Simon Elliman considers the possible effects which the recent referendum vote may have upon policy and resourcing in the NHS.
One of the most contentious claims made by ‘Vote Leave’ campaigners in the run-up to the referendum was that £350 million a week could be freed up for the NHS by leaving the EU. Although this particular claim was conceded by Nigel Farage subsequently to have been inaccurate, I thought it would be interesting to try to analyse the overall likely effects of the Brexit vote upon the NHS.
It is widely recognised that the NHS is currently struggling to recruit and retain permanent staff, with particular gaps in nursing, midwifery and health visitors (National Audit Office 2016). The EU’s freedom of movement and mutual recognition of professional qualifications within the EU means that many health professionals in the UK have come from other EU countries.
Of course, Brexit itself changes nothing and the policy on freedom of movement remains unchanged until the UK extracts itself from its obligations under EU treaties. The government needs to clarify its intentions in respect of the ability of EU nationals to work in the health service going forward as quickly as possible; otherwise not only will recruitment be made more difficult, but EU staff already working in the UK may seek work in other countries where their futures will be more certain.
In the period of government “purdah” during the referendum campaign, policy implementation came to what was thought to be a temporary halt. But with the ensuing uncertainty, nothing has yet been kick-started back into life. The biggest impending health policy initiative is the childhood obesity strategy. It was postponed in the autumn of 2015, and again when the referendum campaign began, and a July launch was expected. The timing has now become much more uncertain.
The Department of Health has been set to launch its consultation on fixed fees in clinical negligence compensation since October 2015, but this also has yet to see the light of day, and may have been further delayed by the Brexit vote.
Some have argued, prior to Brexit, that EU nationals are using up NHS resources; the evidence, however, suggests that the average use of health services by immigrants and visitors is lower than that of people born in the UK (perhaps due to the fact that immigrants and visitors are, on average, younger).
An interesting aspect of Brexit relates to British migrants living abroad. There are around 1.2 million British migrants living in other EU countries. At present, if they hold a European Health Insurance Card, they can access health care in the country where they are staying, with the cost being reclaimable under reciprocal health care agreements. Should that cease to be the case, many of them may return to the UK, and become regular users of the NHS again.
As mentioned already, the NHS was promised significant additional funding by Vote Leave, which pledged to invest an additional “£100 million per week cash injection” in the NHS over and above the additional funding provided in the last Spending Review. It remains to be seen whether those funds will be forthcoming.
However, the most important factor will be the wider economy. Prior to the vote, NHS England Chief Executive Simon Stevens argued that “when the British economy sneezes, the NHS catches a cold”. If an ailing economy requires cuts in public spending, the NHS is bound to suffer, and it is already struggling to live within its existing budget.
Meanwhile, we have already seen a significant decline in the value of sterling, and if this persists it is likely to lead to higher inflation, leading to higher prices for drugs and other goods and services which the NHS purchases.
Brexit is likely to have a profound effect on the NHS in the short and medium term. Many of the effects remain within the power of the government to control, in terms of the way in which the present EU regulations are replaced. Short term policy making is bound to be delayed, as the Department of Health faces up to the massive task of reviewing individual EU regulations, and deciding whether they should be repealed or replaced with UK-drafted alternatives. In the longer term the full effects will be determined by how the economy responds to the shock of the unexpected vote.