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.

Health and Social Care Workforce

One of the immediate effects of Brexit will be on the workforce of the health and social care sector. Today, over 60,000 Europeans are employed by the NHS and another 90,000 work in adult social care. To this day, those workers have been treated as nationals in terms of their immigration status and conditions of employment. However, the UK’s withdrawal from the EU could change that, for both the current and the future staff of the British healthcare system. A new immigration and professional qualification regime will need to be adopted post-Brexit, to regulate the entrance, residency, and employment of EU medical and social care workers in the UK. The impact of Brexit on this domain is already visible. In March 2017, a 92% drop was reported in the number of EU nurses registering to the NHS, which could be linked to the uncertainty for EU workers about their future status. A decline, although much lesser, has also been observed after the Brexit referendum in the applications of EU licensed doctors to the NHS. Again, the underlying uncertainty of workers about their immigration and employment conditions has been identified as the main reason for this trend.

Reciprocal Healthcare Coverage and Cross-border Healthcare

Apart from working rights across the EU, freedom of movement allows EU visitors who possess a European Health Insurance Card (EHIC) to use the health care services of the NHS. Conversely, the great number of UK travellers or pensioners who reside to European countries can currently receive free or low-cost health services outside the UK. This reciprocal healthcare coverage could end once the UK exits the EU. Although the UK might benefit from the fact that it will no longer provide health services to non-UK nationals, it will need to cover the health expenses of the UK nationals (and particularly pensioners) who were previously insured by EU countries. The number of people who will need to be covered by the NHS post-Brexit will be much greater than before. According to reports, about 145,000 UK pensioners rely on EU health services at the moment, whereas only 4,000 EU pensioners are registered to the NHS. Recently, the UK Government announced that the EHIC should be safeguarded after Brexit.

Medicines, Products, and Devices

The EU regulates the licensing and supply across its members of all kinds of health products -from pharmaceuticals and medical devices, to substances of human origin, like blood and organs. The competent authority for this work is the European Medicines Agency (EMA), which, until recently, was based in London and is now relocated to Amsterdam. It is not yet certain whether the UK’s withdrawal from the EU will also terminate the country’s participation in the above licensing mechanism. But if it does, the UK will no longer be able to distribute its medical products across the EU at the current levels of high speed and low cost. Of course, the UK has its own medical authority, called the Medicines and Healthcare Products Regulatory Agency. However, this organisation deals exclusively with the supply of medicines at national, rather than at cross-border level. If the UK wishes to keep using medical products from the EU or supply the community with its own ones, it will need to make a special arrangement with the EMA.

Public Health

Within the years, the EU has developed a comprehensive and innovative legal framework, controlling: the consumption of foods and products which are responsible for diseases like obesity and diabetes; the distribution of tobacco and alcohol; and the control of toxic emissions from cars and industries which could be harmful to people’s health. The EU has also shown outstanding competence to respond to cross-border health threats, like Ebola, in a co-ordinated and effective manner. By leaving the EU, the UK will potentially no longer have a voice in shaping the community’s health agenda. Likewise, the UK’s departure from the EU law could mean that the decisions of the EU courts on matters of healthcare will no longer bind the UK and its regulatory bodies. This might be detrimental to any British citizens, who will seek to protect their rights in the future against national healthcare service providers.

Resources

The EU is a significant source of funding. Initiatives, like the Horizon 2020 programme, and bodies, like the European Social Fund and the European Regional Development Fund provide EU members with the necessary means to conduct research and make significant discoveries in the field of healthcare and medicine. Since 2001, the EU Investment Bank has provided over €3.5 billion to the NHS. The UK Government has announced its willingness to preserve Horizon 2020 funding, but not at “any cost”. It remains to be seen whether similar arrangements will be made for other EU resources. The UK’s departure from the EU will mean that these funds need to be covered by domestic sources. Moreover, every year, a number of scholarships are awarded to British universities and institutions for the conduct of postgraduate studies or conferences on sciences, like medicine.

Market Functioning and Trade Agreements

Finally, Brexit will have an impact on trade. The creation of a single market in the EU allows the conduct of economic and trade activities without severe tax or regulatory barriers. The above benefits extend to the provision of healthcare services within the EU. They contribute to lower transaction costs between the member States, and which in turn can contribute to more effective patient care. A shift in the existing framework may entail the imposition of quotas, tariffs and other measures that would affect the flow of goods and services between the single market and the UK. This would affect the management of British hospitals and NHS clinics, the procurement of medical supplies, and eventually, the provision of services to patients.

The areas of the UK’s healthcare which are likely to be affected by Brexit are numerous and diverse. But whether this impact will be minimal, substantive, or devastating for the NHS has yet to be measured. Insofar as negotiations are still in progress, one can only estimate the magnitude of the potential outcomes, rather than make accurate predictions. The early studies support that, overall, the impact of Brexit on the NHS could be negative.

Marianthi Pappa is a Researcher and PhD candidate at the University of Aberdeen.

This article was originally posted on the University of Aberdeen School of Law blog and is reposted with permission.

Note: The views expressed in this post are those of the author, and not of the UCL European Institute, nor of UCL.

Photo by Gordon Joly on Flickr.