At a time when the UK’s National Health Service (NHS) is facing operational and economic pressures, and junior doctors are striking and threatening to move to Australia, the looming uncertainty of Brexit (which means “Brexit” apparently according to Teresa May), leaves us questioning, what is going to happen to the great NHS?
The already short staffed NHS currently consists of many health care professionals from other EU countries. Currently 55,000 NHS workers come from the EU. That is 5% percent of NHS staff, 10% of doctors, and 4% of nurses are EU immigrants. Dr. Sarah Wollaston MP said, “If you meet a migrant in the NHS, they are more likely to be treating you than ahead of you in the queue”.
Currently, freedom of movement polices are unchanged. However, the government will need to seriously consider retaining the ability of EU nationals to work in the NHS if they want to avoid further staff shortage issues, especially in the context of the fading retention of junior doctors. Only 52% of junior doctors who finished their foundation training chose to stay in the NHS in 2015.
Brexit could result in changes to the regulation to enable common professional standards and medical education between EEA countries. UK doctors wishing to practice in the EU may no longer necessarily have their qualifications acknowledged and may have to sit expensive exams in order to be able to practice in the EU. Similarly, EU doctors may not have their qualifications acknowledged in the UK, further deterring them from coming to fill the UK’s staff shortages. Currently non-EU doctors coming to the UK are subject to expensive and time consuming exams, paperwork, and visas, discouraging them from contributing to the staff force.
UK citizens living in other EU counties, are entitled to a European Health Insurance Care (EHIC) which allows them reciprocal health care agreements. When in the EU, they receive health care equivalent to that of nationals in the country they are in and they can claim the cost of treatment from the UK. There are approximately 1.2 million UK nationals living in other EU countries. Whilst roughly 3.3 million EU nationals live the UK, and are entitled to healthcare under the NHS. These immigrants arriving in the UK are on average younger, which may be why their average use of NHS services is lower than that of UK nationals. If UK nationals, particularly pensioners, living in other EU countries are no longer able to receive health care in the EU countries they reside, they may have to return to the UK for their healthcare needs, placing further pressure on the already overburdened NHS.
The Working Time Regulations are part of EU legislation and limit the maximum amount of hours an NHS employee can work in a week to 48, as well as regulating minimum rest and annual leave requirements. Currently, the UK law enacts this EU directive. If these regulations are repealed or amended, this will have significant implications to NHS staff work conditions and contracts. However, if the UK remains in the European internal market, implying they have to be compliant with EU regulation, the working time directive will continue to apply.
Leaving the EU may result in the UK losing out on some pharmaceutical trials of new medications which have the potential to benefit UK patients. The European Medicines Agency allows countries to submit applications for new drug trials to obtain marketing authorisation valid in EU, EEA and European Free Trade Association (i.e. Iceland, Liechtenstein, Norway, and Switzerland) countries.
The European Centre for Disease Prevention and Control works to identify, assess, and communicate threats to health posed by infectious diseases like H1N1, Ebola, and Zika virus, as well as tackling antibiotic resistance. When the UK leaves the EU, they could lose this coordinated defence network.
Furthermore, the UK will lose out on the EU public health strategy which supports disease prevention and new health care technologies, as well as EU run public health campaigns. These campaigns on important issues like nutrition promotion, and decreasing smoking, will have to be funded by the UK instead of the EU if the UK continues to run them.
Collaborating with the EU enables the UK to further its scientific progress via access to a larger pool of skilled research talent and to sources of funding. From 2007-2013, the UK received €8.8 billion in funding for research, development, and innovation actions, whilst it contributed only €5.4 billion to EU research and development in that time. By leaving the EU, the UK may lose the ability of UK researchers to attract EU funding, as well as impact the free movement of researches across Europe.
The NHS currently costs about £100 billion per year and it faces a shortfall of £8-30 billion by 2020. The Leave campaign infamously promised that £350 million a week would be spent on the NHS if the Brexit vote won, then when the time came, Nigel Farage claimed the money could not be guaranteed.
The UK economy contracted by 2% in the month following Brexit, increasing the UK’s chance of slipping into a recession. If this continues, funding for the NHS will be at risk. The drop in the strength of the pound has already led to drugs, services, and equipment bought by the NHS from overseas becoming more expensive due to unfavourable exchange rates.
The UK government’s Department of Health now faces the task of overcoming its capacity issue and reviewing individual EU regulations and deciding whether to repeal them or replace with UK-drafted alternatives. Ultimately it is now a waiting game, but the government should be urged to place importance on the health of its people.