and transform its regulatory landscape in the health sector.

The UK has a strong tradition in life-sciences, including in developing new medicines and medical devices to help improve healthcare. Pharmaceutical companies have been among the most successful UK companies. Medicines and medical devices are very highly regulated.  Many of these regulations are essential for protecting patients, but they also slow down innovation. With the UK on course to leave the European Union at the end of March 2019, it is important to assess the relative merits of the UK remaining closely tied to the EU’s regulations for medicines and medical devices, or to diverge from EU regulations to catalyse innovation in products that could benefit patients and help grow businesses.

For example the cabinet minister Michael Gove has argued the great British success of the pharmaceutical industry is “held back by the principles of the Clinical Trials Directive”. Former life science minister, George Freeman, makes case for a Brexit that will counter ‘anti-science’ politics in the EU. As an example, he looks at the rapidly growing area of digital health where he argues old regulatory silos can stifle innovation.

Could leaving the jurisdiction of EU clinical trial regulations and medical device regulations lead to a renaissance in innovation in medical drugs and technology that could strengthen the UK life science sector?

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A Cardiologist Views Brexit

Historic NHS

John Martin draws from his personal experience as a member of the European Society of Cardiology to explain the benefits of European cooperation in medical research and beyond. He stresses the need for the UK to join the moral leadership championed by the EU in the world.

I am as British as any Brexiteer. I served as Regimental Medical Officer in the Ghurkha Field Force in Hong Kong. An ancestor lost a leg at Waterloo. My family members were decorated in several wars. Thirty members of my family served around the world in the East Yorkshire Regiment and the Northumberland Fusiliers. Imperial glory runs in my veins. I feel the tingle of a special relationship when in Delhi or in “The Commonwealth of Connecticut”. But the past belongs to the past, I belong to the future; I enjoy reverie as part of my personal culture, however it does not determine my destiny.

I am now a European first, a Yorkshireman second and British third. I have taken my British past and incorporated it into a new rich forward-looking vision as a citizen of the European Union. I lived this vision as a member of the board of the European Society of Cardiology (ESC) for eight years. The ESC is a forum for European cardiologists to discuss science and clinical practice. In its Practice Guidelines, following rigorous analysis, it brings the best practice in one member state to the attention of the others. This is important in itself but it also balances the commercial importuning of industry. (These guidelines are often different from the US equivalent.) The ESC’s Annual Scientific Meeting is the biggest professional congress in the world. I want to be there at the heart of the decision making process of the ESC just as, alas, I wanted the UK government to be at the heart of EU decision-making.

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Those with changing preferences on Brexit are the engaged, not the dissatisfied and alienated

Boatleave - 10The so-called swing voters are often portrayed as being dissatisfied and disengaged from politics. Germ Janmaat draws from the conclusions of a research paper on changing preferences on Brexit to challenge that view and shows that the voters that changed their mind on Brexit express a high interest in politics and believe they are better informed than average.

Much research has already been done on the predictors of the view that Britain should leave the European Union. We thus know that older people, males, whites, and the less well educated are more inclined to vote for Brexit than their counterparts. We also know that those with socially conservative values and opinions on issues such as immigration, raising of children, and law and order are much more likely to prefer Leave over Remain. It is further common knowledge that opinions on UK’s membership of the EU are not exactly static:  While 53.8 per cent of the British public wanted the UK to leave the EU in June 2011, this percentage declined to 37.0 in May 2015 before it rose again to more than 50 in 2016.

We do not know, however, who changed their view on Britain’s membership of the EU and how they changed it. Was it primarily the indifferent and disengaged voters who started leaning more towards leave from a position of indecisiveness? Or was it a feature of well-informed and involved citizens who made a radical switch from backing Remain to supporting Leave? Knowing this will help us in making meaningful predictions about future trends in opinions about Brexit. If the changers were mainly engaged voters closely following the news, one could imagine that support for Leave starts to decline if the economy splutters and Brexit is increasingly blamed for this in the public debate. In contrast, if volatility is a feature of the disengaged, it might be more difficult to predict future developments.

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