There is little doubt that Brexit is a decision that polarised our nation in a way few decisions ever have before. As the primary source of much recent political, social and economic turmoil, Brexit’s implications are far reaching. Indeed, few doubt that its backlash will affect all corners of life within the UK. But with so much uncertainty shrouding the Brexit negotiations, what will this mean for health in Britain and our NHS in particular? 

In short, it will mean uncertainty. On one hand, the decisions and deals brokered due to Brexit could potentially help strengthen the NHS for the years to come. Or conversely, this could plunge the NHS into a state of further disarray. After all, the outcome of Brexit negotiations will affect many areas of the NHS, from funding to employment, even cross-border healthcare.

NHS funding and budgetary issues are closely linked to the outcome of Brexit. The rallying call of the “Vote Leave” campaigners was a pledge to take the £350 million that was paid to the EU per week and  instead use this money to fund the NHS. However, this was swiftly retracted by Nigel Farage the morning of the referendum result and replaced with a more genuine pledge of £100 million per week. Yet, despite the immediate boost in budgets arising from this pledge, this would do little to help an already underfunded NHS. Furthermore, the short-term slowing of the economy associated with leaving the EU will result in lower tax revenue and higher welfare spending from the government. The Office of Budgetary Responsibility (OBR) forecast a £15.2 billion reduction to public finances by 2020/2, resulting directly from Brexit. This would mean that if this were to be shared proportionally throughout the public sector, based on its current make up there will be a £2.4 billion reduction in annual NHS spending in England alone.

However, the situation is not as hopeless as one might think. There are in fact measures that can be taken by the State to help prevent this financial burden from impacting the NHS. An example of such measures would be raising taxes and introducing austerity measures in other sectors to help lessen the projected deficit. In addition to these suggested measures, the Conservative party have pledged to deliver an £8 billion increase in real terms for the NHS over the next 5 years. However, where this money will come from given the current economic climate remains to be seen. Indeed, this pledge should be treated somewhat skeptically considering the government’s inconsistent and decidedly opaque leadership since the EU referendum.

The aforementioned tax rises and austerity measures to counteract the projected financial burden is, however, conditional upon the government making a firm commitment to continue allowing substantial nurse migration once we have left the EU, as the alternative is extremely costly. Currently there are 58,000 EU nationals working within the NHS and the UK imports approximately 10,000 nurses per year from Europe to staff our NHS. With a 92% decrease in post-referendum arrivals coupled with the possibility of nurse migration shutting off completely, the Department of Health estimates a shortage of 20,000 nurses by 2025/26 ( This would augment the issue of our already chronically understaffed NHS.) Additionally, this means that a commitment from our government allowing nurse migration to continue once we leave the EU is the only viable option, (with the alternative being a rigorous increase in domestic training of doctors, nurses and healthcare staff.)  An increase in domestic training then, would be ideal as it would reduce our dependence on the EU to staff our NHS.

Nonetheless, the facts remain,  funding this would cost an inordinate amount of money and time. Even if this were to be implemented immediately, it would take three years from training to joining the workforce, taking us a year past the Brexit date and resulting in a period of chaos for the NHS.

Cross-border healthcare is another area that requires our attention. Currently the EU’s policy on healthcare for pensioners states that they have the right to travel to any member state and receive the same healthcare rights as nationals. With approximately 190,000 expat pensioners living abroad it is paramount to secure a deal in which they retain their healthcare rights. This is because the burden will fall to the NHS to care for those who are legally required to leave by their circumstances. The financial burden posed by the forced return of our expat pensioners is costly; the Department of Health pays roughly £500 million to other countries to cover the cost of care for our expats, and upon return the increase in annual costs for the NHS could amount to an extra £1 billion. This figure however neglects the need for increased resources and staff needed to provide care. Estimates suggest that we would need 1,600 additional nurses and 900 hospital beds (equivalent to two new hospitals being built) to provide care for those returning. As previously discussed, the NHS is already understaffed and with hospital bed admissions maintaining a fairly high rate. This, too is a serious problem for the NHS. Furthermore, the additional funding required to make this possible only contributes to the already heavy financial burden associated with Brexit.

Therefore,  leaving the EU poses a serious risk to the future of the NHS. Even prior to the Brexit referendum, the NHS was challenged with limited funding and understaffing.Furthermore, there are clear signs that the Brexit negotiations will exacerbate these issues and drive the NHS to an irreparable state. To ensure the sustainability of our NHS post Brexit, it is paramount that the government provides us with firm commitments protecting the legal status of healthcare workers from the EU, residing in Britain. This is specifically needed for nurses, who need to be legally protected from any migration restrictions that may be implemented post-Brexit. Such a commitment on the government’s behalf would not only relieve any potential issues that would surface due to insufficient staffing but this would also allow us to circumvent the need to increase domestic training of healthcare professionals.

Moreover, with regards to the NHS’ budgetary issues, there is little that can be done to lessen the impact of the OBR’s projected £2.4 billion reduction to NHS spending by 2020/21, (that is to say, other than implementation of higher tax rates and stringent austerity measures in other sectors.)  As for the Conservative pledge to increase NHS spending by £8 billion over the next 5 years, although it has not materialized yet, there is little doubt that this could help current circumstances.

It is also extremely important to maintain the cross-border healthcare policy that is currently in play or perhaps, implement a new one as similar to it as possible. An influx of expat pensioners seeking care in the wake of Brexit would, of course, be detrimental to the NHS. Furthermore, failing to maintain this cross-border healthcare policy will only contribute to the aforementioned financial burdens and apply a great deal of extra pressure to the currently insufficient workforce.

Lastly, it is imperative that the Conservative government who have promised a strong and stable leadership be more transparent with their intentions. The opaque leadership style we have witnessed heading into the Brexit negotiations clearly demonstrates contempt and actively diminishes the gravitas of the matter at hand. This negotiating stance that has been taken is only exacerbating the veil of uncertainty that shrouds the outcome of the Brexit negotiation, placing the fate of the NHS in jeopardy.

 

Luke Symons currently holds the position of PC President for Global Health at King’s Think Tank.

 

 

 

 

 

 

References

Blitz, J. (2017). The Brexit risk for the NHS. Financial TImes. [online] Available at: https://www.ft.com/content/7658ec98-202f-11e7-b7d3-163f5a7f229c [Accessed 1 Sep. 2017].

Conservative Party (2017). The Conservative and Unionist Party Manifesto 2017. London: Conservative Party, pp.66-73.

Content.digital.nhs.uk. (2017). Hospital Episode Statistics – NHS Digital. [online] Available at: http://content.digital.nhs.uk/hes [Accessed 8 Sep. 2017].

Mason, R. (2017). European leaders can ‘go whistle’ over EU divorce bill, says Boris Johnson. The Guardian. [online] Available at: https://www.theguardian.com/politics/2017/jul/11/european-leaders-can-go-whistle-over-eu-divorce-bill-says-boris-johnson [Accessed 1 Sep. 2017]. Nhsconfed.org. (2017). The Implications. [online] Available at: http://www.nhsconfed.org/regions-and-eu/nhs-european-office/brexit/implications [Accessed 8 Sep. 2017].

Nuffield Trust (2017). Getting a Brexit deal that works for the NHS. General Election 2017. [online] London: Nuffield Trust, pp.1-17. Available at: https://www.nuffieldtrust.org.uk/resource/getting-a-brexit-deal-that-works-for-the-nhs [Accessed 1 Sep. 2017].

Office for Budget Responsibility (2016). Economic and fiscal outlook. [online] Office for Budget Responsibility. Available at: https://www.gov.uk/government/publications [Accessed 8 Sep. 2017].

Pearson, A. (2017). Forget the nursing crisis. Here’s how Brexit can save the NHS. The Telegraph. [online] Available at: http://www.telegraph.co.uk/women/politics/forget-nursing-crisis-brexit-can-save-nhs/ [Accessed 1 Sep. 2017].

Stone, J. (2016). Nigel Farage backtracks on Leave campaign’s ‘£350m for the NHS’ pledge hours after result. Independent. [online] Available at: http://www.independent.co.uk/news/uk/politics/eu-referendum-result-nigel-farage-nhs-pledge-disowns-350-million-pounds-a7099906.html [Accessed 1 Sep. 2017].