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In the run up to the EU referendum, both sides used the NHS as ammunition. The Vote Leave campaign stated that £350 million a day would be put back into the NHS. The Remain campaign, meanwhile, predicted that a weakened post-Brexit economy would lead to government spending cuts of £40 billion, meaning less money for the NHS, longer waiting times and reduced appointments. As we all know, the future is not going to be as simple as some campaigners have been telling us. The Kings Fund has highlighted five areas which could be profoundly affected. However, in this time of great economic and political instability, who knows what will happen?
The NHS is a huge melting pot of people of different cultures and backgrounds. Of the NHS’s 1.3 million strong workforce, 55,000 people have come from abroad to work here, as have 80,000 of the 1.3 million workers in the adult social care sector. Yet it is no secret that the NHS has issues recruiting and retaining staff. The King’s Fund advises that “providers of NHS and social care services should retain the ability to recruit staff from the EU when there are not enough resident workers to fill vacancies.”
In the past few weeks, some EU doctors have said that they have been avoiding applying for posts in the UK. A number of migration agencies said they have been flooded by requests for posts in Canada, Australia and New Zealand by a large number of healthcare professionals. However there is no obvious evidence which supports the idea of doctors leaving their posts in the NHS due to Brexit.
The impact of immigration on the NHS has always been an area of debate. With one of the main reasons for voting Leave being the promise of changed borders, this will have an effect on the number of people from the EU moving to the UK, including more people who need medical treatment and therefore using the NHS. However, the average use of services by migrants is lower than those born in the UK, which could be partly because of their younger age on average.
Currently, with a European Health Insurance Card (EHIC), a UK citizen can get access to the healthcare treatment within Europe as a resident of the country. No changes have yet been announced to the EHIC service, but this could be set to change. If access is withdrawn, this would have a big impact on British pensioners living abroad, forcing them to move back and increasing pressures on health and social care services.
Many of the regulations on medical materials and employment law are decided and implemented by the EU. Following the vote, the UK has the choice to lift and replace current EU regulation with new alternatives.
Working time directive
In the UK you can ‘opt out’ of the working time directive, which many Doctors chose to do to lift time restrictions on their training. If the working time directive is changed it will have a huge impact on NHS contracts and would require significant changes to the Agenda for Change pay framework.
Procurement and competition law
A combination of the Competition Act, Monitor’s Provider licences and the Procurement, Patient Choice and Competition regulations continues to prohibit anti-competitive behaviour by NHS providers and commissioners. Our withdrawal from the EU means these can be modified, and are now largely dependent on the trade deals that can be negotiated between the EU countries and the UK.
Regulation of medicines
The European Medicines Agency, located in London, is the centralised, unified, authorisation system for the EU. They evaluate human and veterinary medicines and approve products for marketing authorisation for sale in EU, EEA and European Free Trade Association (ETFA) countries. The UK also has its own regulatory agency, the Medicines and Healthcare products Regulatory Agency (MRHA). The MRHA could continue its relationship with the EMA and use quite similar regulations, meaning not much would change.
Being a member of the EU gives you the benefit of the surveillance and early warning of communicable diseases, which is managed by the European Centre for Disease Prevention and Control. The publicity of the H1N1 virus pandemic is a great example of how cross border communications works to save lives. Our withdrawal from the EU could also affect our research behind rare and complex diseases that affect low numbers of people. Collaboration is key, and this will need to be addressed.
Between 2007 and 2013 the UK contributed €5.4 billion to EU research and development, and in return received €8.8 billion for research, development and innovation activities (European Commission). How research money is spent needs to be renegotiated, and we can only speculate about whether the gap left by the withdrawal of EU finding will be filled by government funds.
If the ‘£100 million per week cash injection’ that was floated in the last Spending Review is delivered to the NHS it would have a huge positive impact. However since the result, figures from the campaign have distanced themselves from these claims. Whatever happens, the government needs to be honest with people about how the standards of and access to care will be affected.
On the other hand, England is projected to be significantly poorer out of the EU. It is no secret that 2016/2017 looks set to be a challenging year for the NHS financially and if further cuts to public spending do occur then then the ‘implications for a service already struggling to live within its existing budget would be significant’. (Kings Fund 2016) With the value of the pound changing and exchange rates uncertain, drugs, medical devices are fluctuating in price. One drug, Eculizumab, which is used by people with rare kidney diseases, increased in cost by £16,000 overnight.
The Department of Health now needs to start the mammoth task of reviewing individual EU regulations and decide if they will continue or be replaced with alternatives drafted in the UK. Now, even a month after the result, there is still so much uncertainty that no one really knows how the NHS will be affected, long term or short term. The Health and Social Care team at CSG can help you through this time of uncertainty, and offer help and support including industry and recruitment advice.